senior-insurance-advisors

Best Medicare Plans for Rural Areas & Small Towns

Mon, 06 Apr 2026 15:38:47 GMT

Best Medicare Plans for Rural Areas & Small Towns 

If you live in a rural area or small town, choosing the right Medicare plan can feel more complicated than it should be. Fewer providers, limited hospital access, and smaller plan networks can all impact your coverage in ways that don’t affect people in larger cities.

The good news? With the right strategy, you can still find excellent Medicare coverage that fits your needs and budget.

Why Medicare Choices Are Different in Rural Areas

Living in a smaller community often means:

Fewer doctors and specialists in-network
Limited hospital options
Longer travel times for care
Fewer Medicare Advantage plans available

Because of this, what works well in a big city may not be the best fit for someone in a rural setting.

Option 1: Original Medicare + Supplement (Medigap)

For many people in rural areas, this is often the most flexible option.

Why it works well:

You can see any doctor nationwide who accepts Medicare
No network restrictions
Great for people who travel for care or need specialists

Things to consider:

Higher monthly premium
You’ll also need a separate Part D drug plan

�� Best for: People who want maximum freedom and predictable costs

Option 2: Medicare Advantage Plans

These plans can be more limited in rural areas—but not always.

Pros:

Lower (sometimes $0) monthly premiums
May include dental, vision, and drug coverage
All-in-one convenience

Cons in small towns:

Smaller provider networks
You may need referrals
Out-of-network care can be expensive or not covered

�� Best for: People who are comfortable staying within a local network and want lower upfront costs

Option 3: Medicare Cost Plans (where available)

In some rural states, Cost Plans are still offered and can be a great hybrid option.

Benefits:

Flexibility to go outside the network
Often lower cost than Medigap
Works well in areas with limited providers

�� Best for: People who want flexibility without paying full Medigap premiums

Key Factors to Consider in a Rural Area

Before choosing a plan, ask:

1. Are my doctors covered?

Make sure your local clinic and nearest hospital accept the plan.

2. How far is the nearest in-network specialist?

Travel distance matters more in rural communities.

3. What happens in an emergency?

Check coverage for out-of-area care.

4. Do I travel often?

If you leave your area frequently, flexibility is critical.

Common Mistakes to Avoid

Choosing a plan with too small of a network
Not checking hospital coverage
Focusing only on premium instead of total cost
Assuming all plans work the same everywhere

What’s Usually the Best Choice?

While everyone’s situation is different:

Most flexibility: Original Medicare + Supplement
Lowest upfront cost: Medicare Advantage
Best middle ground: Cost Plans (if available)

In many rural areas, people lean toward Medigap plans because they remove network limitations.

Final Thoughts

Living in a small town shouldn’t limit your healthcare options—but your Medicare plan can if you’re not careful.

The key is choosing a plan that fits:

Your local provider access
Your travel habits
Your budget
Your long-term health needs

Need Help Choosing the Right Plan?

If you’re in a rural area and unsure which Medicare option is best for you, Senior Insurance Advisors can help you compare plans available in your area and walk you through your options step by step.

Feel free to reach out to schedule a quick consultation—there’s no cost, and it can save you from costly mistakes down the road.

What Can You Do When Your Medigap Rate Goes Up?

Tue, 03 Mar 2026 22:18:10 GMT

What Can You Do When Your Medigap Rate Goes Up?

If you’ve opened your mail and seen that your Medicare Supplement (Medigap) premium is increasing — you’re not alone. Rate increases are common, especially with popular plans like Plan G and Plan N.

The good news? You have options.

Let’s walk through what’s happening and what you can do about it.

Why Do Medigap Rates Increase?

Medigap premiums typically rise for three main reasons:

1️⃣ Age-Based Increases

Some policies are “attained-age rated,” meaning your premium increases as you get older.

2️⃣ Inflation & Healthcare Costs

As medical costs rise, insurance companies adjust rates to keep up.

3️⃣ Claims Experience

If a large number of policyholders on your specific plan are using benefits, rates can increase for that group.

Rate increases don’t necessarily mean you made a bad choice — but it is smart to review your options.

Step 1: Don’t Panic — Review the Details

Before making changes, ask:

How much did the rate increase?
When does it take effect?
Is it an annual increase or an unusual spike?
How does the new rate compare to other carriers in your area?

Sometimes the increase is modest and still competitive.

Step 2: Shop Other Medigap Carriers

Medigap plans are standardized by the federal government. That means:

Plan G with one company has the same medical coverage as Plan G with another company.
The only real differences are price, rate stability, and company service.

If your rate has increased significantly, you may be able to switch to another carrier offering the same plan at a lower premium.

⚠️ Important: In most states, switching plans requires medical underwriting unless you are in a guaranteed issue situation.

Step 3: Consider a Different Plan Letter

If you’re currently on Plan G, you might compare:

Plan N (lower premium, small copays)
High-Deductible Plan G (much lower premium, higher deductible)

Depending on your health usage, these options could reduce your monthly cost.

Step 4: Review Household Discounts

Many Medigap companies offer household discounts if:

You live with another adult
Your spouse also has a policy
Sometimes even if you simply reside together

This can reduce premiums by 5–12% in many cases.

Step 5: Evaluate Medicare Advantage (Carefully)

For some people, switching from Medigap to a Medicare Advantage plan may lower premiums significantly.

However:

Networks apply
Referrals may be required
Out-of-pocket exposure changes
Prescription coverage is included

This should be reviewed carefully — especially if you value provider flexibility.

Step 6: Ask About Long-Term Rate History

When reviewing new carriers, it’s important to ask:

How long has the plan been in the market?
What have past rate increases looked like?
How large is the membership pool?

A lower rate today doesn’t always mean better long-term stability.

When Should You Stay Put?

Sometimes staying is the best choice if:

Your increase is in line with market averages
You have health conditions that make underwriting difficult
Your carrier has historically stable rates
The difference between carriers is small

Switching always requires weighing short-term savings against long-term stability.

Final Thoughts

A Medigap rate increase isn’t necessarily a crisis — but it is an opportunity to review your coverage.

Before making any changes:

✔ Compare options
✔ Understand underwriting rules
✔ Evaluate long-term rate stability
✔ Make sure your doctors and coverage needs stay protected

If you’ve received a rate increase, now is the time to review your options. I’m happy to provide a personalized comparison to see whether staying put or switching makes the most sense.

A quick review before the new premium takes effect could potentially save you money — and give you confidence in your decision.

Why Would Someone Choose a Medicare Advantage Plan?

Tue, 03 Feb 2026 18:51:12 GMT

Choosing the right Medicare coverage is an important decision, and for many people, Medicare Advantage plans offer an attractive option. These plans combine medical, hospital, and often prescription drug coverage into one plan, along with extra benefits not offered by Original Medicare.

Here’s a closer look at why someone might choose a Medicare Advantage plan and who may benefit most.

1. Lower Monthly Premiums

One of the main reasons people choose Medicare Advantage is the low monthly premium. Many plans offer premiums as low as $0 (in addition to the Part B premium), making them appealing for individuals on a fixed income.

This cost structure works well for people who prefer lower upfront costs and are comfortable with cost-sharing when services are used.

2. All-in-One Medicare Coverage

Medicare Advantage plans bundle:

Medicare Part A (hospital coverage)
Medicare Part B (medical coverage)
Often Medicare Part D (prescription drug coverage)

Having everything under one plan simplifies coverage, billing, and plan management.

3. Extra Benefits Beyond Original Medicare

Many Medicare Advantage plans include benefits not covered by Original Medicare, such as:

Dental, vision, and hearing coverage
Over-the-counter (OTC) allowances
Healthy food benefits
Fitness memberships (e.g., SilverSneakers)
Transportation to medical appointments

These added benefits can create real value for members who use them.

4. Annual Out-of-Pocket Maximum

Unlike Original Medicare, Medicare Advantage plans include an annual out-of-pocket maximum. Once you reach this limit, the plan covers 100% of covered medical services for the remainder of the year.

This feature provides financial protection and peace of mind for those concerned about large medical expenses.

5. Coordinated Care and Provider Networks

Many Medicare Advantage plans emphasize coordinated care through primary care providers and established networks. This can help streamline care, reduce duplication of services, and improve communication between providers.

This structure works well for individuals who prefer an organized healthcare approach.

6. Prescription Drug Coverage Included

Most Medicare Advantage plans include prescription drug coverage, eliminating the need to enroll in a separate Part D plan. This can simplify coverage and potentially reduce overall costs for members with routine medications.

7. A Good Fit for Certain Lifestyles

Medicare Advantage plans may be ideal for individuals who:

Are generally healthy
Are comfortable using provider networks
Do not travel frequently
Want predictable, lower monthly costs
Value extra benefits like dental and vision

For these members, Medicare Advantage can offer strong coverage at an affordable price.

Final Thoughts

Medicare Advantage plans offer affordable premiums, bundled coverage, and valuable extra benefits, making them a good option for many people. However, they are not the right fit for everyone due to networks and plan rules.

The best Medicare choice depends on health needs, budget, and lifestyle. Understanding how Medicare Advantage works allows individuals to choose coverage confidently and avoid surprises.

Not sure which Medicare option is right for you?
Contact Senior Insurance Advisors for personalized guidance and help choosing coverage that fits your needs and budget.

Medicare Advantage vs. Medigap: Which Plan Fits Your Retirement Needs?

Mon, 05 Jan 2026 16:43:59 GMT

Choosing the right healthcare coverage during retirement is one of the most important decisions you’ll make. With multiple Medicare options available, it’s common to feel overwhelmed — especially when comparing Medicare Advantage vs. Medigap plans. While both options can provide valuable coverage, they work very differently and are designed for different retirement needs.

At Senior Insurance Advisors , we help retirees and those approaching Medicare eligibility understand their options clearly, so they can choose a plan that fits their lifestyle, budget, and long-term healthcare goals.

Understanding Medicare Advantage and Medigap

Before comparing the two, it’s important to understand what each option is and how it fits into the Medicare system.

Medicare Advantage plans (Part C) are offered by private insurance companies and replace Original Medicare (Part A and Part B). These plans provide the same core coverage as Original Medicare but often bundle additional benefits such as prescription drug coverage, dental, vision, and hearing services into one plan.

Medigap plans , also known as Medicare Supplement plans, work alongside Original Medicare. Rather than replacing it, Medigap helps pay out-of-pocket costs like deductibles, copayments, and coinsurance that Original Medicare does not cover. You cannot have both a Medicare Advantage plan and a Medigap plan at the same time, you must choose one or the other.

Key Differences Between Medicare Advantage vs. Medigap

Understanding how these plans differ can help you determine which option best aligns with your retirement needs.

How Coverage Is Structured

With Medicare Advantage, the plan becomes your primary coverage. All your care is managed through the private insurance plan, often with bundled benefits and structured cost-sharing.

With Medigap, Original Medicare remains your primary insurance, and the Medigap policy fills in coverage gaps. This structure can lead to fewer surprise medical bills and more predictable healthcare expenses.

Provider Access and Flexibility

One major difference between Medicare Advantage vs. Medigap is provider access.

Medigap plans typically allow you to see any doctor or specialist who accepts Medicare, without needing referrals or staying within a network. This flexibility is especially valuable for retirees who travel frequently or want unrestricted access to providers.

Medicare Advantage plans often use provider networks, meaning you may need to stay in-network to receive the lowest costs. While emergency care is still covered outside the network, routine care may be more limited.

Monthly Premiums and Out-of-Pocket Costs

Medicare Advantage plans often feature lower monthly premiums, and some plans have very minimal upfront costs beyond your Medicare Part B premium. However, out-of-pocket expenses can add up depending on how often you use healthcare services.

Medigap plans generally have higher monthly premiums, but they often result in lower out-of-pocket costs when you receive care. For many retirees, this predictability makes budgeting for healthcare easier.

Additional Benefits

Medicare Advantage plans may include extra benefits such as dental, vision, hearing, fitness programs, and wellness services. These benefits can be appealing for individuals who want comprehensive coverage under one plan.

Medigap plans focus strictly on medical coverage and do not usually include these extras. However, many retirees prefer Medigap for its simplicity and broad provider access.

Prescription Drug Coverage

Many Medicare Advantage plans include prescription drug coverage as part of the plan.

With Medigap, prescription drug coverage is not included, so a separate Part D plan is typically added to ensure complete coverage.

Which Plan Is Right for Your Retirement?

When deciding between Medicare Advantage vs. Medigap, there is no one-size-fits-all answer. The right choice depends on several personal factors, including:

Your current and expected healthcare needs
Your monthly budget and tolerance for out-of-pocket costs
Whether you prefer provider flexibility or structured networks
How often you travel or receive care outside your local area

For retirees who want lower monthly premiums and bundled benefits, Medicare Advantage may be a good fit. For those who value predictability, provider freedom, and long-term stability, Medigap may be the better option.

It’s also important to consider enrollment timing and future flexibility, as switching plans later may involve underwriting or limited enrollment windows.

How Senior Insurance Advisors Can Help

Navigating Medicare options can be confusing, but you don’t have to do it alone. At Senior Insurance Advisors , we take the time to understand your unique situation and walk you through the differences between Medicare Advantage vs. Medigap in clear, simple terms.

Our goal is to help you choose coverage that supports your health, protects your finances, and gives you peace of mind throughout retirement.

Ready to Find the Right Medicare Plan?

The right Medicare plan can make a meaningful difference in your retirement years. Whether you’re enrolling for the first time or reviewing your current coverage, we’re here to help you make a confident, informed decision.

Contact Senior Insurance Advisors today to get personalized guidance, a free quote and find the Medicare plan that best fits your retirement needs.

Understanding Your New Social Security Statement: What to Know About Medicare Part B and Potential IRMAA Surcharges for 2026

Fri, 12 Dec 2025 18:30:33 GMT

Understanding Your New Social Security Statement: What to Know About Medicare Part B and Potential IRMAA Surcharges for 2026

As we move into a new year, many people begin receiving updated Social Security benefit statements in the mail. These statements not only show your projected monthly benefit but also reveal your Medicare Part B premium for the upcoming year—along with any additional charges, such as IRMAA (Income-Related Monthly Adjustment Amount), that may apply.

If you recently opened your 2026 Social Security statement and noticed higher-than-expected deductions, you're not alone. Here's what you need to know.

Why Your Social Security Statement Shows New Medicare Premiums

Each fall, Medicare announces updated premiums for the coming year. Your Social Security statement includes these amounts so you can see:

Your gross Social Security benefit
Your Medicare Part B premium deduction
Any applicable IRMAA surcharges for Part B and/or Part D
Your net monthly benefit (what you’ll actually receive)

This transparency helps you plan for the year ahead—especially if your premium has changed.

What Is Changing for Medicare Part B in 2026?

Every year, Part B premiums may adjust to reflect health care costs and changes in the Medicare program. Your statement will show the new monthly premium for 2026, and this amount will automatically be deducted from your Social Security benefit unless you pay it separately.

Why You Might See IRMAA Charges

IRMAA stands for Income-Related Monthly Adjustment Amount, and it’s an additional charge added to your Medicare Part B and Part D premiums if your income is above certain limits.

How IRMAA Is Determined

Social Security looks at your tax return from two years prior—which means your 2024 income determines your 2026 IRMAA tier.

You may see IRMAA charges in your statement if:

You had unusually high income in 2024 (such as capital gains, Roth conversions, property sales, etc.)
Your income increased due to bonuses, overtime, or distributions
You filed jointly but now file singly (or vice versa)
Your tax return was amended or corrected

What If Your Income Has Gone Down Since 2024?

Many people receive IRMAA charges even though their current income is much lower—especially after retiring.

The good news:
You may qualify to have IRMAA reduced or removed.

You can file an IRMAA Reconsideration Request if you experienced a life-changing event, such as:

Retirement or reduced work hours
Marriage or divorce
Death of a spouse
Loss of income from property
Employer settlement payout ending

Social Security may then adjust your IRMAA based on your current income, not your income from two years ago.

What to Do When You Receive Your Statement

If your 2026 statement has unexpected Part B premiums or new IRMAA charges, here are the steps to take:

✔ 1. Review the premiums carefully

Confirm the Part B amount and look for any IRMAA line items.

✔ 2. Compare them to your current financial situation

If the income used to calculate IRMAA doesn’t reflect your actual current income, you may be eligible for a reduction.

✔ 3. Gather supporting documents

This may include recent pay stubs, retirement letters, or other financial documentation.

✔ 4. File an appeal if needed

You can request a review using Form SSA-44 if you experienced a qualifying life-changing event.

Don’t Panic—Help Is Available

Seeing higher-than-expected deductions on your Social Security statement can be frustrating and confusing. But in many cases, higher premiums—especially IRMAA—can be corrected with the right documentation.

If you’re unsure whether you qualify or need help understanding your 2026 statement, reaching out to Senior Insurance Advisors can help you make sense of your situation and explore available options.

What’s Changing for Medicare in 2026: A Breakdown of Part A & Part B Costs

Wed, 19 Nov 2025 18:07:24 GMT

Medicare costs are going up in 2026 — and it’s important to know exactly how those changes could affect you or your loved ones. The Centers for Medicare & Medicaid Services (CMS) recently released updated premium, deductible, and coinsurance figures for Medicare Parts A and B, as well as revised income-related adjustment amounts for Part D. Below is a breakdown of what these changes mean and how to prepare.

1. Part A (Hospital Insurance) Updates

Part A covers inpatient hospital care, some skilled nursing facility stays, hospice, and more. While most people don’t pay a Part A premium (because they’ve paid into Social Security for at least 40 quarters), the deductible and coinsurance are increasing:

Inpatient hospital deductible (per benefit period):
Goes from $1,676 in 2025 to $1,736 in 2026 .

Hospital coinsurance (days 61–90) :
Rises to $434/day (from $419).

Hospital coinsurance (lifetime reserve days) :
Increases to $868/day (from $838).

Skilled Nursing Facility (SNF) coinsurance (days 21–100) :
Jumps to $217/day (from $209.50).

For those who don’t have enough Medicare work credits (fewer than 40 quarters), Part A still has a monthly premium:

$311/month for those with 30–39 quarters
$565/month for those with fewer than 30 quarters

2. Part B (Medical Insurance) Cost Changes

Part B helps cover doctor visits, outpatient care, medical equipment, and more. Here’s how the 2026 numbers shape up:

Standard monthly premium :
Rising to $202.90 , up by $17.90 from 2025’s $185.

Annual deductible :
Increasing to $283 (from $257).

Why the jump? CMS says the increase is largely driven by projected increases in utilization and prices — though policy changes helped tamp the rise.

3. Income-Related Premium Adjustments (IRMAA) for Part B

If you have a higher income, your Part B premium could be significantly higher than the standard rate. These “Income-Related Monthly Adjustment Amounts” (IRMAA) apply to roughly 8% of Medicare beneficiaries.

Here are the 2026 monthly premiums by income:

2026 Modified Adjusted Gross Income (AGI) IRMAA Total Part B Premium

≤ $109,000 (individual) / ≤ $218,000 (joint) $0 $202.90

$109,001–$137,000 / $218,001–$274,000 $81.20 $284.10

$137,001–$171,000 / $274,001–$342,000 $202.90 $405.80

$171,001–$205,000 / $342,001–$410,000 $324.60 $527.50

$205,001–$500,000 / $410,001–$750,000 $446.30 $649.20

≥ $500,000 / ≥ $750,000 $487.00 $689.90

There’s also a separate table for those who only have Part B coverage for immunosuppressive drugs , with its own IRMAA structure.

4. What This Means for You

Budget for higher costs.
If you’re on Original Medicare, expect higher monthly Part B costs and a bigger deductible. This could affect how much you need to set aside or how you evaluate supplemental (Medigap) plans.

High earners take note.
If your income is above the thresholds listed above, your Part B premium could be substantially higher. That’s something to factor into both your retirement planning and Medicare enrollment.

Review your coverage.
These changes may influence whether you choose Original Medicare + Medigap, a Medicare Advantage plan, or certain Part D plans. Make sure to revisit your options during the next enrollment period.

Plan ahead .
Since these amounts go into effect in January 2026, you still have time to adjust your budget, shift savings, or explore different Medicare plan options.

