Medicare Advantage Archives - Hanover Mortgages

Apache is functioning normally

July 27, 2023 by Brett Tams

Medicare is the United States’ federally administered health care program.

The program was established in 1965 for the purpose of paying certain health care expenses for people age 65 and over, as well as for other select individuals, such as those who have end stage renal disease.

When originally established, there were only two parts. These were Part A for hospitalization coverage, and Part B for doctors’ services. Over time, the Medicare program has been expanded to offer additional coverage and choices for its enrollees.

We understand that any type of insurance coverage, from the best car insurance companies, best life insurance coverage, or best burial insurance for seniors, can be quite confusing. Remember, we are here to help!

How Coverage Works

The Medicare program today is divided into four parts, and each of these covers a different area. These parts include:

Part A – Hospital Coverage. Part A coverage will help an enrollee pay for inpatient care in a hospital or in a skilled nursing home facility. It also covers some types of home health care, as well as some hospice care. In most cases, there is no cost for participating in Part A.
Part B – Medical Coverage / Doctors’ Care. Part B helps to pay for doctors’ services, as well as for a variety of other medical services and supplies not covered in Part A. Those who are enrolled in Part B will be required to pay a monthly premium. In 2015, most people pay a premium of $104.90 per month. This can vary, however, based upon the individual’s income and on whether they file their tax return jointly with a spouse or as a single individual. This article goes in depth about the income limits and fees that high earners -“Medicare IRMAA brackets“- may have to pay regarding Part B and Part D coverage.
Part C – Medicare Advantage / Managed Care. Part C is also referred to as Medicare Advantage. It provides a managed care approach to delivering Medicare-covered services, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Those who are eligible for Parts A and B may alternatively choose to receive all of their services through a Medicare Advantage provider organization under Part C. The premium one pays for Part C will depend upon the plan that is chosen, as well as on the enrollee’s geographic location. You can learn more about this coverage HERE.
Part D – Prescription Drug Coverage. Part D helps to pay for prescription drugs doctors prescribe for the treatment of a patient. The premium charged for a Part D policy will depend upon the prescriptions you are taking, and thus, the actual plan that is chosen.

Recipients of Medicare, also referred to as beneficiaries, are able to choose coverage via the Original plan – which is actually Parts A and B – or they may choose Part C – which is Medicare Advantage.

Who Qualifies?

In order to be eligible, an individual must have lived in the United States for at least 5 continuous years, and also be a permanent resident of the U.S.

In addition, qualified recipients of benefits must be at least 65 years of age or over, or have a specific type of qualifying disability.

For a person to be considered permanently disabled, they must be entitled to receive benefits from Social Security, and they must have been receiving those benefits for a minimum of two years.

An individual who is diagnosed with end stage renal disease and who also requires kidney dialysis or a kidney transplant may also be considered eligible for benefits from the program.

With the high costs of health care it makes sense for those eligible for Medicare to take advantage of this government administered health care program.

Adults Over 65

Most adults in the United States are eligible for Medicare when they turn 65. Individuals must be U.S. citizens or permanent residents and enroll in the Medicare program to qualify.

Individuals who are already receiving Social Security benefits will be automatically enrolled in the Medicare program. Approximately three months before their 65th birthday, an enrollment package will be sent and must be completed to activate coverage.

Medicare Part A, which covers hospitalizations, requires no payment. However, adding Part B – which is for doctors visits, outpatient procedures, or additional coverages, such as prescription drug coverage, does cost money. The premium is determined based on income level. So, individuals must decide what plan is best for them when enrolling and what they can afford to have.

Individuals with Disabilities

Medicare coverage is also available to individuals with disabilities regardless of their age. Once an individual has been collecting social security disability payments for twenty-four months, they become eligible for Medicare during the 25th month.

An enrollment package will be sent a few months before a person becomes eligible for Medicare coverage. If a person with Social Security disability does not receive the enrollment package, they should contact their local social security office to request a packet.

Like an individual who is over age 65, disabled persons who have been getting Social Security disability payments are automatically eligible for Medicare. There is no reason to decline coverage, as Medicare Part A costs nothing and covers hospital care and nursing facility care.

However, if a disabled individual would like, they can decline Medicare Part B coverage, which would require premium payments. There is a card that comes with the enrollment package that the individual can mail back declining Part B coverage.

Who Does NOT Qualify for Medicare

People who are not already receiving Social Security benefits will need to contact their local Social Security office to apply for Medicare coverage. This should be done three months before the individual’s 65th birthday.