Final Thoughts

Rising Medicare costs are a reality again in 2026 — especially for Part B. While these increases can be frustrating, being informed puts you in a stronger position to adapt. Review your income, your coverage choices, and your long-term budget to make sure Medicare continues to work for you.

If you’d like help understanding how these changes might affect your situation (or someone you care for), Senior Insurance Advisors be happy to walk through options and planning strategies.

How to Set Up Medicare After Losing Your Job Unexpectedly

Wed, 12 Nov 2025 17:28:22 GMT

Losing a job is stressful enough on its own, but when your health insurance is tied to your employment, it adds another layer of uncertainty. If you’re approaching Medicare age and find yourself suddenly without employer coverage, the good news is—you have options. Here’s what you need to know about setting up Medicare after an unexpected job loss.

1. Know Your Enrollment Window

If you’re 65 or older and lose your job (and your employer health insurance), you qualify for a Special Enrollment Period (SEP) . This gives you 8 months from the time your coverage ends to sign up for Medicare Part A and Part B without facing a late enrollment penalty.

�� If you already signed up for Part A (hospital coverage) earlier because it’s premium-free, you’ll just need to add Part B (doctor visits, outpatient care, etc.).

2. Don’t Delay Part B

Some people postpone enrolling in Part B while working, since employer coverage is often sufficient. But once you lose that coverage, it’s critical to enroll right away. If you delay beyond your 8-month SEP, you could face lifetime penalties and gaps in coverage.

3. Consider COBRA Carefully

You may be offered COBRA to continue your employer health plan for up to 18 months. While COBRA can bridge a short gap, it does not count as “creditable coverage” to delay Medicare enrollment. If you rely only on COBRA and skip signing up for Medicare, you’ll face penalties later. In most cases, it’s better to elect Medicare first and consider COBRA only as a supplement if needed.

4. Add Prescription Coverage

Once you have Part A and Part B, you’ll want to consider how to cover prescriptions. You have two main paths:

Part D prescription drug plan (standalone, paired with Medicare Supplement).
Medicare Advantage plan (Part C) that often bundles medical and drug coverage in one plan.

If you skip Part D without other creditable drug coverage, penalties may apply later.

5. Think About Extra Coverage

Original Medicare doesn’t cover everything. After losing employer coverage, many people choose to add:

A Medicare Supplement (Medigap) plan to help with deductibles and coinsurance.
Or a Medicare Advantage plan that often includes extras like dental, vision, and hearing.

Your best option depends on your health needs, budget, and doctors.

6. Get Help if You Need It

Sorting through Medicare choices after an unexpected job loss can feel overwhelming. The good news is you don’t have to navigate it alone. Senior Insurance Advisors can help you compare plans, understand your enrollment deadlines, and avoid costly mistakes.

Final Thoughts

Losing your job unexpectedly is a tough transition, but getting your Medicare coverage set up doesn’t have to add to the stress. By acting quickly and understanding your options, you can ensure your healthcare needs are covered without gaps or penalties.

How Caregivers Can Help Loved Ones Prepare for Medicare Annual Enrollment

Thu, 16 Oct 2025 15:26:37 GMT

The Medicare Annual Enrollment Period (AEP) is a crucial time for seniors to evaluate their healthcare coverage. For caregivers, this period offers an opportunity to ensure that loved ones have the most suitable and cost-effective Medicare plan. Understanding the AEP and how to assist during this time can significantly impact the quality of care and financial well-being of those you support.

What Is the Medicare Annual Enrollment Period?

Medicare AEP runs annually from October 15 to December 7. During this window, beneficiaries can:

Switch from Original Medicare to a Medicare Advantage Plan (Part C) or vice versa.
Change Medicare Advantage plans.
Enroll in, drop, or switch Medicare Part D (prescription drug) plans.
Make changes to Medigap (Medicare Supplement) policies if eligible.

Any changes made during this period take effect on January 1 of the following year.

How Caregivers Can Assist Loved Ones

1. Understand the Available Medicare Plans

Familiarize yourself with the different Medicare options:

Original Medicare (Parts A & B): Provides hospital and medical coverage.
Medicare Advantage (Part C): An alternative to Original Medicare, often including additional benefits like vision, dental, and prescription drug coverage.
Medicare Part D: Offers prescription drug coverage.
Medigap: Supplemental insurance to cover costs not paid by Original Medicare.

Understanding these options helps in comparing plans and selecting the best fit for your loved one's healthcare needs.

2. Review Current Healthcare Needs

Assess your loved one's health status, including:

Chronic conditions or ongoing treatments.
Preferred healthcare providers and hospitals.
Current medications and prescription needs.
Budget for healthcare expenses.

This review ensures that the chosen plan aligns with their specific requirements.

3. Compare Medicare Plans

Utilize online tools and resources to compare different Medicare plans . Pay attention to:

Monthly premiums.
Deductibles and out-of-pocket costs.
Coverage for prescription drugs.
Network of healthcare providers.

Resources like Medicare.gov and PlanEnroll.com offer plan comparison tools to assist in this process.

4. Seek Professional Guidance

Consider consulting with Medicare advisors or insurance agents who specialize in senior healthcare plans. They can provide personalized advice and help navigate the complexities of Medicare. Senior Insurance Advisors offer free consultations to assist in selecting the appropriate coverage.

5. Ensure Proper Documentation

To manage your loved one's Medicare plan effectively, ensure you have the necessary documentation:

Authorization forms allowing you to discuss their health information.
Durable Power of Attorney (DPOA) if you need to make decisions on their behalf.
Medicare cards and records of previous coverage.

Having these documents facilitates smoother interactions with healthcare providers and insurance companies.

6. Monitor and Adjust Plans Annually

Medicare plans can change annually, affecting coverage and costs. Regularly reviewing and adjusting the plan ensures that it continues to meet your loved one's needs. Set reminders to evaluate their plan each year during the AEP.

Tips for Caregivers

Stay Organized: Keep a file with all Medicare-related documents, including plan details and correspondence.
Communicate Clearly: Discuss plan options with your loved one, considering their preferences and comfort.
Be Proactive: Start the review process early to avoid last-minute decisions.
Utilize Available Resources: Take advantage of community workshops, online webinars, and informational sessions offered by local agencies or insurance providers.

How Senior Insurance Advisors Can Help

Senior Insurance Advisors specialize in simplifying the Medicare process for seniors and their caregivers. They offer:

Free consultations with no obligation to enroll.
Assistance in comparing and selecting Medicare plans.
One-on-one support to address specific concerns.
Educational resources to empower informed decision-making.

Their goal is to ensure that seniors receive the coverage they need without confusion or unnecessary costs.

Final Thoughts

The Medicare Annual Enrollment Period is an essential time for seniors to reassess their healthcare coverage. As a caregiver, your support in navigating this process can lead to better health outcomes and financial savings for your loved one. By staying informed, seeking professional guidance, and maintaining open communication, you can make this process more manageable and beneficial for those you care for. Contact Senior Insurance Advisors for a free consultation.

How to Get a Jump Start on Changes to Your 2026 Medicare Plan During Medicare Annual Enrollment

Fri, 12 Sep 2025 15:40:34 GMT

Medicare’s Annual Enrollment Period (AEP) — October 15 through December 7 — is the one time each year when you can make changes to your Medicare Advantage (Part C) or Part D prescription drug plan for the coming year.

And while it’s tempting to wait until late October or November to review your options, getting a jump start on your 2026 Medicare plan changes can make all the difference — especially with rising healthcare costs, evolving plan benefits, and potentially limited appointment availability with agents.

Whether you’re happy with your current plan or curious about new options, here’s how to stay ahead of the game and ensure you make smart, timely decisions during AEP.

�� Why It Pays to Start Early

Waiting until the last minute can result in:

Rushed decisions
Limited time to compare plans
Missed benefits or cost savings
Delays in accessing care or prescriptions in January

Starting early gives you time to evaluate, compare, ask questions, and feel confident about your choices before the December 7th deadline.

✅ Step 1: Review Your Annual Notice of Change (ANOC)

Every September, your Medicare Advantage or Part D plan will mail you an ANOC. This document outlines what’s changing in your current plan for 2026, including:

Premiums
Deductibles
Copays
Drug formulary changes
Provider network updates
Extra benefits (dental, vision, hearing, OTC, etc.)

Take 10–15 minutes to read through it carefully and flag any changes that could affect your budget or care.

✅ Step 2: Make a List of What Matters Most

As you prepare to compare plans, ask yourself:

Are my current doctors and specialists still in-network?
Have my prescriptions changed?
Did my out-of-pocket costs feel too high this year?
Am I using extra benefits like dental, vision, or OTC?
Do I anticipate any changes in my health or care needs in 2026?

Having a clear list of priorities helps narrow down the best plans for your situation.

✅ Step 3: Gather Your Information

If you’re working with a Medicare agent (highly recommended!), gather this information ahead of your appointment to make the process smooth and accurate:

Medicare card and plan ID cards
List of current prescriptions and dosages
Preferred pharmacy
Name of primary care physician and specialists
Preferred hospital or medical group
Any current dental/vision providers you use

Having this ready allows your agent to compare accurate costs and networks across all available 2026 plans in your ZIP code.

✅ Step 4: Schedule Your Medicare Review Early

Many agents begin plan reviews as early as October 1st, so schedule your appointment as soon as possible. By mid-to-late October, calendars tend to fill up fast.

Appointments are typically short (15–30 minutes) and can often be done over the phone or video for convenience.

✅ Step 5: Don't Assume Your Current Plan is Still Best

Even if you're happy with your current plan, it's wise to compare it to new 2026 options. Plans can and do change — and the "best" plan this year may no longer offer the best value or coverage next year.

There may be new plans in your area with:

Lower premiums
Better drug coverage
Lower maximum out-of-pocket limits
Improved dental/vision benefits

✅ Step 6: Enroll Early to Avoid Delays

Once you’ve chosen a plan, don’t wait. Submitting your application early in the enrollment window ensures:

Timely delivery of ID cards and welcome materials
No delays in accessing care on January 1st
Less stress around the holidays

Final Thoughts: Early Planning = Peace of Mind

Medicare Annual Enrollment doesn’t have to be overwhelming or confusing. By reviewing your current plan, identifying your priorities, and working with a trusted agent, you can confidently make a smart, informed decision for 2026 — without the last-minute rush.

Need help reviewing your Medicare options for 2026?
I’d be happy to walk you through a personalized plan comparison and help you enroll early for peace of mind. Let’s schedule your review today — spots are filling fast!

Top 10 Red Flags to Watch Out for When Choosing a Medicare Insurance Agent

Mon, 11 Aug 2025 20:06:40 GMT

Top 10 Red Flags to Watch Out for When Choosing a Medicare Insurance Agent

Navigating Medicare can be overwhelming, especially with all the plans, rules, and changes that happen year after year. A trustworthy Medicare insurance agent can make the process smoother, clearer, and tailored to your needs. But not all agents have your best interests at heart. Whether you’re new to Medicare or reviewing your current plan, it’s essential to recognize the warning signs that you might not be dealing with the right agent.

Here are the top 10 red flags to look out for when choosing a Medicare insurance agent:

1. They Push One Insurance Company Only

A reliable Medicare agent should offer multiple carriers and plan options, not just one. If they constantly promote only one company without explaining why it suits you best, you may be dealing with a captive agent or someone more focused on commission than your needs.

2. They Promise Too Much

Be cautious if an agent guarantees extra benefits, huge savings, or "secret" perks. Medicare is standardized and regulated—no one can promise you a miracle plan that no one else can access. If it sounds too good to be true, it probably is.

3. They Skip the Needs Assessment

A good agent will ask about your doctors, medications, preferred pharmacies, travel habits, and budget before recommending a plan. If an agent jumps straight into selling you something without understanding your situation, that’s a red flag.

4. They Rush You to Enroll

If you’re being pressured to sign up on the spot, take a step back. A trustworthy agent will give you time to compare plans, ask questions, and even consult family or advisors.

5. They Don’t Explain the Fine Print

Medicare Advantage and Part D plans come with rules, networks, co-pays, and coverage phases. If an agent glosses over these details, it could cost you later. You need to understand what you're signing up for.

6. They Avoid Putting Things in Writing

Every conversation and recommendation should be documented. If an agent hesitates to give you a summary in writing, or won't email you details, that’s suspicious. Transparency is non-negotiable.

7. They’re Not Licensed or Certified

Agents must be licensed in your state and certified annually to sell Medicare Advantage and Part D plans. Always verify their credentials. You can check with your state’s Department of Insurance.

8. They Ignore Your Doctors and Medications

Your preferred providers and prescriptions should be central to plan selection. If an agent doesn’t check formulary coverage or provider networks, you might end up in a plan that doesn’t meet your needs.

9. They Don’t Disclose Their Compensation

Agents are usually paid by insurance companies, not by you. But ethical agents will explain this clearly and won’t steer you toward plans based solely on commissions. If an agent seems evasive about this, be cautious.

10. They Disappear After You Enroll

Support shouldn't end after enrollment. A good Medicare agent will offer ongoing help—answering questions, helping with appeals, and checking in during the Annual Enrollment Period. If they vanish after you sign, that's a major red flag.

Final Thoughts

Choosing a Medicare plan is a big decision. The right agent should act as your advocate—someone who listens, explains, and genuinely wants to help. If you spot any of these red flags, trust your instincts and seek help elsewhere. Your health and financial well-being are too important to leave in the hands of someone who isn’t looking out for you.

Senior Insurance Advisors is your trustworthy partner to help you with Medicare

We’ll begin with a brief conversation to understand your specific needs—like your medications, preferred doctors, and what you want from your coverage. Then we’ll compare plans from several top companies and explain the differences in clear, simple terms. There’s no pressure at all—you’ll have all the time you need to make a confident, informed decision. Get in touch today to book your no-cost consultation.

How to Maximize Your Medicare Benefits in Retirement

Tue, 08 Jul 2025 13:31:55 GMT

Medicare is a vital part of retirement planning, providing essential health coverage for millions of Americans aged 65 and older. But simply enrolling in Medicare isn’t enough. To get the most value from your benefits, it’s important to understand how the system works, what options are available, and how to tailor your plan to your needs.

At Senior Insurance Advisors , we specialize in helping retirees navigate the complexities of Medicare. Our team is here to ensure that you not only get the coverage you need but also maximize your benefits and savings for a healthy, secure retirement.

Understand the Basics of Medicare

To make the most of your benefits, start with a clear understanding of the different parts of Medicare:

Medicare Part A covers hospital stays, skilled nursing facility care, and hospice.
Medicare Part B includes outpatient care, doctor visits, and preventive services.
Medicare Part C, or Medicare Advantage is an all-in-one alternative to Original Medicare, often including extra benefits like dental, vision, and prescription coverage.
Medicare Part D provides standalone prescription drug coverage.

Knowing what each part covers, and what it doesn’t, is the first step in choosing the right plan for your lifestyle and budget.

Enroll at the Right Time

Timing is everything when it comes to Medicare. Missing your Initial Enrollment Period (IEP) can lead to late enrollment penalties and gaps in coverage.

Your IEP begins three months before your 65th birthday, includes the month you turn 65, and ends three months after. If you’re still working and covered by employer insurance, you may qualify for a Special Enrollment Period (SEP) later.

Our licensed advisors at Senior Insurance Advisors can help you navigate Medicare enrollment to avoid unnecessary costs and ensure continuous coverage.

Consider a Medicare Advantage Plan

Medicare Advantage plans (Part C) often provide greater value by bundling multiple benefits into a single plan. These plans are offered by private insurers approved by Medicare and can include:

Dental and vision coverage
Hearing aids
Gym memberships and wellness programs
Prescription drug coverage

Some plans even offer transportation services and telehealth options—important perks for retirees. To see if Medicare Advantage is right for you, visit our Medicare Advantage page.

Don’t Overlook Prescription Drug Coverage

Prescription drugs can be a significant expense in retirement. Whether you choose Original Medicare with a Part D plan or a Medicare Advantage plan that includes drug coverage, it’s important to review your medications each year to ensure your plan still meets your needs.

Our team at Senior Insurance Advisors can conduct a free Medicare plan review to help you compare your options. Learn more about how we can help on our Medicare Part D page .

Take Advantage of Preventive Services

Medicare offers a wide range of preventive services at no cost, including:

Annual wellness visits
Cancer screenings
Flu shots
Cardiovascular screenings
Diabetes prevention programs

Staying proactive with your health can help you catch conditions early—and avoid costly treatments down the road.

Review and Adjust Your Plan Annually

Your health needs and budget can change from year to year, which is why it’s important to review your Medicare coverage annually during Open Enrollment (October 15 – December 7). During this time, you can:

Switch from Original Medicare to Medicare Advantage or vice versa
Change your Medicare Advantage plan
Enroll in or switch Part D plans

At Senior Insurance Advisors, we offer free annual Medicare reviews to help you stay informed and covered.

Work with a Licensed Medicare Advisor

Choosing the right Medicare plan can be overwhelming—but you don’t have to do it alone. A licensed advisor can help you:

Understand plan benefits and costs
Avoid coverage gaps and penalties
Tailor your plan to your specific health needs and lifestyle
Save money on premiums and prescriptions

Our advisors provide personalized Medicare guidance. We’re here to simplify the process and help you make confident, informed decisions.

Get the Most Out of Your Medicare in Retirement

Maximizing your Medicare benefits isn’t just about saving money, it’s about ensuring peace of mind as you enjoy retirement. With the right plan and expert guidance, you can get better coverage, avoid surprises, and stay healthy for the years ahead.

Ready to get started?
Schedule your free Medicare review today with one of our licensed advisors at Senior Insurance Advisors, your trusted partner in Medicare and retirement planning.

What Medicare Doesn’t Cover & How to Fill the Gaps

Tue, 08 Apr 2025 13:50:52 GMT

Medicare provides essential health coverage for millions of Americans, but many people are surprised to learn that it doesn’t cover everything. Gaps in Medicare coverage can leave beneficiaries responsible for significant out-of-pocket costs. Understanding what Medicare doesn’t cover—and how to protect yourself financially—can help you make informed decisions about your healthcare.

What Medicare Doesn't Cover

While Medicare Parts A and B (Original Medicare) cover hospital stays, doctor visits, and certain medical services, they do not include several important healthcare expenses:

1. Dental, Vision, and Hearing Care

Medicare does not cover routine dental exams, cleanings, fillings, dentures, eyeglasses, or hearing aids. These services are essential for maintaining overall health, yet they can be costly without supplemental insurance.

2. Long-Term Care

If you need help with daily activities such as bathing, dressing, or eating, Medicare won’t cover extended stays in a nursing home or assisted living facility. Medicaid may help those who qualify financially, but most individuals will need other planning strategies.

3. Prescription Drugs

Original Medicare does not cover most prescription medications. Beneficiaries must enroll in a Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage to help with these costs.

4. Overseas Medical Care

If you travel outside the U.S., Medicare typically won’t cover your healthcare expenses. Without supplemental insurance, you could face high medical bills if you need care while abroad.

5. Alternative and Cosmetic Treatments

Medicare does not cover acupuncture (except for certain cases of chronic pain), chiropractic care beyond spinal adjustments, or elective cosmetic procedures.

How to Fill the Gaps in Medicare Coverage

Fortunately, there are several ways to protect yourself from the costs Medicare doesn’t cover:

1. Medicare Supplement Plans (Medigap)

Medigap policies help pay for expenses such as copayments, deductibles, and coinsurance. These plans, offered by private insurers, can reduce your out-of-pocket costs and provide peace of mind.

L earn more about Medicare Supplement Plans →

2. Medicare Advantage Plans

Many Medicare Advantage (Part C) plans include additional benefits such as dental, vision, hearing, and even wellness programs. These plans are a great alternative to Original Medicare, offering broader coverage under a single policy. Medicare Part D provides prescription drug coverage and is sold by private insurance companies. Most Medicare enrollees purchase prescription drug coverage as an addition to their Medicare coverage.

Learn more about Medicare Advantage (Part C) →

3. Standalone Dental, Vision, and Hearing Insurance

Since Medicare doesn’t cover routine dental, vision, or hearing care, separate insurance policies can help cover these essential services.

4. Long-Term Care Insurance

Long-term care insurance can help cover the costs of assisted living, nursing homes, and in-home care, reducing the financial burden on families.

5. Travel Insurance with Medical Coverage

If you travel frequently, investing in a travel insurance plan that includes emergency medical

coverage can provide peace of mind.

Get Expert Guidance on Medicare Coverage

Navigating Medicare’s complexities can be overwhelming, but you don’t have to do it alone. At Senior Insurance Advisors, we help individuals understand their Medicare options and find the best supplemental coverage to meet their needs. Contact us today to ensure you have the protection and benefits you need for a secure and healthy future!

How does Tricare and VA work with Medicare?

Tue, 25 Mar 2025 16:10:37 GMT

How does Tricare and VA work with Medicare?

Service members who leave active duty may qualify for health care coverage through either the Department of Veterans Affairs (VA) or TRICARE, depending on how they separated from the military.

But what happens to your VA or TRICARE benefits when you turn 65, which is the age most people become eligible for Medicare ? Do veterans and military retirees have to take Medicare Part A and Medicare Part B , or do the VA and TRICARE provide enough coverage?

It’s all about what works for you. Medicare can add another layer of coverage, protection, cost savings, and convenience if you already have VA benefits or TRICARE. Here’s how.

VA benefits and Medicare enrollment

You can be enrolled in benefits through Veterans Affairs (VA) and Medicare at the same time. Having both gives you more options for care, as well as the flexibility and freedom to choose providers within the VA or with a non-VA provider in your Medicare network. Plus, Medicare Advantage plans can come with extra benefits that most veterans don’t receive through the VA, such as dental, vision, gym memberships, over-the-counter allowances and transportation benefits.

How Medicare and VA benefits work together

Although you can have benefits through Veterans Affairs (VA) and Medicare, you’ll need to choose which benefits you want to use when receiving care:

To use your VA benefits, you must visit a VA doctor or VA medical facility. The VA may also cover care at a non-VA facility if it’s preauthorized.
To use your Medicare benefits, you must receive care at a Medicare-authorized facility. In some cases, Medicare may also be able to pay for services the VA has not authorized.

What Medicare does and doesn’t cover will depend on your plan, where you’re receiving care, and which benefits you plan to use — if you can use both.

TRICARE and Medicare enrollment

As a veteran, your coverage under TRICARE ends once you become eligible for Medicare. That means you’ll need to enroll in Medicare Parts A and B during your Initial Enrollment Period to avoid any lapse in TRICARE coverage. When you enroll in Medicare Parts A and B, TRICARE will automatically switch to TRICARE For Life (TFL). TFL acts as supplemental coverage for your Medicare plan. That means Medicare is your primary payer, while TFL reduces or eliminates out-of-pocket costs for deductibles, coinsurance, and copayments.

How Medicare and TRICARE work together

When you have Medicare and TRICARE For Life, you can visit any authorized provider. Here’s how the two work together to pay your health care costs:

The provider will file the claim(s) with Medicare.
Medicare will then pay the portion it’s responsible for and send the claim to the TRICARE For Life.

TRICARE For Life will pay its portion directly to the provider for the services TRICARE covers.

There are so many factors to consider when choosing the Medicare coverage that is right for you, and it can be an overwhelming process. We would love for you to schedule a free consultation to go over your unique needs. We want to empower you to choose the coverage that is the best for you.

Ready to enroll now? Click here to enroll and enter your zip code to get started!

What is the Importance of Hospital Indemnity Policy

Mon, 24 Feb 2025 19:34:38 GMT

What is the importance of Hospital Indemnity policy?

A hospital stay can be upsetting to your health, your wallet and your family. Even if you have other medical insurance, some costs may not be covered. That’s when a Hospital Indemnity insurance can provide a peace of mind in your time of need.

Hospital Indemnity insurance complements your existing health insurance by giving you cash to help with the cost your plan doesn’t cover.

Unlike standard health insurance, Hospital Indemnity insurance pays you directly. You are paid a set benefit amount, depending on your plan and the length of your stay. And you can use the payment in any way you want. There’s no deductible, and you receive payment even if you have other insurance.

How do Hospital Indemnity insurance plans work?

The age at which you can apply for Hospital Indemnity insurance varies by provider, but is typically between 18 and 85 years old. A cash benefit is paid for each day your billed for a hospital stay. You simply choose the days of coverage and daily cash benefit.

· The number of days you can choose from (3, 6, 7, 8, 9, 10, 21, or 31)

· The cash benefit amount per day (from $100 to $600 in increments of $25)

· Premiums are age and gender related and they do not increase as you age.

If you remain at the hospital for 60 continuous days, your policy benefit period resets, along with most of the additional riders listed below.

The other additional riders that can be added are: emergency room services, observation unit monitoring, inpatient mental health services, travel to the hospital or medical facility, ambulance or urgent care center services, cancer diagnosis, outpatient surgery, outpatient therapy and chiropractic, and skilled nursing.

How do you get paid?

When you need to use your Hospital Indemnity coverage, you can access your benefits by following a few steps.

1) Complete a claim form.

2) Submit the claim form along with any other required information for any covered items.

3) Receive a check in the mail.

Hospital Indemnity insurance is a separate insurance product with a distinct purpose and benefits that are paid for specifically covered events. However, the benefit may help lessen the financial impact of your hospital stay, and perhaps it will help you maintain your retirement savings or avoid hardship withdrawals, as you encounter out-of-pocket costs .

Choosing A Hospital Indemnity Plan

Whether you’re just learning about supplemental health plans, like Hospital Indemnity insurance or actively planning to enroll in them, make sure they have the appropriate coverage to compliment your Medicare coverage.

Senior Insurance Advisors will work with you so you’re able to make informed insurance decisions for today and tomorrow. We encourage you to reach out so we can show you how Hospital Indemnity insurance and health insurance together can help you plan for the unplanned.

The Pros and Cons of Senior Health Savings Accounts (HSAs)

Tue, 14 Jan 2025 16:55:11 GMT

As we age, managing healthcare costs becomes increasingly important. Many seniors are looking for ways to save on medical expenses and ensure they have sufficient funds for future healthcare needs. One option that has gained popularity in recent years is the use of a Health Savings Account (HSA). While HSAs offer several benefits, they may not be the right fit for everyone. In this blog, we’ll explore the pros and cons of senior health savings accounts (HSAs).

What is a Health Savings Account (HSA)?

An HSA is a tax-advantaged account that allows individuals to save money for qualified medical expenses. The main advantage of an HSA is its triple tax benefit:

Contributions are tax-deductible,
Growth (interest or investment earnings) is tax-free,
Withdrawals for qualified medical expenses are also tax-free.

HSAs are available to individuals who are enrolled in a High Deductible Health Plan (HDHP) , which typically offers lower monthly premiums but higher deductibles. While HSAs are often used by people under 65, they can also be a useful tool for seniors, especially those with Medicare.

Pros of Health Savings Accounts (HSAs) for Seniors

Tax Benefits: The triple tax advantage is the most compelling reason to open an HSA. Contributions to your HSA are tax-deductible, reducing your taxable income for the year. The funds you contribute also grow tax-free, and any withdrawals for medical expenses are not taxed. This can significantly reduce your overall tax burden.
Savings for Future Healthcare Costs: As you approach retirement, healthcare costs can become a major concern. An HSA allows you to save for current and future medical expenses. Unlike Flexible Spending Accounts (FSAs), which have a "use-it-or-lose-it" policy, funds in an HSA roll over year after year, so you don’t have to worry about losing any remaining balance at the end of the year.
No "Use-It-or-Lose-It" Rule: Unlike FSAs, which often require you to use the funds within the calendar year or risk forfeiting them, HSAs allow your contributions to carry over indefinitely. This makes them an excellent option for seniors who want to save for larger medical expenses later in life.
Can Be Used for Medicare Expenses: Although seniors over 65 are no longer eligible to contribute to an HSA if they are enrolled in Medicare , they can still use the funds in their HSA to pay for a variety of medical expenses, including Medicare premiums, copayments, and even long-term care services. This can help reduce the strain on your retirement savings and keep you financially secure.
Flexibility and Control: With an HSA, you have full control over your healthcare spending. You can use the funds for a wide range of medical expenses, from doctor visits and prescriptions to dental and vision care. If you don’t need to use the funds immediately, you can invest the money to grow it for future healthcare needs.

Cons of Health Savings Accounts (HSAs) for Seniors

Eligibility Requirements: To open and contribute to an HSA, you must be enrolled in a High Deductible Health Plan (HDHP). Many seniors, especially those who are enrolled in Medicare, may no longer meet this requirement. While you can still use existing HSA funds once you are on Medicare, you cannot make new contributions.
Contribution Limits: For 2025, the annual contribution limit for HSAs is $3,850 for individuals and $7,750 for families. Seniors aged 55 and older can make additional "catch-up" contributions of up to $1,000. While these limits are generous, they may not be enough for seniors with significant healthcare needs or for those who wish to fully fund their future medical expenses.

If you're wondering how to best use your retirement savings, our team can assist with strategies to maximize your funds. Visit Senior Insurance Advisors to learn more.

High Deductible Health Plans May Have High Out-of-Pocket Costs: While HDHPs offer lower premiums, the higher deductibles can be a burden if you experience significant medical costs. For seniors, who may face increased healthcare needs as they age, a high deductible can mean that you must pay a substantial amount out of pocket before your insurance begins covering costs. This may make it difficult to manage healthcare expenses in the short term, even if you have an HSA.
Limited Use of Funds Before Age 65: If you're not yet 65, using your HSA for non-medical expenses will incur a 20% penalty (in addition to taxes). This can make it difficult to access your HSA funds if you need them for reasons other than healthcare, particularly if you’re under 65 and facing unexpected financial hardship.

Is an HSA in Lincoln, Nebraska Right for You?

An HSA can be a powerful tool for saving and paying for healthcare costs, especially for seniors who are looking for tax advantages and long-term savings. However, they are not suitable for everyone. If you're on Medicare, you won't be able to make new contributions, but you can still use your existing HSA funds for qualified medical expenses. Additionally, the eligibility requirements and high deductible plans may not align with your current healthcare situation.

If you’re considering opening an HSA or want more information about how it fits into your retirement strategy, reach out to our team at Senior Insurance Advisors. We can help you navigate the various options available to ensure that your healthcare and financial needs are met.

Do I Need to Review My Medicare Plan?

Tue, 15 Oct 2024 13:30:30 GMT

Reviewing your Medicare plan might not be at the top of your mind, but it’s something that could make a significant difference in your healthcare costs and coverage. Medicare offers a variety of plans, and they’re not “set it and forget it.” Each year, changes can occur, whether it's in your health needs, available plan options, or even costs. That’s why it’s important to regularly review your Medicare plan.

Are you asking yourself, “Do I need to review my Medicare plan?” If so, the answer is yes.

Why Should You Review Your Medicare Plan?

Medicare plans are not static. They can change yearly in terms of costs, coverage, and the network of providers. Even if you’ve been satisfied with your plan in the past, it’s important to review it annually to ensure it still meets your needs. Here are some reasons why you should consider reviewing your Medicare plan:

Your Health Needs May Have Changed

As you age, your health may change, and with that, your Medicare needs. For example, you may require more medical care or need new prescriptions. Your current plan might not cover these services or prescriptions, or there might be a better plan available that offers the coverage you need at a lower cost. Reviewing your plan annually ensures that you're covered for any new or ongoing health concerns.

Costs Could Increase or Decrease

Every year, Medicare plans can adjust premiums, co-pays, deductibles, and out-of-pocket costs. These changes can vary from one plan to another. Even if the changes seem small, they can add up over time. Reviewing your plan will make you certain that you're not paying more than necessary or will help you find a plan that offers similar coverage at a more affordable price.

New Plan Options May Be Available

Medicare plans can change from year to year, and new plans may become available that better suit your needs. These new plans could offer better coverage or a more affordable option for the services you use most. By reviewing your plan, you have the opportunity to explore new options and make sure you're getting the best deal.

Your Current Plan’s Network May Change

If your doctor or healthcare provider is no longer in your plan’s network, you could have higher out-of-pocket costs or even have to switch providers. It’s important to review your Medicare plan to ensure your preferred healthcare providers are still in-network , and that you can continue to receive the care you need without unexpected costs.

Prescription Drug Coverage May Change

Prescription drug coverage ( Part D ) can change annually. If the medications you take are added to or removed from the plan’s formulary, your out-of-pocket costs may go up or down. A review of your Medicare Part D plan can help you avoid paying more for medications than necessary. It’s also important to check if your pharmacy is still in your plan’s network.

Check our recent blog about Everything you Need to Know about Medicare Part D Changes in 202 5 .

When Should You Review Your Medicare Plan?

The best time to review your Medicare plan is during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. During this period, you can switch from one Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plan to another. You can also enroll in a plan for the first time or drop coverage altogether if it no longer meets your needs.

However, it’s important to start reviewing your plan well before AEP. Give yourself time to compare your current plan with other available options, so you can make an informed decision without rushing.

How Can Senior Insurance Advisors Help?

At Senior Insurance Advisors, we understand how overwhelming Medicare can be, especially with all the changes and options available. Our team is here to simplify the process for you. We can help you review your current Medicare coverage and identify areas where you might be able to save money or improve your coverage. We compare plans to find the right one for your needs, whether it's Original Medicare, a Medicare Advantage plan, or a Part D prescription drug plan. We will answer your questions about coverage, benefits, and any changes that may occur in the upcoming year. We’ll help you understand your options, explain the fine print, and ensure that you’re making the best choice for your health and budget.

Ready to Review Your Medicare Plan?

Don’t wait for changes to catch you by surprise. Take the time now to review your Medicare plan and make sure you’re getting the coverage you need.

Contact Senior Insurance Advisors today for help reviewing your current plan or comparing options for the upcoming year. Our expert team is ready to help you find the best Medicare plan for you.

Everything you Need to Know about Medicare Part D Changes in 2025

Wed, 24 Jul 2024 13:18:21 GMT

As we approach 2025, significant changes are on the horizon for Medicare Part D that will impact how prescription drug coverage is managed for seniors. In this blog, we'll breakdown the upcoming changes mandated by the Centers for Medicare & Medicaid Services (CMS) and what they mean for you or your loved ones. Here is everything you need to know about Medicare Part D Changes in 2025.

How is Medicare Part D Changing in 2025

1. Prescription Payment Plan

Beginning January 1, 2025, the Inflation Reduction Act mandates all Medicare Part D plans, including standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage, to offer a Prescription Payment Plan. This plan allows enrollees to pay out-of-pocket prescription drug costs through capped monthly installment payments instead of all at once at the pharmacy. This option is particularly beneficial for those facing high cost sharing early in the plan year, as it spreads out expenses over time.

2. Removal of Coverage Gap/Donut Hole

Thanks to the Inflation Reduction Act, starting in 2025, annual out-of-pocket costs for Medicare Part D enrollees will be capped at $2,000. The coverage gap (commonly known as the "donut hole") will now be eliminated. This means you will no longer experience a gap in coverage where you are responsible for higher out-of-pocket costs for prescription drugs.

3. Impact on Prescription Drug Costs

Seniors enrolled in Medicare Part D can expect potential savings on their prescription drug expenses due to these changes. The redesigned benefit structure aims to address the rising costs of medications and ensure that beneficiaries have access to necessary treatments without facing excessive out-of-pocket expenses.

What You Need to Do

As these changes take effect, it's important for Medicare beneficiaries to stay informed and proactive. Here are steps you can take to stay ahead of the curve:

Review your current Medicare Part D plan to understand how it may be affected.
October 1st start consulting with a trusted insurance advisor to explore new plan options that align with your healthcare needs and budget.
Stay updated on communications from CMS and your healthcare providers. Look out for your Annual Notice of Change letter from your carrier in September, which will detail any coverage and cost changes effective January 1st.

Senior Insurance Advisors is Here to Help

At Senior Insurance Advisors, we specialize in navigating Medicare and are dedicated to helping you understand and benefit from these new Medicare Part D changes. Our team can provide personalized guidance, evaluate your coverage options, and ensure you have the right plan in place for 2025 and beyond.

The upcoming changes to Medicare Part D in 2025 represent a huge step forward in enhancing prescription drug affordability and access for seniors. By staying informed, you can navigate these changes confidently and ensure that your healthcare needs are met effectively.

To schedule a free consultation and learn more about how these changes may impact you, contact Senior Insurance Advisors today. We're here to support you in making informed decisions about your Medicare Part D coverage.

Why is There so Misconception about Medicare Advantage Plans

Wed, 19 Jun 2024 17:04:55 GMT

Why is there so misconception about Medicare Advantage Plans

Medicare Advantage also known as Part C of Medicare can be a polarizing topic. Some people will say they love their Medicare Advantage Plan and others will warn you to stay away. They have a bit of misconception. If you’ve been checking with some of your doctors about what plans they take, chances are, you have heard some of your providers tell you why Medicare Advantage plans are bad. Over the years, we’ve heard from many providers that do not like Medicare Advantage plans because their payments come slower than they do for Original Medicare or there is so much more paperwork involved to receive approvals.

So, are Medicare Advantage plans bad?

Not really - they are just misunderstood. All too often, Medicare beneficiaries try to enroll in coverage on their own without free help from a Medicare insurance broker like Senior Insurance Advisors. They often miss some really important details when they do this. Then they are later unhappy with the plan, but it’s not the fault of the plan. It’s simply that they didn’t know the rules before they enrolled.

So, let’s dive in on some of the reasons why Medicare Advantage plans are bad for certain individuals. We’ll go over some of the most common things that Medicare beneficiaries have reported to us that they don’t like about these plans. Then you can decide for yourself if you wish to enroll in one or not.

Constantly Paying Out of Pocket for Services

Medicare Advantage plans usually have copays and coinsurance.

When you enroll in a traditional Medicare Supplement like Plan G, you pay a higher premium upfront, but very little out-of-pocket on the back end. No copays for doctor visits, lab work or daily hospital copays. You are only responsible for the Part B deductible.

When you enroll in a Medicare Advantage plan, you pay a much lower premium and now, you will pay copays and coinsurance for services as you go along. For example, you might pay $20 for a primary care doctor or $40 to see a specialist. Then that doctor may order an MRI, and you must pay a $200 copay for this service. When you pay a copay at the time of service, the copay gets deducted from the annual out of pocket maximum.

Each Medicare Advantage Plan has a Summary of Benefits. This Summary lists all the costs in detail. Your agent will review this information with you. If you carefully review the summary up front, then there should be no surprise to you.

Unfortunately, people fail to read the fine print, and then they end up thinking that their Medicare Advantage plan is bad. This is not the fault of the plan but rather a failure by the enrollee to do his due diligence upfront.

They Mistakenly Think They Don’t Have to Pay for Their Medicare Part B Premium

Medicare Advantage plans are paid by Medicare. When you enroll in a plan, Medicare pays the insurance company to take on your health risk.

Many Medicare Advantage plans will set very low premiums or a $0 premium for the plan itself. However, the $0 premium is confusing to beneficiaries. Many of them think that a $0 premium means they don’t have to pay for Part B. This is false. You will still pay for Part B the entire time that you are enrolled in a Medicare Advantage plan.

Smaller Networks and Referrals

Most Medicare Advantage plans have local, or nationwide networks, so the plan’s entire network might only have a few thousand providers. However, if you stay with Original Medicare and enroll in a Supplement plan, you would have access to nearly a million providers nationwide.

Many people enroll in a Medicare Advantage plan without realizing this. They fail to check with their favorite doctors and hospitals to confirm they participate in the plan’s network. Then they go to use their coverage, and their doctor turns them away because they don’t accept that coverage.

This one is really easy to avoid by checking the plan’s provider directory online before you enroll in the plan. Be sure that you confirm the doctor’s participation in the EXACT plan name of the plan that you are thinking about. Some insurance companies operate multiple networks.

For example, United Healthcare may have an HMO plan and a PPO plan in your area. Your doctor may participate in one but not the other. If you check the wrong directory, you could come up with a false result.

If you travel often, a Medicare Advantage plan may not be right for you. However, most plans do have nationwide networks. Which means, if you see a doctor and they accept your plan it will be consider in network even though you’re outside the service plan area.