The enrollment period begins in the three months before the month of the 65th birthday and ends three months after. If one enrolls during this time frame, there is no cost for enrollment and coverage should begin at the start of the 65th birthday month or shortly thereafter (if one applies after their birth date).

If, however, one does not apply during that enrollment period, then fees apply. So, it is important to apply on time, and as close to the three month prior date as possible. This will ensure everything is done correctly and coverage starts at the beginning of the individual’s birth month.

How to Enroll

To begin receiving benefits, an eligible individual must enroll through the office of Social Security. There is only one exception to this rule, in that those who are already receiving benefits through Social Security or the Railroad Retirement Board are automatically enrolled when they turn age 65.

All other potential recipients must submit an application for coverage during the open enrollment period. This period of time begins three months prior to the applicant’s 65th birthday and it ends seven months after.

Those who do not enroll in Part A and/or Part B when they are originally eligible are allowed to alternatively enroll between January 1 and March 31 each year. For those who do, their coverage will begin on the following July 1.

Medicare is Not Medicaid

Because their names sound so similar, people can oftentimes confuse Medicare with Medicaid. These two programs, however, are not the same. Medicaid is a joint state and federal program that provides medical assistance to those who meet very specific low income requirements.

In addition to medical necessity, a person must be considered at his or her state’s poverty level in terms of income and assets for Medicaid qualification purposes.

Through the Social Security Act, those who have income and resources not considered to be sufficient enough to meet the cost of their needed medical care, as well as certain long-term care needs, can qualify for Medicaid’s benefits. Therefore, Medicaid is considered a “means” tested program.

When determining which assets “count” toward qualifying for Medicaid, funds and property are divided into three different classes.

These include the following:

Countable Assets – Countable assets include any personal assets that the individual either owns or controls. These funds are required by Medicaid to be spent on the applicant’s care before he or she will be able to qualify for Medicaid’s benefits. Some examples of countable assets may include cash, stocks and bonds, and deferred annuities (provided that the annuities have already been annuitized).
Non-Countable Assets – Even though non-countable assets are still acknowledged by Medicaid, the particular types of assets are not necessarily utilized when making a determination regarding an applicant’s eligibility for Medicaid benefits. Non-countable assets can include household belongings, such as furniture, appliances, term life insurance policies, a burial plot owned by the Medicaid applicant, and the applicant’s primary residence – as long as the value of the home does not exceed a certain amount.
Inaccessible Assets – Assets that are inaccessible are those considered to be resources that would have had to be spent on a person’s care; however, the assets have instead been transferred to another individual or into a trust. This transfer has therefore made the asset inaccessible. With inaccessible assets, Medicaid has the right to review the applicant’s financial records at the time that the application for benefits is made. In most cases, if assets were transferred within a certain amount of time prior to a person’s application, Medicaid may deem the individual as being disqualified from receiving benefits – at least for a certain period of time.

What is Supplemental Insurance and What Does It Cover?

Medicare supplement insurance plans are a type of insurance coverage supplemental to what Medicare covers. This type of coverage can pay for some – or in some cases, all of the copayments and/or deductibles so that the enrollee does not need to pay such expenses out-of-pocket.

Medigap insurance is specifically designed to supplement Medicare’s benefits, and it is regulated by both federal and state law. A Medigap policy must be clearly identified as being Medicare Supplement insurance, and it must provide benefits that help to fill in the gaps in Medicare’s coverage.

Although the benefits are identical for all supplement plans of the same letter (i.e., all Plan A policies offer the same coverage options), the premiums may vary from one insurance carrier to another, as well as from one geographic area to another. There are even three states that do not use the letter system, but have different ways of designating their plans.

What is Medicare Advantage and How Does It Work?

A Medicare Advantage (MA) plan, similar to an HMO or PPO, is type of Medicare plan available to those who are eligible for “Original Medicare”, or Parts A and B. This option is also referred to as Part C. These plans are actually offered by private insurance companies approved by Medicare.

When an individual joins a MA Plan, Medicare pays a fixed amount of their premium every month to the companies that offer these plans. These companies are required to follow strict rules on coverage.

Each of the Advantage Plans are allowed to charge different out-of-pocket costs, and they may also have different rules as to how enrollees can receive their services. For example, some plans may require participants get a referral before going to a specialist. And, these rules may change every year.