Getting a referral

If you enroll in a Medicare Advantage plan with an HMO network, then you will usually have to choose a primary care provider. Most plans do not require a referral to see a specialist.

High Out-of-Pocket Maximums

Medicare Advantage plans all have an Out-of-Pocket Maximum (OOPM) limit to protect you from high out of pocket costs. This is a good thing! It protects you from spending beyond a certain dollar amount each year on Part A and B services.

The downside is that plans can set that OOPM as high as $8,850 in 2024. For people on fixed incomes, coming up with $8,850 in a calendar year is a lot.

Prior Authorizations

Insurance companies are always looking to make sure something is reasonable and necessary. These plans typically involve a greater requirement for your provider to get pre-authorizations before approving services. Sometimes that authorization request might get denied. We see this a lot on medications. The drug is listed in the plan’s formulary, but in the fine print, it requires prior authorization or a quantity limit.

The Expertise of a Local, Licensed Agent

Senior Insurance Advisors offers a valuable opportunity for beneficiaries to get ready and plan for Medicare . By understanding the basics of Medicare, evaluating your current coverage, exploring your options, reviewing your medications, and seeking professional guidance, you can make informed choices that ensure you have the right coverage for your healthcare needs.

Meet with our advisor so you can secure the peace of mind and financial security that proper healthcare coverage offers. With careful consideration and proactive planning, you can confidently navigate your Medicare Enrollment, knowing that you've optimized your healthcare coverage. Call us to schedule a consultation and secure your medical future today!

Can you Disenroll from Medicare if you go back to work after 65?

Fri, 17 May 2024 20:03:46 GMT

Today, it’s not uncommon for people who leave the workforce around Medicare eligibility age (age 65) to return to work later on. Maybe it’s a passionate side-gig, a part-time job or full-time. In any case, when you go back to work, what does that mean for your Medicare coverage?

Can you have employer coverage again when on Medicare?

Yes, if you or spouse go back to work for an employer who offers health insurance, you can take it. You are allowed to have both Medicare and employer coverage, and you can use them together. One will act as primary coverage and the other as secondary coverage. The employer health insurance must be a credible health plan.

The only thing to keep in mind is that when you have Medicare and an employer plan, you cannot contribute to a health savings account (HSA) if it’s offered.

Can I drop Medicare if returning to work?  

If you’re going back to work and can get employer health coverage that is considered credible primary coverage, you are allowed to drop Medicare and re-enroll again without penalties. If you drop Medicare and don’t have credible employer coverage, you’ll face penalties when going back on Medicare.  An employer health coverage is credible when the prescription drug coverage is expected to pay, on average, at least as much as Medicare drug coverage.

Before you decide to drop any part of Medicare, there are some things you’ll want to think about, especially as some choices could end up being costly. 

· Pre-Existing Conditions: If you decide to drop Medicare Part B, you’ll also have to drop your Medicare Supplement plan (Medigap) if you have one. This could make it difficult to enroll in another later on as your pre-existing health conditions will be considered when applying.

· Health Savings Accounts (HSAs): If you want to contribute you an HSA, you will have to drop Part A. You could end up having to repay the government for medical services Medicare covered as well as repaying any Social Security benefits.

· Premium Payments: If you are currently paying premiums for Part A, you cannot disenroll from Part B without also disenrolling from Part A.

Additionally, should you decide to disenroll from Medicare, you’ll need to talk with Social Security directly. You can do this either in-person or on the phone. Social Security requires that you consult with them while you fill out the Part B disenrollment form.

Re-enrolling in Medicare when working after 65

Medicare has rules for re-enrolling after you’ve dropped it for an employer-sponsored health plan. You’ll have an 8-month Special Enrollment Period in which to re-enroll in Medicare Part A and Part B. If you miss this window, you’ll have to wait to enroll in the Medicare General Enrollment Period (January 1 – March 31) and you could face late enrollment penalties if you end up going too long without credible coverage.

NOTE: While you have eight months for Parts A & B, you only get two months after losing the employer coverage or leaving work to re-enroll in a Medicare Part D prescription drug plan or a Medicare Advantage (Part C) plan.  If you enroll later, you’ll face late enrollment penalties for Part D.

Finally, if you wish to re-enroll in a Medicare Supplement (Medigap) plan, you’ll be able to do so any time after re-enrolling in Parts A & B.

Learn more about the Special Enrollment Period for people working past 65  .

There are a lot of things to consider when it comes to Medicare and returning to work. Take your time thinking through your options. Any decision is right so long as it’s what’s best for your health and lifestyle. If you still have questions about you options, we would love to provide you with a no-cost consultation! Give us a call or easily request more information through our website.

Can I Have Both Employer Insurance and Medicare?

Mon, 08 Apr 2024 14:44:45 GMT

Navigating your health insurance can feel like you’re learning a foreign language that changes every year. For many people who qualify for Medicare (age 65 and older), they’re beginning to wonder, “Can I have both employer insurance and Medicare?” The answer (thankfully) is yes, but that means there are more steps to maximizing your coverage.

Understanding Medicare and Employer-Based Plans

Medicare: A federal health insurance program designed for Americans aged 65 and older, or younger individuals with specific disabilities. This coverage comes in two base components: Part A (hospital insurance) and Part B (medical insurance).
Employer-Based Insurance: These health insurance plans are offered by some employers as part of their benefits packages. These plans can vary significantly in coverage, deductibles, copays, and network participation.

The Coordination of Benefits

When you have both Medicare and employer-based insurance, a system called "coordination of benefits" dictates which plan pays first and how they work together. Your employer’s size is a crucial factor, with your policies’ coordination being affected.

If you work for a company with 20 or more employees, your employer's plan is considered the "primary" payer. This means it will typically handle the bulk of your medical expenses first, with Medicare acting as "secondary" insurance and picking up any remaining costs after the employer plan reaches its limits.

Imagine a surgery with a total cost of $20,000. Your employer plan might have a $5,000 deductible, meaning you'd be responsible for that upfront cost. Once you meet the deductible, the plan might pay 80% of the remaining $15,000, leaving you with a copay. Medicare would then step in as secondary insurance, potentially covering that coinsurance depending on your specific Medicare plan (like a Medigap supplement) and its coverage details.

But if your employer is staffed with less than 20 employees , Medicare is the primary payer, handling any initial medical bills. Your employer’s plan then acts as secondary insurance, kicking in to cover leftover expenses after Medicare has reached its limits. Additionally, if your employer’s plan is not “ credible ,” then you must get on Medicare.

Making the Choice: Employer Plan vs. Medicare Advantage

While keeping both employer insurance and Medicare is certainly an option, you should also consider Medicare Advantage plans. Private insurance companies offer these as alternatives to Original Medicare (Parts A & B). They often combine hospital and medical coverage into one plan, sometimes with additional benefits like vision or dental care.

What if you Keep Your Employer’s Plan and Original Medicare:

Pros:

You may have a wider network of doctors and hospitals accepted by your employer’s plan compared to some Medicare Advantage plans.
You might benefit from lower out-of-pocket costs due to your employer plan's contribution.

Cons:

You'll likely face additional paperwork and potential coordination issues between the two plans.
There might be duplicate coverage for certain services, leading to higher overall costs.

What if you Enroll in a Medicare Advantage Plan:

Pros:

Often simpler with streamlined billing and a single point of contact.
May offer additional benefits not covered by Original Medicare, like vision and dental.
Some plans have capped out-of-pocket costs, providing a predictable budgeting process.

Cons:

The network of doctors and hospitals might be more limited compared to some employer plans.
Premiums and coverage can vary significantly between plans, requiring careful research.

Important Considerations Before Deciding:

Review your current employer plan: Carefully analyze your plan's details, including its coverage, deductibles, copays, and network participation.
Evaluate your health needs: Consider your anticipated medical expenses and how each plan would address them.
Research Medicare Advantage plans: Compare plans in your area, specifically focusing on network coverage, cost-sharing details, and additional benefits.
Consult an Insurance Advisor: These experts can guide you through a personalized analysis that considers your health, financial resources, and employer’s options.

Can I Have More Than Both Employer Insurance and Medicare?

To schedule a free consultation with a licensed insurance advisor , contact us today. We can answer your questions, address your concerns, and help you craft a personalized and budget-conscious plan. Don't navigate the future of your health insurance alone – let Senior Insurance Advisors be your trusted guide .

Do you have to apply for Social Security to get Medicare?

Wed, 13 Mar 2024 20:22:13 GMT

Do you have to apply for Social Security to get Medicare?

Millions of seniors rely on Medicare for health benefits in retirement, and depend on Social Security as a key income source. But while the two programs are interrelated, participation in one doesn’t necessarily hinge on being signed up for the other.

Many people think you must enroll in Social Security before applying for Medicare; fortunately, that’s not the case. Social Security and Medicare are tied together in some ways, but in others, they are separate programs. In this post, we’ll go over what you need to know about how the two go together.

At what age do I qualify for Social Security?

You can begin collecting Social Security retirement benefits as early as age 62. Doing so, however, is often not advisable, since it means lowering your monthly benefits.

To collect the full monthly benefit, you must wait until full retirement age to sign up for Social Security. Your full retirement age depends on your year of birth. For each month you file for Social Security ahead of full retirement age, you’ll face a reduction in your monthly benefits.

At what age do I qualify for Medicare?

In order to qualify for Medicare, you must meet one of the following requirements: 65 or older, qualify disability, or at any age with End Stage Renal Disease or ALS. Your initial enrollment period for Medicare begins three months before the month of your 65th birthday, and ends three months after the month you turn 65.

If you miss your initial Medicare enrollment window, you can sign up during the general enrollment period of January 1 through March 31 of each year. The longer you hold off, the more it could cost you. If you wait too long to sign up for Medicare Part B, you’ll face a 10 percent increase in your Part B premiums for every year-long period you were eligible.

If you’re still working and have creditable coverage under a group health plan, you’ll get a special enrollment period that begins when you separate from your employer or your group coverage ends. At this time, you will not have to worry about penalties.

Do I Need to Enroll in Medicare if I’m Receiving Social Security Benefits before 65?

If you are receiving Social Security benefits prior to 65 then you will automatically be enrolled in Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You will receive your card in the mail 3 to 4 months prior to your 65 ^th birthday. You’ll still need to make important decisions about your coverage, like whether you need to add drug coverage.

If you’re not receiving Social Security benefits at the time you are ready to sign up for Medicare, you will need to apply yourself . There are a couple of ways to apply; you can contact us , schedule an appointment with your local Social Security office or visit www.ssa.gov .

Make your decisions independently

Again, collecting Social Security is by no means a prerequisite to getting Medicare. In fact, it’s often advisable to sign up for Medicare as soon as you’re eligible (assuming you don’t have other creditable health coverage) but wait on Social Security to avoid a reduction in benefits.

If you sign up for Medicare alone, the only downside is having to make your premium payments directly, as opposed to having them deducted from your Social Security benefits.

Trust Our Licensed Medicare Advisors

Understanding Medicare coverage doesn’t have to be complicated or intimidating! Our licensed advisors are dedicated to helping you make informed decisions about your healthcare coverage. We’ll gladly support you when enrolling , comparing plans , and navigating rate changes at your convenience.

Our advisors are here for you every step of the way. If you’re turning 65 soon or simply have questions about delaying Medicare, then please feel free to give us a call , send us an email , or contact us online for a free consultation . We believe everyone deserves personalized Medicare support, and we’d love the opportunity to help you, too.

Is Cobra Medical and Prescription Drug Coverage Considered Creditable with Medicare?

Fri, 16 Feb 2024 19:18:50 GMT

This is one question we get when a client is nearing or at 65 and is not on Medicare yet. They are considering retirement but want to continue on the company’s COBRA medical and prescription coverage instead of enrolling in Medicare.

If you remain employed and on your employer group plan past age 65, you do not need to enroll in Medicare Part B (Medical Coverage). Medicare Part B has a monthly premium. If you’re not contributing to Health Savings Account (HSA), then we suggest you to enroll in Medicare Part A (Hospital Coverage). Medicare Part A is premium free if you or a spouse have worked and paid in taxes for 10 years or longer.

If your employment ends and enrolling in your company’s COBRA medical and prescription coverage may be an available option. But you need to beware that you’re possibly creating a problem for yourself.

The government does not consider COBRA to be creditable medical coverage (medical or prescription drug coverage that has minimum coverage requirements). Group coverage and prescription drug coverage from your employer, while you are employed, is typically considered creditable coverage. COBRA medical coverage is not, although COBRA prescription drug coverage may be.

Once you lose your employment group coverage, Medicare will allow you an 8-month period to enroll in Medicare Part B. This 8-month period is called Special Enrollment Period. If you wait until after this 8-month period has expired, you may be subject to a late enrollment penalty. Enrollment in COBRA does not extend this 8-month period. Even though COBRA can last 18 months or longer, it does not extend the 8-month period to enroll in Part B.

We recommend our clients to enroll in Part B within 8-months of losing their employment. That way there will be no penalty for late enrollment.

Trust Our Licensed Independent Advisors

Our advisors are here for you every step of the way. If you’re turning 65 soon or simply have questions about your current Medicare coverage, then please feel free to give us a call , send us an email , or contact us online for a free consultation . We believe everyone deserves personalized Medicare support, and we’d love the opportunity to help you, too.

How do I get Medicare to pay for Home Care in 2024?

Thu, 18 Jan 2024 17:43:04 GMT

Medicare is a vital support system for many seniors’ essential healthcare, including for home care services. However, knowing how to get Medicare to pay for home care can be a complex, seemingly unending, process. Allow us to delve deeper into the crucial aspects for seniors and their families when seeking Medicare's support for home care services.

1. Eligibility for Medicare Home Care Coverage

Medicare coverage for home care requires meeting stringent requirements. For example, Medicare does cover at-home care like skilled nursing care, physical therapy, occupational therapy , or speech-language pathology . However, Medicare doesn't readily cover long-term home care services unless they’re directly associated with skilled care needs.

To qualify, applicants must be homebound due to illness or injury and receive a doctor’s certification. These two steps ensure that Medicare’s support goes towards essential care that’s a medical necessity.

2. Covered Services under Medicare for Home Care

Medicare's Parts A and B cover many important at-home services. Some essential services include skilled nursing care, physical therapy, and occupational therapy. However, these services may have limited coverage, potentially requiring seniors to navigate coinsurance or copayments.

So, forming a comprehensive care plan often requires specialized advice. This informed awareness helps seniors actively choose and maximize any available benefits. Plus, they know more about any potential financial obligations that come with their chosen services.

3. Limitations and Exclusions

While comprehensive, Medicare notably excludes continuous:

24-hour-a-day care at home
meal delivery services
homemaker services
personal care assistance with daily living activities (ADLs)

Consider any limitations like these so you can proactively form a well-thought-out care plan. This helps you explore diverse alternatives like long-term care insurance or using Medicaid to bridge the gap. If you qualify for Medicare, you can sometimes access necessary care and support beyond what Medicare provides without having to foot the bill.

4. Alternative Options and Supplementary Coverage

While Medicare is a pivotal support for many seniors who need home care, supplementary coverage significantly enhances their healthcare. Plans like Medicare Advantage (Part C) or Medigap policies extend coverage, potentially closing Medicare’s loopholes. Deliberately evaluating and comparing these supplementary plans helps seniors access tailored, comprehensive support for their home care needs. This can help them fill any gaps in their Medicare coverage, possibly preventing a disastrous loophole.

5. Incorporating Preventive Measures for Home Care Eligibility

Proactive health management can potentially minimize the need for extensive home care services. This includes embracing a healthy lifestyle, engaging in regular physical activity, and adhering to recommended screenings and vaccinations.

Many times, seniors can easily reduce the risk of developing conditions that require extensive home care. Medicare, in turn, supports routine check-ups and preventive screenings as part of their priority to motivate better health nationwide.

6. Importance of Regular Review, Updates, and Advisor Consultations

Finally, regularly reviewing your Medicare coverage can help you stay on top of our constantly evolving policies. That’s why periodically meeting with a Medicare advisor is so important. These knowledgeable professionals can decipher Medicare’s intricacies , helping many seniors optimize their coverage. During these consultations, seniors learn about any policy changes, new benefits, or nationwide updates. This support makes sure that any evolving needs are consistently met with the best possible coverage.

Work With us to get Medicare to pay for Home Care

Fine-tuning your home care coverage with Medicare requires up-to-date, informed decisions. Schedule a meeting with Senior Insurance Advisors today for personalized guidance, giving you peace of mind and financial security. Call us to take that crucial step to confidently secure your medical future .

When is Medicare Open Enrollment in 2023?

Wed, 18 Oct 2023 18:00:15 GMT

Medicare is a critical healthcare program for millions of Americans either aged 65 and older or who have certain disabilities. Each year, the designated period known as Medicare Open Enrollment allows these beneficiaries to be ready and select different policies. However, many Americans aren’t sure how to navigate these sophisticated plans, leaving them in the dark. That’s why we’re here to help you navigate this recurring period and choose the best possible plans.

Being Ready for Medicare Open Enrollment

Medicare Open Enrollment is an annual period that allows Medicare beneficiaries to fine-tune their coverage. Lasting from October 15th to December 7th , this is a vital opportunity to evaluate and adjust your plan. Failing to take advantage of this period could mean that you’re enrolled in the wrong plan for an entire year, potentially resulting in higher costs or inadequate coverage . Therefore, taking advantage of this open enrollment window is crucial to making the most of your Medicare benefits.

1. Evaluate Your Current Coverage

The first step in preparing for Medicare Open Enrollment is to assess your current coverage by asking a few questions.

Are you satisfied with your current plan?
Have your healthcare needs changed over the past year?
Do you anticipate any upcoming medical procedures or prescription drug needs?

Answering these questions will help you determine if your existing plan still works best for you. Changes in your health or medical services can significantly impact your current plan’s effectiveness. Consequently, a thorough evaluation of your current coverage is the foundation upon which you can build a more tailored healthcare plan during open enrollment.

2. Explore Your Options

During the Open Enrollment period, you can explore alternative Medicare plans. This might include switching to a Medicare Advantage Plan or changing your Part D coverage . Take the time to research and compare different plans available in your area, considering factors like premiums, deductibles, coverage limits, and out-of-pocket costs. Like shopping for the best deal, you won’t miss out on more cost-effective or comprehensive plans that could better suit your needs. The effort invested in comparing plans can lead to significant savings and improved healthcare coverage.

3. Review Your Medications

If you have a prescription drug plan (Part D), it's crucial to review your current medications and check if you can obtain them at an affordable cost. This is because it’s not uncommon for a plan’s coverage to change from year to year.

Additionally, different plans have varying tiers and co-pays for medications, so reviewing your options can simultaneously minimize your coverage and satisfy your medical needs. This step can be especially significant for those who rely on ongoing medications to manage chronic conditions.

4. Seek Professional Guidance

Making big decisions about your Medicare coverage can be quite complex and stressful. However, we recommend meeting with a Medicare advisor or consultant If you're not sure where to turn. These professionals can provide personalized guidance that helps you navigate any intricate plan, ensuring that your choices align with your health and financial objectives. By scheduling a consultation during Open Enrollment, you can craft a well-informed plan that provides the optimal balance of coverage and cost savings.

The Expertise of a Local, Licensed Agent

Medicare Open Enrollment is a valuable opportunity for beneficiaries to get ready and adjust their healthcare coverage as needed. By understanding the basics of Medicare, evaluating your current coverage, exploring your options, reviewing your medications, and seeking professional guidance, you can make informed choices that ensure you have the right coverage for your healthcare needs.

Meet with our advisor so you can secure the peace of mind and financial security that proper healthcare coverage offers. With her careful consideration and proactive planning, you can confidently navigate Medicare Open Enrollment, knowing that you've optimized your healthcare coverage. Call us to schedule a consultation and secure your medical future today!

How Much Does Medicare Cost?

Thu, 13 Jul 2023 21:09:06 GMT

Medicare plays a vital role in ensuring access to necessary medical services for Americans aged 65 and older. However, many people are often left wondering about the cost associated with this program. Understanding the expenses involved with Medicare is crucial for seniors and their families to make informed decisions about their healthcare needs. That's why we're going over the various aspects of one's Medicare cost, shedding light on what beneficiaries can expect.

The Four Main Medicare Costs

Medicare, the federal health insurance program, is comprised of four main parts - Parts A, B, C, and D - each serving specific purposes to provide comprehensive healthcare coverage. Understanding each part's cost , purpose, and benefits, is essential to navigating the complexities of Medicare.

Medicare Part A

Medicare Part A , also known as hospital insurance, covers inpatient hospital stays, skilled nursing facility care, and some home healthcare services. For most individuals, Part A is premium-free, as they have previously paid Medicare taxes. If you haven't worked long enough to qualify for premium-free Part A, you may have to pay a premium. In 2023, the Part A premium is capped at $506 per month.

It's worth noting that Part A also has deductible and coinsurance costs. The deductible for each benefit period in 2023 is $1,600, and this amount covers the first 60 days of inpatient hospital care. Beyond 60 days, beneficiaries are responsible for daily coinsurance amounts.

Medicare Part B

Medicare Part B covers outpatient services, including doctor visits, preventive care, medical supplies, and some outpatient procedures. Unlike Part A, Part B requires beneficiaries to pay a monthly premium . The standard premium for Part B in 2023 is $164.90 per month. However, this amount can vary based on income.

In addition to the premium, Part B also includes an annual deductible, which is $226 in 2023. After meeting the deductible, beneficiaries typically pay 20% of the Medicare-approved amount for most services.

Medicare Part C (Medicare Advantage)

Medicare Part C, also known as Medicare Advantage , is an alternative way to receive Medicare benefits from approved private insurance companies. The costs associated with Medicare Advantage plans can vary depending on the specific plan you choose. While some plans have no monthly premiums, others may require a monthly premium in addition to the Part B premium.

Furthermore, Medicare Advantage plans often have different copayments , coinsurance, and deductibles, when compared to Parts A and B. It's crucial to review the details of each plan to understand the specific costs involved.

Medicare Part D

Medicare Part D provides prescription drug coverage . This coverage is offered through private insurance companies approved by Medicare. The costs associated with Part D plans can vary depending on the specific plan, the drugs you take, and the pharmacy you use. Part D plans generally have a monthly premium, an annual deductible, and copayments or coinsurance for medications.

It's important to carefully compare Part D plans to ensure they cover the medications you need at a cost that aligns with your budget.

Additional Considerations of Your Medicare Cost

In addition to the costs mentioned for Medicare Parts A, B, C, and D, it's important to consider other factors that may affect your overall healthcare expenses.

Medicare Supplement Insurance, also known as Medigap, is available to help cover the gaps in Original Medicare (Parts A and B). These policies, sold by private insurance companies, can help pay for expenses such as deductibles, copayments, and coinsurance. The cost of Medigap plans can vary depending on the coverage level and the insurance company. It's essential to compare Medicare Supplement and Advantage plans to find one that suits your needs and budget.

For individuals with limited income and resources, there are various programs available to provide financial assistance with Medicare costs. The Medicare Savings Programs (MSPs) help pay for premiums, deductibles, and coinsurance for eligible individuals. The Low-Income Subsidy (LIS), also known as Extra Help , assists with prescription drug costs under Medicare Part D. These programs can significantly reduce the financial burden associated with Medicare. Additionally, it's worth exploring whether you qualify for any state or local assistance programs that may provide further support with healthcare expenses.

To fully understand the costs and potential assistance available, seek guidance from a trusted independent insurance agent . They can provide personalized information based on your specific circumstances and help you navigate the complexities of Medicare costs. By considering these additional factors and exploring available assistance programs, you can ensure that you have a comprehensive understanding of the potential expenses associated with Medicare and make informed decisions about your healthcare coverage.

We Take the Confusion Out of Medicare

Understanding the cost of Medicare is crucial for anybody seeking or possessing enrollment in the program. While Medicare Part A may be premium-free for most beneficiaries, Parts B, C, and D involve various premiums, deductibles, and coinsurance amounts. By familiarizing themselves with these costs, seniors and their families can better plan for their healthcare expenses and make informed choices about their coverage options.

It's always advisable to consult with an experienced independent insurance agent for the most up-to-date information on costs and coverage details. If you have any questions about any Medicare components, give us a call today to arrange a free consultation. With this knowledge in hand, beneficiaries can navigate Medicare confidently and ensure their healthcare needs are met.

Does Medicare Cover Dental?

Thu, 08 Jun 2023 13:13:06 GMT

Medicare is a common insurance program that covers some medical expenses for beneficiaries aged 65 and above. However, when it comes to dental care, Medicare doesn’t cover most dental procedures unless they impact another medical condition. However, there are options for beneficiaries seeking coverage for their oral health needs. Today, we’ll discuss what options are available to those pursuing affordable dental care.

Medicare Coverage of Dental Costs

Original Medicare (Parts A and B) provides limited coverage for dental care. Medicare doesn’t cover routine dental services such as cleanings, fillings, extractions, dentures, and crowns. However, Medicare Part A does cover dental services that occurred due to an emergency or hospitalization. Part A also covers some dental procedures which help treat an injury or illness. Similarly, Medicare Part B may cover certain dental services that are necessary to diagnose or treat a medical condition.

For instance, Medicare may cover procedures like oral infection treatments or tooth extraction before radiation therapy. However, just because Medicare may cover certain dental services under specific circumstances, it doesn't mean that all costs will be covered. Typically, a beneficiary is responsible for the cost of the deductible, coinsurance, and copayments associated with basic dental service.

Lastly, the Medicare Savings Program provides financial assistance to people with limited income and resources. The program helps pay Medicare premiums, deductibles, and coinsurance costs. While the program does not cover dental expenses, it can help reduce overall healthcare costs, including those incurred from dental care. If you’re still looking for comprehensive dental coverage, there are options available for beneficiaries.

Alternative Options for Dental Coverage

If you want to have common dental services covered under Medicare, you may consider enrolling in a Medicare Advantage Plan (Part C) that includes dental coverage. Medicare Advantage plans are offered by private insurance companies that have a contract with Medicare. Medicare Advantage plans provide the same benefits as original Medicare, along with additional benefits such as dental coverage, vision coverage, and prescription drug coverage.

Another way to get dental coverage under Medicare is through a standalone dental insurance plan. Since dental insurance plans aren't offered through Medicare, they must be separately purchased through a private insurer. There are plenty of choices available, and the benefits included will vary by plan.

These plans tend to cover a wide range of dental services such as preventive care, emergency treatment, and major procedures. Before choosing a plan, it is critical to read the terms and conditions carefully, including any pre-existing condition exclusions, waiting periods, and network restrictions.

Ask About Your Dental and Medical Coverage

While original Medicare doesn’t cover routine dental care, there are options available for those seeking dental coverage. Medicare Advantage plans and stand-alone dental insurance plans are both options for those looking for comprehensive coverage for their oral health needs. You can also discuss the Medicare Savings program with your insurance advisor if you may qualify for these critical benefits. Regardless of what option you choose, make sure to read the terms and conditions carefully and understand the benefits included, so you can make an informed decision.

We hope this information has been informative and helped you understand the dental coverage options under Medicare. If you have questions about your Medicare coverage, then we encourage you to reach out to us and schedule a free consultation . We’ll gladly sit down with you and answer any questions about using Medicare benefits to cover your home healthcare needs.

What Is Medicare's Extra Help Program?

Fri, 10 Mar 2023 15:02:38 GMT

For those with limited resources who face high prescription and insurance costs, there’s a fantastic Medicare program for your needs. Extra Help, known as Low Income Subsidy or “LIS,” provides financial assistance with Medicare Part D plans. Covered expenses generally include copays, premiums, and deductibles related to Medicare’s prescription drug coverage. Extra Help will also waive the Medicare Part D penalty for anyone affected by it. Let’s dive into this plan together and see how you may benefit from this assistance.

Benefits of Extra Help

People limited resources may struggle to afford Part D coverage for their prescriptions. This led to the creation of Extra Help to fill the gap. The plan reduces out-of-pocket costs for copays, premiums, and deductibles through various subsidies.

Extra Help plans place prescription drugs into tiers to reduce overall costs. While each tier varies from plan to plan, higher tiers generally feature more expensive copays. However, a copayment is sometimes reduced upon your doctor’s request if the prescription is needed.

One example involves the monthly cost of insulin . Through recent regulatory action, a price cap of $35 per month on insulin is now in place for all Part D plans. While price ceilings are new to Extra Help, this action alone shows the value offered by this Low Income Subsidy. 

Additionally, anybody receiving a Low Income Subsidy can utilize Medicare’s Special Enrollment Period from January to September. In this period, changes can be made to Plan D coverage once per quarter with Extra Help.

Requirements for Extra Help

Anybody looking to apply for Extra Help must have Part A or B coverage and meet certain financial or enrollment requirements.

To qualify financially, an individual must earn $20,385 or less in annual income and own $15,510 or less in "counted assets." Married applicants must meet similar thresholds of $27,465 or less in yearly income and hold $30,950 or less in relevant assets.

Assets that factor into your qualification include cash, retirement, stocks, bonds, mutual funds, two or more cars, and secondary real estate. Certain assets that don’t affect your qualification include a primary home, one automobile, burial plots, or $1,500 in savings for burial expenses.

Another way to qualify is through enrollment in specific programs. Those with full Medicaid coverage, state assistance in Part B premiums, and Supplemental Security Income (SSI) are enrolled automatically in Extra Help. This automatic enrollment will be maintained unless it’s updated before the end of the year.

Maintaining the Low Income Subsidy 

New members receive an introductory letter describing the added cost and coverage as part of the year’s membership. If you qualify for the program but haven’t received a letter by October 1st, then you can apply online or at your local SSA office . We’d also be happy to assist you with this process.

Keep in mind that Extra Help requires an annual evaluation of your eligibility. If you have Medicaid, Supplemental Security Income, or a Medicare Savings Program, then you will qualify for LIS. Once the Social Security Administration is notified of your eligibility, then you’ll be enrolled in Extra Help.

For those who originally applied for LIS, you may need to reapply before the end of the year. The Social Security Administration will send an application in August or September if they believe you may no longer qualify. After receiving the application, you have 30 days to reapply with your updated information. If you need a longer application period, then please call your local Social Security office to request an extension.

Ask Us about the Low Income Subsidy

If you qualify for this helpful program but aren’t enrolled yet, then we encourage you to apply right away. Simply visit the SSA’s secure website and click the “Apply Now” button at the bottom of the page. We encourage you to reach out if you have questions about how to apply for Extra Help.

If you need any additional guidance or assistance, we’re always here to help you! Please give us a call or even send a message to arrange your free consultation today. We’ll gladly walk you through the application process at your convenience.

Avoiding Medicare Scams

Wed, 08 Feb 2023 22:37:23 GMT

The world of healthcare can be tricky, especially when it comes to Medicare. Not only is Medicare a complex system , but it’s also vulnerable to cons and fraudulent activities. It’s important for everyone who uses Medicare or is considering using it to learn how to protect themselves from potential scams. Here are some common Medicare scams and what you can do to keep criminals at bay.

Common Medicare Scams

Medicare scams often target people who are new to the program or don’t understand their benefits. Fraudsters may use a variety of tactics to try and get your personal information, so it’s important to know what they look like. It’s common for scammers to be especially active around the annual open enrollment period . This is the annual period when Medicare Providers can be switched, leading to these common fraud and scam tactics.

1. Emails Asking for Sensitive Information

A common tactic called “phishing” involves sending fraudulent emails that mimic a company or person to steal personal data. These fake emails may ask for personal information like Social Security or financial account numbers in order to falsify your identity.

Never click on links in emails sent from unknown or suspicious parties. Always look closely at any link before you click on it to make sure it’s from the official website of the supposed sender.

2. Unsolicited Phone Calls and Visits

Don't give out any personal information over the phone unless you know who’s calling and why. Scammers will often try to get your personal information by posing as an official Medicare representative over the phone or in person.

Never provide any personal information unless you know you’re speaking with an official representative from Medicare or another agency authorized to access your records. If in doubt, contact the agency directly via their website or official customer service line before providing any information.

3. Carefully Worded Contracts and Loopholes

Read all contracts thoroughly before signing them. Make sure you understand exactly which services are included in each package and which costs are associated so there are no surprises down the road.

Always review contracts carefully before committing yourself financially—even if it seems like a great deal—as fraudsters may try to sneak hidden fees into agreements that could end up costing more than expected in the long run.

4. Suspiciously Priced Coverage and Products

Remember, there’s no such thing as “free” insurance, as any plan will require some form of payment to stay active. Be sure to always read the fine print before signing up for anything! Scammers often conduct convincing phone calls offering free medical services or equipment.

To be safe, never pay cash upfront for services or products related to Medicare. Always use an established method of payment such as a credit card or check so the payment can be traced. You can check with the National Consumer Protection Agency (NCPA) for more information about any offers you receive. If something sounds too good to be true, then it probably is!

5. Fake Medical Supplies

Other common issues are fake prescription drugs being sold at a discount or free medical equipment that you don’t need. These products may look legitimate at first glance, but they’re typically low quality and potentially dangerous if used incorrectly.

It’s wise to ignore door-to-door salespeople who sell prescription drugs or other medical products without a doctor’s prescription. Always research any product before buying it and consult with your healthcare provider as needed.

Report Suspicious Activity Immediately

If you suspect someone is trying to scam you out of your personal information, then don't hesitate to file a report at once! If you come across a suspicious insurance representative, you can verify their status through your state’s insurance department .

Contact your local law enforcement office or federal agency that handles fraud complaints (such as the FBI). You should also call Medicare’s official line at 1-800-MEDICARE (1-800-633-4227) if you think someone has tried to scam you using Medicare services or products.

Look Out for Medicare Scams

Medicare scams can cause serious harm if proper precautions aren't taken. By following these simple guidelines, protecting yourself isn’t as difficult as it might seem. Staying vigilant and aware of Medicare scams will ensure your transactions are secure and your personal information remains safe.

We at Senior Insurance Advisors are here for you if you ever need assistance navigating Medicare. We’d be more than happy to set up a consultation with you at no cost to look over your options and benefits.

Our Licensed Medicare Advisors

Fri, 20 Jan 2023 16:04:45 GMT

When it comes to making the most of your healthcare coverage, our licensed Medicare advisors are always eager to help. Our team has years of experience navigating and simplifying Medicare, and we’re licensed in 10 different states across the country.

We’re dedicated to helping our clients make informed choices regardless of their unique healthcare needs. Allow us to briefly explain how we can support you and your loved ones today.

What Our Licensed Medicare Advisors Do

Our licensed Medicare advisors provide personalized assistance that empowers our clients to choose coverage with confidence. We’ll gladly explain your options in a straightforward manner to help you select the best plan for your needs. Our team can also help you enroll in any plan and teach you how to use it to your advantage.

We also offer resources designed to make navigating your healthcare needs easier overall. From planning for home healthcare to providing helpful articles about managing costs , we strive to bring you all the information needed to make informed decisions about your healthcare coverage. If you have any questions about changes to existing plans, then our advisors will also be there to guide you through the updates to make sure you’re getting the benefits you deserve.

Benefits of Our Licensed Medicare Advisors

When you work with one of our Medicare advisors, you can expect an individualized approach tailored to your current needs and future goals. Our advisors consider not only your health insurance but also any long-term coverage that may be available to you. They always provide useful advice on how best to use your resources for maximum savings and benefits.

Our advisors understand everyone is different and no two situations are identical. That’s why they take extra care to provide customized guidance that’s unique to each individual. We always strive to stay up to date with the latest CMS changes so we can provide accurate information and assistance at all times. Plus, we’re committed to staying connected with our clients throughout the entire process by addressing questions or concerns at a moment’s notice.

We also serve as advocates for our clients when dealing with Medicare and insurance companies on their behalf. Our advisors understand how important it is to get fair treatment, and they actively pursue solutions that ensure our clients receive quality support for their needs.

Our Commitment to You

We’re committed to providing high-quality assistance when it comes to choosing a Medicare plan and covered healthcare services . Our team is always available if you need someone to address questions that arise during this process. In fact, we’re so dedicated to your overall experience that we gladly offer our services at no cost to you.

We know how valuable it is for individuals and families alike to have an experienced Medicare advisor in their corner. That’s why we dedicate ourselves to ensuring our clients receive personalized support and the most correct information at every turn. Whether you’re curious about open enrollment , Medicare Part A and Part B , or coordination of insurance benefits , you can trust us to always keep your best interests at heart.

Trust Our Licensed Medicare Advisors

Understanding Medicare coverage doesn’t have to be complicated or intimidating! Our licensed Medicare advisors are dedicated to helping you make informed decisions about your healthcare coverage. We’ll gladly support you when enrolling , comparing plans , and navigating rate changes at your convenience.

Does Medicare Pay for Home Caregivers?

Tue, 27 Dec 2022 23:07:11 GMT

In the United States, millions of people rely on in-home aid to perform their daily tasks. But does Medicare pay for home caregivers and their services? The short answer is yes, but there are a few key details to keep in mind. Let’s take a closer look at what you need to know about using Medicare to pay for home caregivers.

What Services Does Medicare Cover?

Medicare does cover some helpful home healthcare services. These typically include part-time nursing care, at-home medical supplies, injectable osteoporosis drugs, and various medical therapies. Medicare may also cover the cost of care that assists with activities of daily living (ADL), but only if the patient also requires additional services. However, Medicare rarely covers the full cost of these essential services.

In general, patients can expect Medicare to cover about 80% of home caregiver services. To receive this coverage, a patient must qualify for Medicare Part A and Part B . They must also be under the care of a primary physician who’s certified them as homebound, and this physician must review their patient’s written healthcare plan regularly.

When it comes to home healthcare, Medicare Part A covers a wide variety of services such as nursing visits, physical therapy, occupational therapy, speech-language pathology services, medical social work services, and home health aide services. These services must be ordered by a physician and provided in the patient’s place of residence.

In addition to covering nursing and physical therapy visits at your home, Medicare also covers home healthcare aides who help with personal care and other related tasks. These aides may provide basic medical care such as changing bandages or taking vital signs if they’ve been trained and certified by the state.

Medicare Part B covers many types of outpatient care that don’t require a stay in a hospital or nursing facility. This includes doctor visits, diagnostic tests and screenings, preventive healthcare services such as vaccinations and flu shots, and durable medical equipment (DME) such as crutches, wheelchairs, and walkers.

Keep in mind that while both Medicare Part A and Part B may cover some costs associated with home caregivers, neither will cover the entire cost. You may still have out-of-pocket expenses that you need to pay yourself.

Additional Medicare Benefits

Medicare Advantage plans (Part C) may offer added benefits that traditional Medicare doesn’t. These often include vision coverage, hearing coverage, dental coverage, and prescription drug coverage.

In addition to these extra benefits, some plans may also cover certain types of home healthcare services such as skilled nursing visits or physical therapy sessions that aren’t covered by Medicare Part A or Part B. It’s important to check with your plan administrator to find out which options are available under your particular plan.

When Should I Use Home Caregiver Services?

Home caregivers are incredibly beneficial for anyone who’s unable to perform activities of daily living due to age or disability. If you find yourself needing assistance with everyday tasks like getting dressed or preparing meals but don’t require full-time care, then hiring a home caregiver might be the best choice for you.

Remember that if you choose this option, then you must understand which costs will and won’t be covered by Medicare. That way, you can plan accordingly when budgeting for your needs in the future.

Understand Your Coverage

Home caregivers provide invaluable assistance with their patients’ activities of daily living. Luckily, several types of home healthcare services are covered by both Medicare Part A and Part B under certain conditions. However, some out-of-pocket expenses must still be paid by the individual receiving care.

If you have questions about your Medicare coverage, then we encourage you to contact us today for a free consultation . We’ll gladly sit down with you and answer any questions about using Medicare benefits to cover your home healthcare needs.

Medicare Coordination of Benefits

Mon, 28 Nov 2022 16:38:30 GMT

It's important to understand how Medicare coordination of benefits works if you’re covered by Medicare and another healthcare plan. In short, this process outlines which insurer is responsible for paying first when there are overlapping benefits between them. Let’s take a closer look at this process, how it works, and what you need to know.

What Is Medicare Coordination of Benefits (COB)?