MA Plans also have an annual cap on how much participants will pay for their Part A and Part B services throughout the year. This annual, maximum out-of-pocket amount can differ from plan to plan. You can get a full understanding of how MA plans can be a benefit to you HERE.

How to Find the Best Coverage

When seeking Supplemental or Advantage coverage, it is best to work with a company that has access to more than just one insurer.

That way, you can obtain information on numerous different benefits and quotes to see what your options are and what benefits are available to you.

When you’re ready to begin the process, you can use the form on this page and a top independent agent will work with you to get the best policy at the best rates.

Source: goodfinancialcents.com

Apache is functioning normally

July 22, 2023 by Brett Tams

A Medicare Advantage plan, similar to an HMO or PPO, is type of Medicare plan that is available to Medicare enrollees. This option is also referred to as Medicare Part C. These plans are offered by private insurance companies that are approved by Medicare.

By joining a Medicare Advantage Plan, a participant essentially gets all of their Medicare Part A (Hospitalization Coverage) and Medicare Part B (Physicians Coverage). In fact, Medicare Advantage Plans are required to cover all of the services that the Original Medicare covers except for hospice care. This is because Original Medicare covers hospice care, even if the participant is enrolled in Medicare Advantage.

In addition, a Medicare Advantage Plan may offer additional coverages such as vision, dental, and / or health and wellness programs. And, most Medicare Advantage plans also include Medicare prescription drug coverage, too.

When an individual joins a Medicare Advantage Plan, Medicare pays a fixed amount of their care every month to the companies that offer these plans. These companies are required to follow strict rules that are set by Medicare.

However, each of the Medicare Advantage Plans are allowed to charge different out-of-pocket costs, and the plans may also have different rules as to how enrollees can receive their services. For example, some plans may require participants to get a referral before going to a specialist. And, these rules may change every year.

Medicare Advantage Plans also have an annual cap on how much participants will pay for their Medicare Part A and Part B services throughout the year. This annual maximum out-of-pocket amount can differ from plan to plan.

Different Types of Medicare Advantage Plans

Essentially, there are two primary types of Medicare Advantage plans. These are network and non-network. Network plans offer care to enrollees through their network of physicians and hospitals and are identified as HMOs and PPOs.

The non-network Medicare Advantage plans are a type of personal fee-for-service plan that does not require the participant to see a specific doctor or go to a specific hospital. However, the doctor or hospital that is chosen must be willing to accept the plan’s payment structure.

With a Medicare Advantage Plan, a participant may choose to stay in the traditional Medicare program or in their current managed care plan. Or, as an alternate option, the participant may choose to receive their Medicare-covered services through any of the additional following types of health insurance plans:

Health Maintenance Organization (HMO) – These plans consist of a network of approved hospitals, doctors, and other types of health care service professionals who agree to provide their services in return for a set monthly payment from Medicare. These health care providers will receive the same fee each month, regardless of the actual services that they provide.
Preferred Provider Organization (PPO) – These plans are somewhat similar to HMOs, however with a PPO, the beneficiaries do not need to obtain a referral in order to see a specialist who is outside of the network. Also, participants are allowed to see any provider or doctor that accepts Medicare. However, PPOs do limit the amount that their members pay for care outside of the network.
Private Fee-for-Service Plans (PFFS) – These types of plans offer a Medicare-approved private insurance plan. With these plans, Medicare will pay the plan for Medicare approved services while the PFFS determines – up to a certain limit – how much the care participant must pay for their covered services. In these plans, the participant handles the difference in cost between the amount paid by Medicare and the amount that the PFFS charges.
Special Needs Plans (SNP) – These types of plans provide a more focused type of health care for those who have specific health conditions. An individual who joins a SNP plan will receive their health care services as well as more focused care in order to manage their specific condition or disease.
Coordinated Care Plans (CCPs) – These plans are managed care plans that include HMOs (health maintenance organizations), PPOs (preferred provider organizations), and regional PPOs. They provide coverage for health care services either with or without a point-of-service option (the ability to use the plan or out-of-plan health care providers).
Some CCP plans will limit the participant’s choice of health care providers. Other plans may offer benefits in addition to those offered in the traditional Medicare program, such as prescription drug coverage. Still other CCP plans may limit the choice of health care providers and the supplemental benefits that may be received.
Cost Plans (1876 Cost Plans) – Cost plans are a type of HMO plan that gets reimbursed on a cost basis rather than on a capitated, or per head, amount such as with other types of private health care plans. Cost enrollees are allowed to receive care outside of their HMO and have those costs be reimbursed through the traditional fee-for-service system.
Medicare Medical Savings Account Plans (MSAs) – These types of plans will combine a high deductible Medicare Advantage Plan with a medical savings account for medical expenses. These Medical Savings Accounts consist of two parts. These are:
- A private Medicare Advantage insurance policy with a high annual deductible
- A medical savings account

The health insurance policy does not pay for covered health care costs until the deductible has been met. Then, the medical savings account will come into play when Medicare deposits money into an account for the participant. These funds may then be used for any type of health care expense – including the participant’s deductible.

Participants in these types of plans will typically pay for their medical expenses out-of-pocket for the amounts under the deductible. In addition, there could be tax-related penalties if a participant withdraws funds from the account for any reason other than medical.

Preferred Provider Organization Demonstration Plans (PPO Demo)
Private Contracts
Cost Plans
Other Demonstration Plans
Religious and Fraternal Benefit Society Plans – Medicare Advantage plans may even be offered by religious and fraternal organizations. These organizations are able to restrict enrollment in their plans to their members.

In these cases, the plans must meet the Medicare financial solvency requirements. In addition, Medicare may also adjust payment amounts to the plans in order to meet the characteristics of the participants that are enrolled in the plan.

Who is Eligible for a Medicare Advantage Plan?

In order to be eligible to enroll in a Medicare Advantage plan, a participant must meet two conditions. These are:

They are entitled to Medicare Part A, and they are also enrolled in Medicare Part B as of the effective date of enrollment in the Medicare Advantage plan
The participant lives within the service area that is covered by the Medicare Advantage plan

There are a few exceptions, however, to these requirements. One exception is that a Medicare participant will not typically be allowed to enroll in a Medicare Advantage plan if they have end-stage renal disease that requires regular kidney dialysis or a transplant to maintain life.

If, however, a participant is already enrolled with the Medicare Advantage organization when they first develop end-stage renal disease, and they are still enrolled with the Medicare Advantage organization at that time, then they are allowed to stay in the existing plan or join another plan that is offered by this same company.

Should an individual wish to enroll in a Medicare Advantage plan, they can do so by completing a paper application, calling the plan, or by enrolling on the plan’s website. They can also go directly to Medicare’s website at www.medicare.gov.

There are specific times, however, when an individual may enroll in a Medicare Advantage plan. These include:

Initial Election Period (IEP) – This period is also referred to as the initial coverage enrollment period. Therefore, an individual may elect to enroll in a Medicare Advantage plan when they first become entitled to both Medicare Part A and Medicare Part B.This initial election period will begin on the first day of the third month prior to the date on which the individual is entitled to both Part A and Part B and will end on the last day of the third month after the date that the person became eligible for both parts of Medicare. Three months prior, the month of, and three months after, will essentially create a seven-month election period. This is the same election period as for enrolling in Medicare itself.Participants who are within this initial period of time will not need to wait for any other type of enrollment period. Their coverage will begin on the first day of their birth month. For those who are enrolled in disability coverage, there is also a seven-month window for enrollment from the time that the person receives their Medicare disability benefits.
Annual Coordinated Election Period (ACEP) – During this time, a participant may elect to enroll, drop, or change their enrollment in a Medicare Advantage and / or Medicare Part D plan. Starting in the year 2011, this period began running from October 15 through December 7 of each year. This period can also be referred to as the fall open enrollment period or as the annual enrollment period.
Special Election Period (SEP) – These are considered to be special periods of time during which an individual will be allowed to enter into or to discontinue enrollment in a Medicare Advantage plan. They may also change their enrollment to another MA plan or return to the Original Medicare plan at this time if they so choose.In addition, an individual may enroll in a Medicare Advantage plan during this time if they have recently become disabled. And / or, an individual may also begin receiving assistance from Medicaid. In this case, the individual will not need to wait until the October 15 ACEP enrollment period. There are also sometimes whereby a special election period will be allowed. These include:

The Medicare Advantage plan that the participant is enrolled in is terminated. This is referred to as being an involuntary disenrollment. This will result in involuntary loss of creditable coverage for the participant.
The Medicare Advantage company that offers the plan violated a material provision of its contract with the enrollee.
The participant moves out of the area of plan service.
The participant recently experienced a disability.
The participant meets other certain material conditions as CMS may provide. These can include a delayed enrollment due to an employer’s or a spouse’s coverage being terminated, or an involuntary loss of creditable group coverage.
The participant is receiving any assistance from Medicaid that could include the following:
- Beneficiaries who reside in long-term care facilities
- Full dual eligibles
- Partial dual eligibles
The participant meets other qualifications that are related to long-term facilities, low-income subsidy eligibility, Medicare Part D coverage, and other circumstances that give CMS the discretion to create an SEP.