Medicare coordination of benefits (COB) applies when someone receives coverage from Medicare and another form of health insurance. Under COB rules, the secondary insurance coverage kicks in after the primary insurer pays its share. This often includes payments for deductibles, coinsurance, or copayments.

If the individual has Medicare and employer coverage, then Medicare will be primary when the employer has 20 or less employees. If the employer has more than 20 employees, then employer coverage is primary.

Other types of coverage such as Medicaid , TRICARE, Medigap, and retiree coverage from a former employer may also become the secondary payer. If you're unsure whether your other coverage is primary or secondary to Medicare, then you can always contact your benefits administrator.

How Coordination of Benefits Works

When you have two overlapping health insurance plans, each one has its own coordinator. The coordinators for each plan communicate with each other to figure out who should pay first. This process is known as coordination of benefits.

There are several things the coordinators will assess when determining who should pay first . For example, they'll look at who is considered the primary insurer under each plan. They'll also figure out whether one plan considers the other to be a secondary insurer. Ultimately, the coordinators will work together to decide which insurer handles which benefits.

Medicare-Covered Services

Typically, if you have Original Medicare ( Part A and Part B ) and another form of health insurance (such as through an employer), then both plans will cover medical services if Medicare is the primary payer. These services may include:

Preventive care: Screenings, vaccinations, and counseling to prevent illness or disease,
Diagnostic tests: X-rays, MRIs, and CT scans used to diagnose a condition,
Inpatient care: Care received while staying in a hospital overnight,
Outpatient care: Services received outside of a hospital setting (e.g., at a doctor's office),
Emergency care: Treatment received for acute conditions that require immediate attention,
Other medically necessary services: Any services necessary to treat an illness or injury that meet certain standards set by Medicare, and
Durable medical equipment: oxygen tanks, wheelchairs, walkers, and other forms of mobility assistance.

What Does Coordination of Benefits Mean for You?

The specifics of your COB will differ depending on your unique situation. However, there are a few key things to keep in mind. For one, you usually won’t have to pay anything out of pocket if you see a doctor who accepts assignment from Medicare.

This means the doctor agrees to accept the Medicare-approved amount as payment in full. Remember that you’ll still be responsible for any deductibles or copayments required by your supplemental insurance policy.

In some cases, you may also need to submit a claim form to your supplemental insurer for reimbursement for covered services. Be sure to check with them ahead of time to find out what their claims process entails. This will ensure there are no surprises when you get your final bill.

We're Always Here to Help

Medicare and coordination of benefits can both be confusing. However, by recognizing how the process works and what your coverage is, you’ll rest assured that your claims are correct and you're getting all the benefits you deserve.

If you have any questions about Medicare , coverage options , or coordination of benefits, then please feel free to give us a call , reach out via email , or send us a message online . We’re always available to answer your questions and provide one-on-one support whenever you need it.

Getting Ready for Medicare Open Enrollment

Fri, 28 Oct 2022 17:45:45 GMT

It's that time of year again! Medicare open enrollment is upon us, which means it's time to review your coverage and make sure you're getting the best plan for your needs. Whether you're new to Medicare or have been enrolled for a while but feel like you could use a refresher, then this post is for you.

Open enrollment is the yearly period when people who are already enrolled in Medicare can make changes to their coverage. Here are a few tips to help you prepare for open enrollment and make the best decision for your health and your wallet.

1. Keep Track of the Open Enrollment Window

Medicare open enrollment runs from October 15th to December 7th every year. Mark these dates in your calendar so you don't miss the deadline to make changes to your coverage. If you need to make changes after December 7th, then don't worry! There may be other opportunities to modify your coverage during the year.

2. Review Your Current Coverage

Take some time to sit down and review your current Medicare coverage. Which parts of your current plan do you love? Which parts do you wish were different? Jot down a list of pros and cons to help you evaluate different plans during open enrollment.

Think about how your healthcare needs and budget have evolved in the last year. Even if your health and finances haven’t changed much, your plan might have. Read through the Annual Notice of Change letter your carrier sent to see if your current policy still meets your needs.

3. Compare Plans

Once you know what you're looking for in a Medicare plan, it's time to start comparing different options . If you’re not sure where to start, then Senior Insurance Advisors will gladly help you compare plans and find the best one for your needs. Relying on the expertise of a licensed agent will help you understand your options and feel confident in your decision.

4. Make Your Changes

If you decide to switch plans during open enrollment, the process is pretty simple. After you’ve compared plans with an advisor or through our comparison portal , then you can enroll in a new plan as soon as you’re ready. Your new coverage will take effect January 1st of the following year. Once you've made your selection, be sure to cancel your old plan so you don't end up paying for two sets of coverage.

If you're happy with your current coverage and don't want to make any changes, then that's great! All you’ll need to do during open enrollment is make sure your contact information is up to date. This way, both CMS and your carrier have accurate records of where to send your bills and correspondence.

Taking some time to review your current coverage and compare plans before making any decisions means you can be sure you're getting the best possible deal on your Medicare coverage. If you need any assistance along the way, then we can help! Simply give us a call or send us a message to set up your no-cost consultation and get on the path towards your perfect policy today.

CMS Compliance Updates at Senior Insurance Advisors

Mon, 03 Oct 2022 20:26:14 GMT

We’re always looking for ways to better serve our clients! Recently, that has included a couple of small administrative changes to keep us aligned with new CMS compliance requirements. Most of these will have a limited impact on our working relationships, but we want to keep you in the know about everything we do. Here's an overview of the updates and what they mean for you as a Medicare enrollee.

Phone Calls

If you have us saved as a contact in your phone, then you’ll want to update it with our new phone number! Dana is now available at 402-673-6950 if you need to call or text about your coverage or set up an in-person meeting. Some of our calls may need to be recorded moving forward, too. You’ll also hear or see a disclaimer about the plans we offer in your area. This has always been true for Senior insurance Advisors, and if you’re an existing client, we’ve probably talked about it before! CMS is simply having us standardize the wording all advisors use so they can ensure the same level of quality communication we have always offered.

Online

In addition to the plan offering details you’ll hear on the phone, you’ll also notice some new language on our website and in our emails. This is also information that has always been true, just communicated in a more standardized way! We’re here to help you understand your Medicare options overall and can help you select the perfect plan from the variety of carriers we partner with. While we may not sell every single plan available in your area, our partnerships and advice can still help you find coverage that will fit your unique needs.

Why Did CMS Change Their Requirements?

In short, the Centers for Medicare & Medicaid Services (CMS) have made these changes to protect Medicare recipients. We’ve always worked to help our clients understand their options when it comes to Medicare, so these CMS compliance updates are a natural extension of how we’ve always operated. Having a standardized set of information across all independent agents offering Medicare advisement helps every Medicare enrollee in the long run.

What Does This Mean for Me?

Aside from updating your saved contact, you don’t have to make any changes in how you work with us! As we come up on the Annual Enrollment Period, you’re still able to keep your existing coverage or explore other options that may be a better fit for your insurance needs. If you have any questions about your plan at any time, then please feel free to give us a call. You can expect the same great service and advice you’ve always received.

Whether you’re new to Medicare or have had coverage for years, we’re here to help! Our services are always offered at no cost to you, from one-on-one meetings to the informational content we post in our blog . We encourage you to reach out if you have questions about the Medicare enrollment process or your current coverage.

Medicare MSA Plans

Thu, 18 Aug 2022 20:11:16 GMT

Some private insurance companies offer health care coverage through Medicare Medical Savings Account (MSA) Plans. Similar to a Health Savings Account (HSA), a MSA allows enrollees to pay for healthcare costs through a dedicated savings account. These unique plans can help protect you from high health care costs and give you control over your health care spending.

What Is a Medicare MSA Plan?

Medicare MSAs are paired with a high-deductible Medicare Advantage policy. This combination is designed to allow enrollees to use their MSA to pay for health care expenses until they meet their deductible. Medicare Part A and Part B expenses you pay for with your MSA and out-of-pocket both count towards your yearly deductible. After you reach your deductible, your Advantage Plan will pay for your Medicare-covered health care expenses.

Some Medicare MSA Plans also include coverage for health care services like hearing, vision, or dental. Check with your carrier or reach out to one of our Medicare advisors to learn more about these kinds of coverage. While these monthly premiums are optional, all MSA Plan enrollees are responsible for their monthly Part B premium .

How MSA Plans Work

Your plan receives funding from Medicare, which they then deposit into your Medical Savings Account. These funds are deposited the first month your coverage begins, and then at the beginning of each calendar year. Both the amount of money provided for your MSA and your deductible will depend on the carrier and plan you choose.

If you have funds left in your MSA at the end of the year, that money rolls over into the next year. Your annual deposit will not be decreased if you have funds rolling over from a previous year. One key difference between a Medicare MSA and non-Medicare HSA: you as an individual cannot make deposits into the savings account. If your MSA account balance reaches zero and you have not met your deductible, you will have to pay out of pocket for your healthcare expenses until your deductible is met.

Managing Your MSA

While Medicare MSA Plans offer a lot of flexibility, you are responsible for managing how the funds are spent. Only expenses normally covered by Medicare Part A and B will count towards your Medicare Advantage Plan deductible. You can use your MSA to pay for expenses outside of these categories, but they will not bring you closer to reaching your deductible. This includes using your MSA for prescription drug copayments.

Be sure to keep record of the health care expenses you pay for with your MSA. You will receive a form from your plan at the end of the year to file with your taxes. It’s up to you to provide documentation that the MSA funds were used for Qualified Medical Expenses . If you use MSA funds for non-qualified expenses, those amounts will be counted as part of your annual income and taxed accordingly. You may also face additional tax penalties for using MSA funds for non-medical expenses.

If you’re considering a Medicare MSA Plan, we’d love to hear from you ! You can also view the policies available in your area through our enrollment portal . A Senior Insurance Advisors agent can help you find the right coverage for your unique budget and healthcare needs. Our consultations are available at no cost to you and we’re proud to provide ongoing support to all of our clients.

Does Medicare Cover International Travel?

Tue, 26 Jul 2022 17:12:05 GMT

While Medicare can cover many health expenses stateside, there are limited opportunities for coverage while you’re traveling. Understanding Medicare’s rules is an important part of preparing for your next international trip. Everyone’s circumstances are unique, but we’re covering some of the more common travel questions our clients ask.

What Counts as International Travel?

Just being outside of the fifty states doesn’t necessarily mean your Medicare plan won’t cover your healthcare expenses. Medicare considers U.S. territories like Puerto Rico, Guam, and the U.S. Virgin Islands to be a part of the United States. If you need medical care while traveling to these destinations, you’ll still need to make sure that your provider accepts Medicare. If they don’t, you will be responsible for 100% of the costs you incur for treatment.

What About Cruise Ships?

Medicare Part B may pay for some medically necessary services while you are on a cruise ship. To be eligible, the ship must either be docked at a U.S. port or be at sea fewer than 6 hours from a U.S. port. If your ship is beyond this 6-hour mark, you are financially responsible for any care you receive onboard.

Does Medicare Cover International Purchases of Prescription Drugs?

In short, no. If you travel outside of the U.S. and fill a prescription, Medicare will not cover that cost. Be sure to pack enough of every prescription you take when you travel to avoid any unexpected expenses. It’s also a good idea to bring along extra medication in case your travel plans are delayed.

What If I Need Emergency Medical Attention While Traveling?

Certain Medicare Supplement Plans do cover some emergency care coverage while you travel internationally. A few important points about Medigap emergency travel coverage:

Not all plans are currently available
The care you receive must begin within 60 days of leaving the U.S.
Original Medicare must not cover the care under normal circumstances
You are responsible for a $250 deductible and 20% of the medically necessary emergency care

Before you travel, contact your carrier to confirm how your specific plan handles medical emergencies while you’re traveling.

Original Medicare may also cover some emergency expenses while you travel in a few rare cases . It is up to you to prove to Medicare that your medical care fell under one of these exceptions, as well as to submit an itemized invoice to Medicare for the services you received. Medicare will only pay for expenses in these circumstances that would normally be covered by your Original Medicare plan.

How Do I Make Sure I’m Covered When I Travel?

Travel medical insurance is the best way to avoid unexpected out of pocket healthcare expenses while you travel internationally. Not all travel insurance plans cover medical costs, be sure to double check the specifics of the policy before you purchase. Senior Insurance Advisors can help you find additional coverage for peace of mind while you travel. Selecting a plan in advance will also help ensure you don’t go without coverage if your policy has a waiting period.

A medical emergency is the last thing any of us wants to experience while traveling, but being prepared is essential. Knowing what Medicare will and won’t cover while you’re on your trip will help you make the best decision about purchasing additional coverage. We’re here to answer any questions you may have about Medicare and your upcoming travel plans, and we’d love to hear from you !

What Is a Medicare Special Enrollment Period?

Fri, 01 Jul 2022 15:17:01 GMT

A Medicare Special Enrollment Period (SEP) provides an opportunity to change your Medicare coverage when your life changes significantly. Your unique situation determines what Parts of Medicare you can change and how long you have to do so. Unlike most other Medicare Enrollment Periods , SEPs generally do not fall during a set time of year. We’ve chosen to highlight some common life changes that can result in Special Enrollment Period eligibility.

Qualifying Life Events While Already Enrolled in Medicare

For people already enrolled in Medicare, a qualifying life event provides a chance to change your Medicare Advantage or Part D prescription drug plan. You may be eligible to make changes under a Special Enrollment Period if you move, your plan’s contract changes with Medicare, or you have an opportunity to enroll in coverage other than Medicare. Qualifying life events most commonly initiate a 2-month Special Enrollment Period. Your Medicare advisor will be able to confirm both when you enter an SEP and how long you have to make changes to your coverage.

Joining Medicare After Losing Creditable Employer Coverage

If you worked past age 65 and delayed Medicare enrollment due to creditable employer coverage, you are eligible to enroll in Medicare during a Special Enrollment Period. You have 8 months from when you leave your job or your employer ends your creditable coverage to enroll in Original Medicare.

Decisions about joining a Medicare Advantage Plan or enrolling in Part D prescription drug coverage, though, must be made in the first 2 months from your loss of employer coverage. This smaller, 2-month window also applies to people whose employer coverage was previously creditable but isn’t any longer. Delaying enrollment in Medicare Advantage or Part D coverage can result in late enrollment penalties.

How Assistance Programs Impact Medicare SEPs

If you are enrolled in a State Pharmaceutical Assistance Program (SPAP), you may enroll in Medicare prescription drug coverage through an SEP once in a calendar year. This can be either a standalone Part D plan or through a Medicare Advantage Plan. Losing eligibility for your SPAP assistance also opens up this one-time Special Enrollment Period.

Medicare enrollees who also receive Medicaid can change their Medicare Advantage or Part D prescription drug coverage once during each of the Special Enrollment Periods that run from January to March, April to June, and July to September. If you are dual-eligible and lose your Medicaid eligibility, you have a separate 3 month SEP to add, switch, or drop parts of your Medicare coverage.

Similar to Medicaid recipients, Medicare enrollees who qualify for Extra Help have access to Special Enrollment Periods throughout the year. If you’re receiving Extra Help, you can make changes to your Medicare prescription drug coverage during the same quarterly SEPs from January to September of each year.

We can help you understand your options during a Special Enrollment Period so you’re never without the right coverage. When you’re ready, reach out by phone or send us a message . Our trusted advisors are here year-round to let you choose your Medicare coverage with confidence.

The Difference Between Medicare and Medicaid

Thu, 19 May 2022 20:48:14 GMT

Many of the clients we help ask us about the difference between Medicare and Medicaid. Both help to cover the cost of healthcare expenses, but they do this in different ways. The differences in eligibility, cost, and coverage are especially important to understand for people who may qualify for both programs.

Who is eligible?

For most people, Medicare eligibility begins at age 65. Individuals who receive disability benefits can be eligible for Medicare Parts A and B before turning 65. While you can qualify for lower Part B premiums or Extra Help based on your income, it is not a deciding factor in your overall Medicare eligibility .

Medicaid eligibility varies slightly from state to state . For states without expanded coverage, you may be eligible for Medicaid based on factors like limited income, disability, and household size. People living in states with expanded Medicaid coverage can qualify based on their income alone.

What about dual eligibility?

Some people are eligible for both Medicare and Medicaid coverage. This isn’t the case for everyone, but dual-eligible individuals sometimes see an overlap in what each program covers. In these instances, Medicare pays first and Medicaid will pay towards any remaining balance. The combination can be especially helpful for people who would otherwise have difficulty paying for their healthcare.

What are the expenses?

Medicare Part A is provided at no monthly cost when enrollees have worked and paid US taxes for at least 10 years. Other types of Medicare coverage do come with a monthly premium. This monthly cost can depend on your income and the type of coverage you’ve chosen. Like private insurance, Medicare plans also have deductibles. You can easily compare Medicare plans to find coverage that meets your needs and budget.

Because the program is designed for people with limited resources, the cost of Medicaid is generally very low. States make decisions individually on how much Medicaid enrollees must pay in monthly premiums and out of pocket costs for their care. There are also select groups and services that are exempt from out of pocket costs entirely.

How is coverage provided?

Medicare is a federal health insurance program, but the government does not directly provide your coverage. Instead, private insurance carriers offer insurance plans that meet the requirements that Medicare has set. You must apply during a Medicare Enrollment Period to receive coverage.

Medicaid coverage comes from a partnership between the state and federal government. Private insurance carriers do provide coverage for some Medicaid programs, but other programs pay your provider directly. Unlike Medicare, you can apply for Medicaid coverage at any time .

What services are covered?

Medicare can cover a variety of hospital, medical, and prescription drug costs. The specific covered services largely depend on the type of plan you’ve chosen. Insurance companies that offer Medicare coverage must meet certain basic coverage requirements, but some offer extra benefits like vision, hearing, and dental. Hospital indemnity insurance is also available to cover expenses you incur during a hospital stay.

Like Medicare, Medicaid programs are federally required to cover certain health expenses . These include hospital services, labs and imaging, and family planning services. States can choose whether to offer additional benefits like prescription drug coverage, physical/occupational therapy, and vision services. Medicaid also covers nursing home and personal care services, something Medicare usually does not.

Just like any other health insurance, simply having coverage doesn’t guarantee you’ll be able to see a particular provider. Doctors are not required to accept Medicare or Medicaid for services they provide. Be sure to confirm that your coverage is accepted by a provider ahead of time to avoid unexpected out of pocket costs.

Senior Insurance Advisors can help at any step in your insurance journey. Whether you’re new to Medicare or have seen your supplement plan rates change , we’re here for you! We’ll listen to the kind of coverage you’re most likely to need and confirm what programs provide the best match for your unique situation. Give us a call or attend an upcoming event to put our expertise to work for your health.

What Is Hospital Indemnity Insurance?

Tue, 26 Apr 2022 21:08:25 GMT

Hospital indemnity insurance policies provide cash benefits for each day of a qualifying hospital stay. The coverage is flexible and goes a long way in providing peace of mind for Medicare enrollees and their families. Just like any other health insurance plan, you’ll pay a monthly premium for your hospital indemnity coverage based on the options you choose. This premium won’t increase based on your age, making hospital indemnity insurance a popular choice for Medicare enrollees on a fixed income.

About Cash Benefits

When you purchase a hospital indemnity insurance plan, you choose the number of covered days and the dollar amount you’d like to receive per day. Some plans pay out in a lump sum once your hospital stay has ended. Others disburse your benefits on a monthly basis. Understanding your payment schedule is an important part of choosing the plan that’s right for you.

These cash benefits can help pay for hospital expenses your primary Medicare plan doesn’t pay for. Many of our Medicare Advantage plan holders choose to add hospital indemnity insurance coverage, too. The extra cash from the hospital indemnity plan prevents them from having to dip into their savings during a hospital stay.

Even if most of your medical expenses are covered, a hospital stay can take a toll on your finances. Hospital indemnity benefits can be spent wherever you need. This gives you the ability to keep up with your bills and household expenses while protecting your hard-earned savings. Your policy resets 60 days after you’re released from the hospital to help cover any future hospitalizations.

What does a hospital indemnity plan cover?