Medicare Advantage Disenrollment Period (MADP) – This is the period of time in which individuals may dis-enroll from a Medicare Advantage plan and / or from a Medicare Advantage with Part D coverage plan and then may subsequently enroll in the Original Medicare plan – either with or without a Part D plan.This period runs from January 1 to February 14. And, the individual’s new coverage will become effective as of the first day of the month following the change in coverage. A participant is allowed to make one change per year from an MAPD to another MAPD or from a Medicare Supplement plan with a stand-alone PD to an MAPD.

Getting Quotes on Medicare Advantage Plans

When obtaining quotes on a Medicare Advantage plan, it is typically best to work with a company or an agency that has access to more than just one insurer. That way, you can obtain a comparison of quotes in order to determine which will work best for you. We can assist you with this. If you are ready to move forward, just fill out the form on this page.

Should you have any additional questions, we can be reached directly by phone by calling, toll-free 888-229-7522. Our experts are happy to walk you through any Medicare Advantage plan information that you may need. So, contact us today – we’re here to help.

Source: goodfinancialcents.com

Apache is functioning normally

June 10, 2023 by Brett Tams

Some people who already receive Social Security benefits are automatically enrolled in Medicare when they turn 65. That’s not the case for everyone, though. People who haven’t started collecting Social Security will need to register for Medicare, but signing up doesn’t have to be challenging. Here’s what you need to know about enrolling in the government insurance program. If you’d like personalized retirement advice, consider working with a financial advisor.

What Is Medicare?

Medicare is a federal health insurance program for people 65 and older, as well as those with disabilities and specific diseases. It’s intended to help provide affordable health care to people who have low incomes or limited resources either due to retirement or disability.

Medicare has three main parts:

Medicare Part A covers hospital expenses such as inpatient stays, hospice care and some home health care.
Medicare Part B covers medical expenses like doctors’ services, outpatient care, preventative care and medical supplies.
Medicare Part C, also known as Medicare Advantage, covers health care related to dental, vision and hearing.
Medicare Part D covers prescription drugs.

For most people, Part A is free and Part B requires you to pay a premium. The standard monthly premium in 2023 is $164.90. Parts C and D are accessed via a Medicare-approved plan for which you will also pay a monthly premium. These premiums will vary depending on the provider and plan you choose.

When Are You Eligible for Medicare?

Leaving aside the minority of Medicare recipients with disabilities or diseases, most will become eligible to enroll in Medicare when they turn 65. You can sign up for Medicare three months before you turn 65.

That period starting three months before you turn 65 is called the Initial Enrollment Period. It lasts seven months, ending three months after the month in which you turn 65. If you miss this Initial Enrollment Period, you’ll have to pay a monthly late enrollment penalty that goes up the longer you wait.

If you sign up before the month in which you turn 65, your Medicare coverage will start the first of the month in which you turn 65. So if your birthday is June 16, and you sign up on May 15, your coverage will begin on June 1.

There’s also a General Enrollment Period each year from Jan. 1 to March 31. Again, your coverage will start the first of the month after you sign up and you may need to pay a late enrollment penalty if you don’t qualify for a Special Enrollment Period. You may qualify for a Special Enrollment Period if you missed your Initial Enrollment Period because of a natural disaster or emergency, got inaccurate or misleading information from your health plan or employer, as well as a few other extenuating situations. In such cases, you can fill out and submit a form to ask for a Special Enrollment Period.

Are You Automatically Enrolled in Medicare at Age 65?

According to the U.S. Centers for Medicare and Medicaid Services, if you live in the United States and are already getting Social Security payments, you’ll be automatically signed up for Part A and Part B of Medicare when you become eligible. So if you’re already claiming your Social Security benefits, you may automatically receive a packet with more information on Medicare a few months before you turn 65.

If you’re not yet getting Social Security benefits or aren’t eligible for them, you won’t be automatically enrolled and will need to complete an application or reach out to the Social Security Administration.