In general, the most basic hospital indemnity insurance plans cover inpatient hospital stays for physical or mental health needs. This extends to days spent in intensive or critical care, too. You can add extra coverage to the plan depending on your needs. These add-ons can be summed up in categories based on when and where they happen in relation to the typical covered days:

Before a hospitalization: Urgent care visits, ambulance rides, emergency service
During inpatient care: Transportation and lodging costs, extra coverage due to a cancer diagnosis
After a hospitalization: Days spent in a skilled nursing facility, chiropractic care, physical therapy
During outpatient care: Observational stays in the hospital, outpatient surgeries

Who should have hospital indemnity insurance?

A hospital indemnity insurance plan could be right for you if you’re not sure you could afford the cost of a hospitalization. Even relatively short hospital stays can quickly add up to tens of thousands of dollars . Are you enrolled in a Medicare plan with a high deductible or maximum out-of-pocket amount? Hospital indemnity insurance may be able to help!

Medicare enrollees with conditions that require frequent hospital stays are usually good candidates, too. Don’t wait until you’re facing a surgery or hospitalization to enroll in hospital indemnity insurance. Policies can sometimes have waiting periods before you’re eligible to receive benefits.

We encourage you to reach out if you have questions about hospital indemnity insurance. You deserve to know that your savings are protected even if you’re hospitalized. No matter your need, we’ll help customize coverage that’s right for you. You’re also welcome to attend our free informational sessions around Lincoln!

How We Help with Medicare Enrollment

Fri, 25 Mar 2022 15:46:18 GMT

When you need Medicare enrollment help, you can count on Senior Insurance Advisors. We’re proud to offer Medicare help for seniors through a variety of channels. We offer trusted advice, no-cost support, and an easy way to purchase your perfect policy.

Expert Guidance

There are lots of places you can get information about Medicare, but a licensed agent is your best bet. The Senior Insurance Advisors team is licensed in 10 states! We have the years of experience to help you find the best coverage at the best price. We’re also well versed in programs that can help you get the most out of your coverage. If we believe you may qualify for Extra Help or a Dual Eligible Special Needs Plan , we will help you navigate that choice, too.

We want everyone we interact with to feel informed and empowered when choosing a Medicare plan. It’s easy to become overwhelmed when you go it alone, but Senior Insurance Advisors is with you every step of the way. We’ll take the time to listen to all of your questions and make sure you fully understand your options.

Free Resources

We gladly provide Medicare help for seniors in many ways. The best part? All of these are available at absolutely no cost to you! Dana regularly hosts Medicare seminars for the public , as well as for employers to educate their team.

One of our most loved resources is the personalized consultation. You’ll meet with an agent one-on-one to go over your unique Medicare needs. Our clients consistently leave us amazing reviews about how much this dedicated time and attention helped them out.

Our blog is another great way to get free information. Some of our top viewed updates include:

If you’re not ready for a deep dive just yet, we’ve still got you covered! Our whole website is designed to provide you with access to free information any time, from anywhere. You can start with the basics if you’re new to Medicare , or check out details on specific Medicare products .

Convenient Shopping Portal

We also help with Medicare enrollment by providing an easy way to compare Medicare plans. Our shopping feature is helpful both for first time enrollees and our clients who already have Medicare coverage. Carriers can change policy specifics and pricing from year to year. Additionally, your personal situation may have changed since you last selected a plan. Comparing plans is one of the best ways you can make sure you have the best coverage at the best price. You can see multiple options at once, filter the results by your needs, and even check out directly through the website.

If you’re an employer, someone who needs coverage, or helping a family member enroll in Medicare, we can help! We’re committed to simplifying Medicare however we can. Come see Dana at Stauffer’s soon, or reach out to an agent directly. We’ll promptly respond to your request and get you on your way to great coverage and total peace of mind.

Why do Medicare Supplement Rates Change?

Wed, 23 Feb 2022 14:48:54 GMT

While each carrier is different, many people see their Medicare Supplement rates increase annually. Our clients rely on these plans to help pay out-of-pocket costs that Original Medicare doesn’t cover. There are a number of factors that play into your monthly premium. Your Medicare Supplement plan cost can be impacted by inflation, number of claims made, and even your age. It’s also important to understand the type of plan you’re in to know how your rates might change year to year.

Medicare Supplement plans are standardized, which means that all carriers must offer the same benefits within a letter-designated plan . Insurance companies, though, don’t have to charge the same monthly premium for the same coverage. Shopping for a policy is one of the best ways to make sure you’re not paying too much for your coverage.

Types of Plans

There are three different ways that insurance companies calculate the cost of their Medicare Supplement plans:

1. Community-rated

In this type of plan, everyone generally pays the same amount for their coverage. Community-rated plan premiums do not increase as you age. Changes in your health status will not impact your rates, either. Some states only allow for community-rated plans to help mitigate the impact of increased Medigap premiums on people over 65.

2. Issue-age-rated

The cost for an issue-age-rated plan will not increase as you get older. Instead, your premium depends on your age when you first enroll in this kind of Medigap coverage. If you choose this type during your Medicare Supplement Open Enrollment Period , you keep the initial rate for as long as you have the plan.

3. Attained-age-rated

Premiums for attained-age-rated plans increase as you get older. You will start off at a lower premium but can expect them to go up every year. The premium can also increase even more based on how your insurance company’s costs change.

Increases Possible for All Plan Types

For all plans, it’s important to consider a carrier’s requirements for enrollment. Some plans offer more lax health requirements to attract more people in need of coverage. This can result in a higher percentage of less healthy people enrolling in the plan. When more people make claims towards the plan, everyone who holds that policy will see premium increases.

Your monthly premium can also be impacted by where you live, your gender, and whether you use tobacco. This is the case even for community-rated plans. Depending on when you enroll in a Medigap plan, your overall health can also play a part in how much you pay every month.

If you are paying more than $150 a month for your Plan F or Plan G coverage, let us know ! Our Medicare experts will get to work finding you the best coverage at the best price. As an added bonus, all of our consultations are offered at no cost to you. We’d also love to have you attend one of our upcoming events if you have questions. Our casual seminars are also free to attend and provide valuable information on how to navigate all of your options.

A Guide to Medicare Dual Eligible Special Needs Plans (D-SNPs)

Fri, 21 Jan 2022 17:50:10 GMT

A Medicare Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage Plan that is only available to a specific subset of Medicare enrollees. More broadly, Special Needs Plans (SNPs) provide coverage to people with specific diseases or circumstances. Dual Eligible Special Needs Plans are set up to help ensure that people experiencing financial hardship have access to the medical care they need.

What is a Dual Eligible Special Needs Plan?

A Medicare D-SNP is available to people who have both Original Medicare and Medicaid. You must maintain your eligibility for both of these programs to stay enrolled in a D-SNP. Not all carriers or regions offer Dual Eligible Special Needs Plans, so check with an expert if you think you may be eligible for enrollment.

Losing your Medicaid eligibility means you will be disenrolled from the D-SNP. After your eligibility lapses, you have a grace period before your coverage ends to reestablish that you meet Medicaid’s requirements. Medicare requires that this grace period lasts at least a month, though some plans may have a larger window.

If you are not able to re-enroll in Medicaid, you aren’t out of options! You enter a Special Enrollment Period (SEP) when you receive notice that you are no longer Medicaid eligible. The SEP runs through your D-SNP’s grace period, and for 2 months after your coverage ends if you are unable to re-enroll. During this time, you can shop for another plan to make sure you are never without coverage.

Medicare Part B: Medical Insurance

Medicare Part B covers doctor visits and outpatient care, including:

Doctor visits, including when you are in the hospital

Diabetes screenings, education, and certain supplies

An annual wellness visit and preventive services, like flu shots

Mental health care

Clinical laboratory services, like blood and urine tests

Durable medical equipment for use at home, like wheelchairs and walkers

X-rays, MRIs, CT scans, EKGs and some other diagnostic tests

Ambulatory surgery center services

Some health programs, like smoking cessation and obesity counseling

Ambulance and emergency room services

Physical therapy, occupational therapy and speech-language pathology services

What Benefits do D-SNPs Provide?

Dual Eligible Special Needs Plans cover the same care as Medicare Advantage Plans . This includes hospital insurance, medical insurance, and prescription drug coverage. D-SNPs also provide additional benefits at no cost to you like dental, vision, and hearing care. Since these plans are designed for people with limited financial resources, most healthcare costs are covered between the Original Medicare and Medicaid components.

Individuals enrolled in D-SNPs also receive benefits to offset the cost of everyday necessities. Some plans offer up to $165 a month in over-the-counter medicine and healthy food allowances. This benefit is designed to help enrollees buy essential health and grocery items. In addition, there are D-SNPs that include flex spending cards for dental, vision, and hearing costs not specifically covered by the plan.

What is a Care Coordinator?

Another benefit provided by D-SNPs is a care coordinator. These skilled professionals work to help you access all of the resources available to you. It can be tough to navigate the benefits you receive through Medicare and Medicaid, not to mention other programs within your community. The care coordinator’s goal is to keep you informed and help you make the best use of these services. Taking advantage of every healthcare benefit at your disposal is a great way to keep you in the best health possible!

Not everyone needs a Dual Eligible Special Needs Plan, but this kind of coverage is incredibly valuable for those who need it. If you have Medicaid and will soon be eligible for Medicare coverage, we’d love to hear from you ! Senior Insurance Advisors will always work hard to make sure you understand your options and empower you to make the best decisions for your Medicare coverage.

What Is The Medicare Part D Donut Hole? Coverage Gap Explained

Mon, 20 Dec 2021 14:33:26 GMT

Prescription drugs are an essential for many people covered by Medicare. What you pay for your medications may vary through the year as you move through the different coverage stages of Medicare Part D. The second to last stage of coverage is known as the Coverage Gap or Donut Hole. While you still have some coverage in this stage, it’s important to understand the limitations to avoid unexpected out-of-pocket costs.

What is Medicare Part D?

Medicare Part D provides coverage for your prescription medications. These plans can be added on to Original Medicare or purchased as part of a Medicare Advantage Plan. The drugs that are covered can vary plan to plan, but Medicare does require all carriers to cover a wide range of medications that enrollees are likely to need. These formulary lists include most drugs in protected classes , like those use to treat seizures and cancer.

Prescription drugs are usually categorized into different tiers. Medications in Tier 1 come at the lowest cost to you, while higher tiers are more expensive. The dividing lines between tiers are unique to each plan, but the general idea is the same. Tier 1 drugs commonly consist of generic prescription medications. Higher tiers include brand-name prescriptions and medications used to treat complex or rare medical conditions.

Medicare Part B: Medical Insurance

Medicare Part B covers doctor visits and outpatient care, including:

Doctor visits, including when you are in the hospital

Diabetes screenings, education, and certain supplies

An annual wellness visit and preventive services, like flu shots

Mental health care

Clinical laboratory services, like blood and urine tests

Durable medical equipment for use at home, like wheelchairs and walkers

X-rays, MRIs, CT scans, EKGs and some other diagnostic tests

Ambulatory surgery center services

Some health programs, like smoking cessation and obesity counseling

Ambulance and emergency room services

Physical therapy, occupational therapy and speech-language pathology services

What is the Donut Hole?

The Donut Hole is a temporary restriction on how much your plan can pay for your prescription drugs. This takes effect after your total prescription drug costs meet the initial coverage limit for the year. In 2022, the initial coverage limit is $4,430. You will pay up to 25% of the total cost for a covered drug while in the Donut Hole stage. You exit the Coverage Gap once you reach $7,050 in prescription costs for 2022.

What Expenses Count Towards the Coverage Gap?

Medicare counts your plan’s deductible, coinsurance, and copayments toward the initial coverage limit. For people whose Medicare Part D plans have a $0 deductible, only the amount you pay towards your covered prescriptions moves you towards the Donut Hole.

Your monthly Part D premium is not factored into your annual spending totals. Expenses for drugs not covered by your plan also do not count. This applies both to drugs that are excluded from your plan’s formulary, as well as those that Medicare does not allow any of their providers to cover.

What if I Receive Extra Help?

Part D Extra Help is designed to offset the cost of prescription drug coverage for Medicare enrollees with limited income. This program lowers the cost that recipients pay for their prescription drugs. People who receive Extra Help are very unlikely to spend enough on their medications in a year to enter the Donut Hole.

Understanding how the Donut Hole works allows you to make educated decisions about your prescription drug spending. One of the best ways to make sure you plan for Coverage Gap expenses is to choose a Medicare Part D plan that is the best fit for you. You can shop plans on your own, or take advantage of our free consultations ! You can trust the experts at Senior Insurance Advisors to help you find the best coverage for your needs and your budget.

Medicare Part B - The Basics

Wed, 24 Nov 2021 14:47:09 GMT

Medicare Part B is the elective coverage offered under Original Medicare. The medical insurance offered by Part B complements the expenses that Part A does not cover. To help you assess whether this type of insurance is right for you, we have outlined some of the basic information about the covered expenses, eligibility, pricing, and other considerations for Medicare Part B.

Coverage

Medicare Part B covers the cost of many kinds of medical appointments. This includes annual wellness visits, doctor’s visits, and physical therapy sessions. Prescription drugs you are given in a clinical setting are also covered by a Part B policy. While outpatient care expenses like wheelchairs and walkers are paid for through Medicare Part B, prescriptions you take at home are not. Part D prescription drug coverage is required for medications not administered at a hospital or other medical facility.

It can be tricky to identify which in-hospital expenses are covered by which part of your Original Medicare plan. The table below lists specific medical expenses that fall under Part B. It’s still a good idea to confirm with your insurance provider whether a particular piece of your health care falls under your Medicare Part B coverage if you aren’t completely sure.

Medicare Part B: Medical Insurance

Medicare Part B covers doctor visits and outpatient care, including:

Doctor visits, including when you are in the hospital

Diabetes screenings, education, and certain supplies

An annual wellness visit and preventive services, like flu shots

Mental health care

Clinical laboratory services, like blood and urine tests

Durable medical equipment for use at home, like wheelchairs and walkers

X-rays, MRIs, CT scans, EKGs and some other diagnostic tests

Ambulatory surgery center services

Some health programs, like smoking cessation and obesity counseling

Ambulance and emergency room services

Physical therapy, occupational therapy and speech-language pathology services

Medicare Part B: Medical Insurance

Medicare Part B covers doctor visits and outpatient care, including:

Doctor visits, including when you are in the hospital

Diabetes screenings, education, and certain supplies

An annual wellness visit and preventive services, like flu shots

Mental health care

Clinical laboratory services, like blood and urine tests

Durable medical equipment for use at home, like wheelchairs and walkers

X-rays, MRIs, CT scans, EKGs and some other diagnostic tests

Ambulatory surgery center services

Some health programs, like smoking cessation and obesity counseling

Ambulance and emergency room services

Physical therapy, occupational therapy and speech-language pathology services

Eligibility

Since Part B is a component of Original Medicare, the eligibility requirements are largely the same as those of Part A . Most Medicare Part B enrollees must be aged 65 or older and have lived continuously in the United States for the past 5 years. Individuals with end stage renal disease (ESRD), ALS/Lou Gehrig’s Disease, or who are receiving disability payments may be eligible for Part B coverage before the age of 65. To confirm your eligibility, schedule a free consultation with a Senior Insurance Advisors expert or visit the Medicare website’s eligibility questionnaire .

Cost

Many people do not have to pay a premium for their Part A coverage, but everyone must pay for Part B coverage if they choose to carry it. In 2022, the standard monthly premium for Medicare Part B totals $170.10 . This number may vary based on your income and can be adjusted if your financial situation or life changes significantly. People who file amended tax returns or experience a qualifying life-changing event can appeal their Part B premium determination.

If you are married, your joint income is used to calculate your monthly premium. It’s important to note, however, that each spouse is responsible for paying their own Part B premium separately. For your convenience, the Social Security Administration and Railroad Retirement Board automatically deduct your Part B premiums from your monthly checks. If you are not receiving benefits from either of these agencies, your provider will simply send a bill every 3 months.

Employment Considerations

Generally, there is a penalty assessed for enrolling in Medicare Part B outside of your Initial Enrollment Period at age 65. If you are still working at the time of your IEP, you may be concerned about having to choose between higher Part B premiums later in life and keeping the health insurance coverage offered by your employer. Medicare does make an exception for people who are still working at 65 to avoid penalizing late enrollees unnecessarily.

It’s important to confirm whether your policy is considered creditable health insurance or not. If you are employed at the time of your IEP and hold a qualifying policy through your employer, you will not be assessed any financial penalties when you do finally enroll in Medicare Part B. In fact, Medicare offers an 8-month Special Enrollment Period for Part B coverage that begins when you stop working or otherwise lose employer-provided coverage.

At Senior Insurance Advisors, we know you have important decisions to make when it comes to Medicare Part B, or any other component of your health insurance. We strive to be your trusted partner in all things Medicare. We encourage you to reach out with any questions you may have! We would love the chance to sit down and talk through your needs, at absolutely no cost to you.

How to Compare Medicare Plans

Fri, 22 Oct 2021 16:05:07 GMT

The Medicare Annual Enrollment Period is here! The AEP runs from October 15th through December 7th and provides a chance for people covered by Medicare to change or add to their existing plan. For many people, the task of comparing insurance plans can seem overwhelming. We are here to walk you through the aspects of your current plan to consider, outline the benefits of comparing Medicare plans, and even provide step-by-step instructions on how to use our convenient shopping portal .

Assessing Your Current Coverage

Three of the main Medicare plan features to take into account are the cost, coverage, and additional resources or benefits offered by your current policy. Take a look at your medical expenses over the past year. Include payments you made towards your plan’s monthly premium, deductibles, and out of pocket expenses like copays or prescription drug costs. If you feel that you are paying too much for your coverage, you might be! You can schedule a no-cost assessment with us to help you identify a plan better suited for your budget and coverage needs.

The AEP is also a good time to check into how your healthcare and prescription drug needs have changed over the last year. A plan that was a perfect fit 12 months ago may no longer be right for your current situation. If you have started taking new medications, changed healthcare providers, or experienced another change in your health, the AEP provides a chance to bring your coverage and your needs back into alignment.

Benefits of Comparing Medicare Plans

Every year, new carriers enter the Medicare market. These additions provide a wider variety of plans to choose from than the previous year. Premiums on Medicare Supplement Plans also go up year over year. You may find that the annual out of pocket cost for a Medicare Advantage Plan is less than your previous total yearly premium! Advantage plans are also likelier to include vision and dental benefits, as well as prescription drug coverage. These factors combined go to show that choosing your Medicare plan isn’t a one-time event for most people.

If you don’t look into the newer options available to you, you might miss out on your perfect plan. Comparison shopping your coverage is a win-win for anyone covered by Medicare. Deciding to switch plans can lead to more comprehensive coverage, better benefits, or more money in your pocket. Even if you check through your current plan and find that it’s still the right one for your needs, simply completing the research ensures that your budget and coverage are being well taken care of.

Steps to Compare Your Options

To start comparing the plans available to you, visit our shopping portal , enter your zip code, and click “View Plans” to see the options available in your area.

Once your list of options has populated, you can use the top tabs , dropdown menu , and filters to fine-tune the results that are displayed. You can organize the plans according to type, carrier, rating, and more!

From there, you can select plans you would like to compare by clicking the “Add to compare” checkboxes. Clicking Compare now takes you to a new page with an apples-to-apples comparison of up to 3 different options.

Senior Insurance Advisors is here to simplify Medicare. Everyone enrolled in Medicare deserves the peace of mind that comes with knowing that their plan is the best fit available. You can rely on our knowledge and expertise to make the most of this year’s Annual Enrollment Period. Whether you use the shopping portal to compare plans or schedule a free one-on-one with Dana to talk through your options, we are here to help!

Medicare Part A - The Basics

Thu, 23 Sep 2021 21:50:03 GMT

Medicare Part A is the Hospital Insurance component of Original Medicare. It frequently works in tandem with Part B to cover most hospital-related medical expenses. For some individuals, supplemental coverage may also be necessary to ensure the full range of their medical needs are insured appropriately. The starting point for making informed decisions about Part A insurance begins with understanding what Medicare Part A covers, who is eligible, and what you can expect to pay for your policy.

Coverage

Medicare Part A covers hospital stays and certain treatment expenses associated with inpatient care. It can also include some longer-term inpatient costs for hospice or home health care. Unlike some other parts of Medicare , Part A does not have policy-specific network or specialist restrictions. You can visit any doctor or hospital nationwide that accepts Medicare.

Some costs that seem like inpatient expenses are actually categorized as outpatient services, and therefore are not covered under Medicare Part A. The table below breaks down some of the healthcare charges that are covered, but it’s a good idea to check with your Medicare insurance broker if you are unsure whether a specific healthcare component falls under Part A.

Medicare Part A: Hospital Insurance

Medicare Part A covers hospital stays and inpatient care, including:

Your hospital room and meals

Skilled nursing services

Care in special units, such as intensive care

Some blood transfusions

Drugs and medical supplies used during an inpatient stay

Hospice care, including medications to manage symptoms and pain

Lab tests, X-rays and medical equipment as an inpatient

Part-time, skilled care for the homebound after a qualified inpatient stay

Operating room and recovery room services

Rehabilitation services after a qualified inpatient stay

Medicare Part A: Hospital Insurance

Medicare Part A covers hospital stays and inpatient care, including:

Your hospital room and meals

Skilled nursing services

Care in special units, such as intensive care

Some blood transfusions

Drugs and medical supplies used during an inpatient stay

Hospice care, including medications to manage symptoms and pain

Lab tests, X-rays and medical equipment as an inpatient

Part-time, skilled care for the homebound after a qualified inpatient stay

Operating room and recovery room services

Rehabilitation services after a qualified inpatient stay

Eligibility

Individuals wishing to enroll in Medicare Part A must meet several criteria to successfully obtain coverage. Generally, enrollees must be aged 65 or older and have held residence within the United States for at least 5 consecutive years before making an application for coverage. Other factors like receipt of disability benefits and medical conditions like ALS (Lou Gherig’s Disease) or End Stage Renal Disease can lead to coverage eligibility before an applicant actually turns 65. If you are unsure about your eligibility status for Medicare Part A, reach out to us or visit Medicare.gov’s Eligibility Calculator to establish your coverage options.

Cost

Many people receive Medicare Part A coverage without having to pay a monthly premium. If you or your spouse held a job where Medicare taxes were paid out for at least 10 years, you will likely fall into this group. If you do not meet this minimum contribution timeline, you have the option to purchase Part A coverage if you meet the age and residence requirements mentioned above.

For individuals previously covered under a premium-free Part A plan: if you’re going back to work and can get employer health coverage that is considered acceptable as primary coverage, you are allowed to drop Medicare and re-enroll again without penalties. If you drop Medicare and don’t have creditable employer coverage, you’ll face penalties when getting Medicare back.

HSA Considerations

Those who are eligible for free Medicare Part A coverage thanks to payment of Medicare taxes during their working years do not see the same kind of late enrollment penalty. While free coverage is undeniably a good thing, there are cases in which it is actually best to defer enrolling in Part A. One such instance is if you are eligible for enrollment due to turning 65 but are still a part of the workforce.

Working individuals who are contributing to a Health Savings Account (HSA) must have a 6-month period between their last HSA contribution and enrolling in Medicare Part A. Depending on the specifics of your HSA, it may be in your best interest to defer Part A enrollment. It is important to have an insurance expert weigh in these instances to make sure you are optimizing both your health insurance coverage and your budget.

There is much more to the potentially cost-free Medicare Part A than meets the eye. We understand that navigating the ins and outs of Medicare can be tricky, which is why we are here to help! If you have questions about Part A or any other Medicare component we have yet to cover, please drop us a line or give us a call . We also welcome all curious minds to attend our upcoming informational events . These informal gatherings are offered at no cost and a great way to learn more about Medicare. We look forward to seeing you!

Medicare Annual Enrollment Period FAQs

Thu, 12 Aug 2021 19:58:29 GMT

Enrolling in Medicare is just the first step in your health insurance journey! One of four annual enrollment opportunities, the Medicare Annual Enrollment Period provides a chance for Medicare enrollees to purchase additional coverage or make changes to an existing plan. We have guided many people through coverage modifications during the AEP and address several common questions we have heard along the way to help you make the best decisions for your own Medicare situation.

When is the Annual Enrollment Period?

Like the name implies, this enrollment period opens up once a year, every year. The AEP begins October 15th and all requested changes must be submitted by December 7th. Medicare plan modifications you make during the AEP take effect January 1st of the following year.

Who is the Annual Enrollment Period for?

Anyone enrolled in a Medicare plan can make changes to their coverage during the AEP. This enrollment period does not serve as a backup for people who need to start their Medicare coverage, and missed out on their Initial Enrollment Period (IEP). If you are a first-time Medicare enrollee, our Initial Enrollment Period Checklist lays out how to prepare for initiating your Medicare coverage.

What changes can I make to my policy?

The changes available to you during the AEP vary based on your current coverage. Depending on your existing Medicare plan, you can make changes like:

Switching from Original Medicare to a Medicare Advantage plan, or vice versa
Adding or removing prescription drug coverage within a Medicare Advantage plan
Joining or dropping a Part D prescription drug plan to/from Original Medicare
Choosing a different plan from your existing insurance carrier
Moving to a new Medicare Advantage plan

Do I have to modify my coverage every year?

If you are happy with your current Medicare plan, you are not required to change it during the AEP. In fact, many plans auto-renew January 1st for your convenience.

How do I decide if I need to make changes?

The AEP provides an opportunity for you to assess how your current Medicare coverage has served you over the past year. Think about things like your existing plan’s costs, your budget, how your health has changed, and whether your insurer will be making changes to your plan. Take time to review the Medicare & You handbook for the next coverage year if you have Original Medicare. Individuals enrolled in Medicare Advantage or Part D prescription drug coverage plans should keep an eye out for an Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC) document from your carrier.

After reviewing these annual disclosures, you may find that your insurer has a different plan better suited to your new healthcare needs, or that it is best to switch carriers entirely. Sometimes you can find a plan with the same coverage at a more affordable cost. The AEP is a great time to comparison shop for your best fit.

I missed the December 7th deadline—what now?

If you are enrolled in a Medicare Advantage Plan, you have another opportunity to make coverage changes during the Medicare Advantage Open Enrollment Period. The MAOEP runs from January 1st through March 31st of every year. Changes made to Medicare Advantage plans during this time period take effect on day 1 of the month following your modified enrollment. For other plan types, there are a few other enrollment period options available to you.

While the Annual Enrollment Period gives Medicare recipients a chance to modify their coverage, plan changes should not be taken lightly. Senior Insurance Advisors has the knowledge to help you make the most informed decisions about your Medicare needs, whether you are a Nebraska native or reside in another of our 8 licensed states. Contact us today to schedule a free, no-obligation consultation or join us at an upcoming community event !

Medicare Initial Enrollment Period Checklist

Wed, 28 Jul 2021 17:48:47 GMT

Many people approaching their 65th birthday know that they should be thinking about enrolling in Medicare but aren’t sure where to start. We know how daunting the process can be, so we have compiled a Medicare enrollment checklist for individuals who will soon be entering their Initial Enrollment Period.

1. Confirm Your Eligibility

People sometimes confuse their Social Security retirement age with their Medicare eligibility date. Whether you are retired or not, you become eligible for Medicare coverage at age 65. Individuals enrolling in Medicare must have lived in the United States for at least the 5 consecutive years preceding their enrollment application. If you meet this requirement and are also turning 65, you are eligible to apply for coverage during a Medicare Initial Enrollment Period (IEP).

2. Identify Your IEP

The Medicare Initial Enrollment Period is made up of a 7-month window. Your IEP consists of the month of your 65th birthday and the 3 months immediately before and after. For example, someone who will turn 65 in January of 2022 will have an IEP that extends from October of 2021 through April of 2022.

You should be mindful of your IEP for a couple of reasons. First, missing out on your IEP enrollment opportunity could result in a late enrollment penalty. This penalty can range from a one-time fee to a premium increase across the lifetime of your plan depending upon the types of Medicare coverage you carry. Second, your IEP is also the only time you can enroll in Medigap coverage without the requirement to provide health history information. A Medigap enrollment attempt outside of your IEP could result in an elevated premium or outright denial of coverage, depending upon an insurance provider’s assessment of your health history.

3. Gather Necessary Documents

Enrollment in Medicare requires verification of eligibility data such as your age, citizenship status, and work or military history. If you are already receiving Social Security benefits, retirement or otherwise, the Social Security Administration may already have some of this information on file. Even if this is the case, you should locate the following documents before your IEP:

Your birth certificate—a certified copy from the issuing agency is acceptable if you have misplaced the original
Proof of citizenship or permanent residency
Income statements from your most recent year of employment
Discharge paperwork for military service occurring before 1968
Your most recent Social Security benefits statement, if applicable

4. Do Your Research

If you are already receiving Social Security or Railroad Retirement Board (RRB) benefits as of your 65th birthday, you can be automatically enrolled in Medicare Parts A and B. If you are not yet receiving retirement benefits when you turn 65, you will need to enroll in the Medicare plan of your choice on your own. In either case, it is important to understand the different Medicare options available. There are a number of factors to consider when determining what kind of Medicare plan is right for you.

Check with your primary care physician, pharmacy, or specialist to confirm whether they accept Medicare. Medicare Advantage plans can also limit your provider choices to their specific network, making it more difficult or expensive to continue seeing a health care provider you trust. If you take prescription medicine, you should verify that the Part C or D plan you are considering includes your existing prescriptions in their formulary list of covered options. Ensuring that you can afford your plan of choice is also a decision-making factor, whether you are able to pay your premiums and out-of-pocket costs independently or would require Extra Help .

5. Enroll in Medicare

Once you have chosen a plan and have entered your IEP window, it’s time to enroll. You may choose to enroll in Medicare online, over the phone, or in-person. Using the personal documents and knowledge you have collected, you will have all the information you need to complete your application. Once your Original Medicare enrollment is complete, you can also add in any additional Medicare coverage you may need.

Still have questions about Medicare or the Initial Enrollment Period? We would love to hear from you! Senior Insurance Advisors hosts Welcome to Medicare events twice a month to guide you through the enrollment process at no cost to you. We also offer one-on-one meetings and employer education options to help you feel confident about choosing coverage based on your needs. Drop us a line today to learn how we are simplifying Medicare.

Medicare Supplement vs. Medicare Advantage—Which is Right for Me?

Fri, 11 Jun 2021 15:11:19 GMT

While Original Medicare (Part A and Part B) goes a long way in providing quality health insurance coverage, sometimes it isn’t quite enough. Enrollees may find that Original Medicare does not cover the cost of their vision and dental care, or prescription drugs. Copayments and deductibles for covered healthcare expenses can quickly add up.

Whether you are new to Medicare or are experiencing the high out of pocket costs that can sometimes occur, it is wise to consider a Medicare Supplement (Medigap) or Medicare Advantage (Part C) plan. These plans work alongside or in place of Original Medicare to more completely cover your healthcare expenses. They do this, however, in very different ways.

The Basics

Medigap plans work to supplement the coverage already provided by Original Medicare. Advantage plans, on the other hand, take its place almost entirely. Because of this, it is not possible to hold both Medigap and Medicare Advantage coverage.

Allowed Accompanying Coverage

Purchasing a Medigap plan requires that you stay enrolled in Original Medicare. Many people who choose to add a Medicare Supplement plan also still have an unmet need for prescription drug coverage. For these individuals, adding in a Part D plan to cover that expense is also necessary.

Choosing Medicare Advantage coverage means you do not have to enroll in multiple separate plans for your health insurance. These plans include all the benefits of Original Medicare, plus additional coverage options. In this way, Advantage plans can function as an all-in-one solution for a lot of people.

Coverage Options

Medigap coverage comes in a relatively wide range of choices. All the supplemental plans Medicare offers are given standardized letter designations . All plans with the same letter offer the same types and levels of coverage regardless of the insurance carrier who is offering the plan. Medigap plans do not generally include vision or dental coverage.

Because they are less tied to Original Medicare, Medicare Advantage plans have a lot more variety when it comes to the kinds of coverage they offer. Unlike Medigap coverage, Advantage plan specifics are not consistent across insurance companies. Many do, though, include Part D prescription and drug coverage, as well as vision and dental coverage.

Provider Specifics

Medicare Supplement plans are accepted anywhere Original Medicare is. Supplemental plans are sold by individual insurance companies, but have the consistency of being standardized by Medicare proper. This allows healthcare providers to have acknowledge of what they can expect from the insurance company when they see a patient covered by a Medigap plan.

Depending on the type of Medicare Advantage plan that you choose, your options for a healthcare provider may be somewhat limited. It is important to be very familiar with the network-related restrictions your specific plan may carry to avoid unexpected costs for your care. Some healthcare providers also restrict the kinds of Advantage plans they accept. This is due in part to the lack of consistency from one plan to another.

Cost Considerations

Though the coverage of a given Medigap plan is regulated, the monthly cost can vary. Your Medicare Supplement premium is dictated by factors like the carrier you choose and the state in which you live. This premium is added on to your existing Original Medicare premium and any additional insurance you may choose to purchase, like Part D prescription drug coverage.

While some Medicare Advantage plans come with a $0 price tag on their monthly premium, the coverage isn’t exactly “free.” You are still responsible for at least your Medicare Part B premium when you purchase a Medicare Advantage plan. Your Advantage plan premium will be based on the coverage option you select and the carrier you choose. Advantage plans offer the benefit of an upper bound on your out-of-pocket costs which can help mitigate your overall healthcare expenses.

There are so many factors to consider when choosing the Medicare coverage that is right for you, and it can be an overwhelming process. This guide is a great place to start, but we would love to see you at one of our upcoming events or to schedule a free consultation to go over your unique needs. We want to empower you to choose the coverage that is the best for you.

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When do you sign up for Medicare?

Sat, 01 May 2021 13:00:10 GMT

While many people are aware that Medicare coverage often begins at age 65, there are a variety of other opportunities for Medicare-eligible individuals to purchase or change their coverage. It is a common misconception that once you reach retirement age, you can simply sign up for Medicare at any time. There are a wide variety of Medicare enrollment periods with which you should be familiar. These range from annual opportunities to individual- and situation-specific enrollment periods, all of which allow for different coverage purchases and changes.

Initial Enrollment Period

The primary Medicare Initial Enrollment Period (IEP) spans a 7-month period around your 65th birthday. The IEP includes the 3 months leading up to your birthday, the month you turn 65, and the 3 months immediately following. During the IEP, you can enroll in Original Medicare (Part A and Part B). It is important to complete the enrollment process during the first 3 months of your IEP to ensure you will not see a delay or gap in your coverage. Additionally, enrolling outside of this window could mean you could be required to pay a late enrollment penalty on your Medicare Part B premiums for as long as you hold the policy.

Annual Enrollment Period

The Medicare Annual Enrollment Period (AEP) spans from October 15th to December 7th of every year. Coverage purchased during the AEP begins January 1st of the following calendar year. The kinds of coverage in which you are eligible to enroll during the AEP depend upon your current plan structure. We encourage all of our clients to take advantage of the AEP to re-revaluate whether your coverage still meets your health and lifestyle needs.

General Enrollment Period

If you missed your IEP, the General Enrollment Period (GEP) provides an opportunity for you to enroll in Original Medicare, Medicare Advantage plans, and Part D prescription drug coverage. While you may be assessed late enrollment penalties, you do not have to miss out altogether on Medicare. The GEP begins January 1st and ends March 31st of every year for Original Medicare, and runs from April 1st to June 30th for Medicare Parts C and D. If you enroll during these windows, the coverage you purchase will go into effect July 1st of the year you enrolled.

Medicare Advantage Open Enrollment Period

Individuals who have already enrolled in a Medicare Advantage plan have the option to change their coverage during the Medicare Advantage Open Enrollment Period (MAOEP). While you are only allowed a single coverage change during this period, it does allow for some flexibility in your coverage. Medicare Advantage members also have the chance to change their enrollment to Original Medicare plus Part D coverage within this period. Similar to the Original Medicare GEP, the MAOEP begins January 1st and extends through March 31st. It differs, however, in that you do not necessarily have to wait until July for your new plan to take effect. Rather, coverage changes requested within the bounds of this enrollment period are implemented on day one of the month following your initial request.

Special Enrollment Period

A Special Enrollment Period (SEP) occurs any time a policyholder or beneficiary has a qualifying life event, or for individuals who delayed enrollment in Medicare because of continued employment past the age of 65. While not a comprehensive list, qualifying events include changes to where you live, loss of coverage, opportunities to purchase alternate coverage, or if your plan sees changes in its agreement with Medicare. Not every instance that falls under these broader categories automatically qualifies you for SEP plan changes or enrollment, so it is important to consult a Medicare expert before attempting to make any changes to your coverage. Because of the wide variety of circumstances that can trigger an SEP, the window for enrollment and date your new coverage begins are also specific to your situation.

Medicare Supplement Open Enrollment - Medigap Coverage

Enrolling in Medicare Part B opens a unique enrollment period known as Medicare Supplement Open Enrollment. Once your Part B coverage begins, you have 6 months from the effective date to take advantage of the guaranteed right to purchase a Medicare supplement plan. During this Medicare Supplement Open Enrollment Period, insurers cannot reject your application for coverage based on your health status. You do have the option to purchase Medigap coverage under a different enrollment period, but you will have to answer the insurance provider’s health questions. This could lead to more costly premium than if you had opted-in during the open enrollment window, or denial of coverage entirely.

You have important decisions to make when it comes to Medicare. We want to help you navigate these often-tricky enrollment periods and ensure you are receiving the perfect coverage for your situation at the best possible price. We encourage you to check out the condensed version of this enrollment period breakdown for easy reference. If you still have questions about enrolling in Medicare, we would love to provide you with a no-cost consultation! Give us a call or easily request more information through our website.

Is Medicare Mandatory?

Fri, 30 Apr 2021 17:01:27 GMT

Here at Senior Insurance Advisors, we are often asked whether Medicare is mandatory. For such a common question, there is no one-size-fits-all answer. Whether or not enrollment is mandatory depends largely on your age, employment status, and other factors.

Do I have to enroll right when I turn 65?

Enrolling in Medicare is an important decision, especially as you near retirement age. If you are already receiving Social Security or Railroad Retirement Board benefits before you turn 65, you will automatically be enrolled in Original Medicare (Parts A and B) for the first day of the month you turn 65. If your birthday happens to fall on the 1st, Medicare coverage will start the first day of the month preceding your 65th birthday.

You have the choice whether to pay a Part B premium or opt out of the coverage. It is important to note, however, that delaying your enrollment in Part B coverage can result in a late enrollment penalty assessed over the lifetime of your policy. From age 65 on, you have the opportunity to reassess your coverage annually during the Medicare Annual Enrollment Period (AEP). During this enrollment period, you can more easily adjust your coverage to best match your needs.

What if I am still working?

Medicare Part A is not mandatory if you are still working at 65. We do, however, generally recommend that you enroll as soon as you become eligible even if you do not plan to retire at this age. Individuals who are Medicare-eligible but covered under their employer’s group health insurance plan can enroll in Medicare Part B during a Special Enrollment Period (SEP). This allows you to add Part B coverage to your existing plan outside of general enrollment, and without the penalties of a late enrollment.

For most people, Medicare Part A does not require you to pay a monthly premium. This is the case if you have been employed in the U.S. for at least 10 years. Even with employer-provided health coverage, Medicare Part A can help cover some hospital costs that you would have otherwise paid for out of pocket. If you are contributing to an HSA, though, it may not be in your best interest to enroll in Medicare Part A right away. You may want to delay coverage under Part A to ensure you can still make HSA contributions.

How about if I am on disability?

Individuals under the age of 65 who are receiving disability benefits are also automatically enrolled in Medicare Part A and Part B in some cases. You must have received these benefits—whether from Social Security or the RRB—for a period of 24 months in order for this enrollment to take place. If you have ALS, Medicare Part A and Part B coverage begins automatically the same month as your Social Security disability benefits.

For individuals receiving Social Security benefits, Medicare Part A often goes hand-in-hand. The other parts of Medicare, however, offer a greater degree of flexibility. Prospective enrollees must take into account their age as it relates to Medicare’s various enrollment periods, as well as their employment and disability status. If you still have questions about which Medicare coverage is right for you, we encourage you to reach out for a free consultation!