How to Enroll in Medicare

If you’re not already receiving Social Security benefits but need to enroll, there are a few steps to the process. First, make sure you know when your Initial Enrollment Period begins and ends so you can enroll in that time frame and avoid a penalty.

Second, you can sign up online at the Social Security website, which the official Medicare website notes is the fastest and easiest way to register. You can also enroll by phone by calling the Social Security Administration at 1-800-772-1213. If you’d like to enroll in person, find your local Social Security office for the address and hours of operation.

Bottom Line

If you’re already receiving Social Security, you’ll likely be automatically enrolled in Medicare once you hit age 65. But if you haven’t yet started your Social Security payments yet, you’ll need to enroll in Medicare online, by phone or in person.

Retirement Planning Tips

If you’re not sure whether you’ve saved enough for retirement, our retirement calculator can help you get a better sense of where you stand. Use it to determine your estimated Social Security benefits, how much money you need to retire and how much annual income you’ll need in retirement.
A financial advisor can help you plan for Social Security, Medicare and retirement. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.

Photo credit: ©iStock.com/Cecilie_Arcurs, ©iStock.com/designer491, ©iStock.com/shapecharge

Source: smartasset.com

Apache is functioning normally

June 6, 2023 by Brett Tams

Have you ever wondered if you could get your Medicare premiums automatically deducted from your bank account each month? Less hassle, less administration?

Good news: You can do this with Medicare Easy Pay.

Medicare Easy Pay is a free service from the federal government that will deduct your Medicare payments from your bank account on a monthly basis.

Who can sign up for Medicare Easy Pay?

You can set up Medicare Easy Pay if Medicare is sending you bills — that is, if you’re paying Medicare directly for your Part A or Part B premiums, or for your Part D income-related monthly adjustment amount (IRMAA).

Most people get their Medicare premiums deducted from their Social Security benefits, so they don’t need to sign up for Medicare Easy Pay.

If you’re getting bills from the Railroad Retirement Board, you cannot sign up for Medicare Easy Pay. You must pay the Railroad Retirement Board directly.

And note that if you’re paying for a separate Part D, Medigap or Medicare Advantage plan — which are plans sold by private insurers — you’ll pay premiums to the insurance company. These payments aren’t eligible for Medicare Easy Pay.

How do you sign up for Medicare Easy Pay?

There are two methods for setting up Medicare Easy Pay:

Log in to your Medicare.gov account. Don’t have one? You’ll need to create one. Then select “My Premiums” and “Sign Up” to access an online form.
Fill out a paper form. You’ll need to mail the form to the Centers for Medicare & Medicaid Services (CMS).

What information do you need to sign up for Medicare Easy Pay?

If you’re signing up online: You’ll need your Medicare card and your bank account information.

If you’re signing up using a paper form: You’ll need your Medicare card and a blank check from your bank account, plus some general information about yourself. If you’re signing up to have payments deducted from a checking account, you’ll need to attach a blank, voided check to your form.

How long does it take to activate Medicare Easy Pay?

It can take six to eight weeks to process your information for Medicare Easy Pay. In the meantime, continue paying your premiums directly.

Once Medicare Easy Pay is active, your Medicare bill will say “THIS IS NOT A BILL” in the upper right corner, according to the CMS. (Here’s a sample.) Your premiums typically will be deducted on the 20th of the month (or the next business day).

Your first deduction may be as much as three months of premiums, which is the Easy Pay limit. If you owe for more than three months, Easy Pay won’t deduct automatically and you’ll need to pay your Medicare premiums a different way until what you owe is within the three-month limit.

When your Medicare premiums change, the amount deducted from your account will update automatically.

What if there’s a problem with the payment?

If your premium can’t be deducted, Medicare will send you a letter explaining why it couldn’t deduct your premium. Then you’ll get your next Medicare bill in the mail, and you’ll need to pay the premium directly. Once you’ve caught up on payments, your Medicare Easy Pay service will resume. If it doesn’t, contact Medicare.

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

Source: nerdwallet.com

Apache is functioning normally

May 20, 2023 by Brett Tams

Medicare covers a lot of services, but only when they’re medically necessary.

Medically necessary services are “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine,” according to the Centers for Medicare & Medicaid Services, or CMS

.

You can look services up online or talk to your health care providers to find out whether and how Medicare covers them. If Medicare won’t cover a service that you or your doctor thinks is necessary, you can appeal that decision.

How do I know whether a service will be covered?

ABNs are provided only to people with Original Medicare (Part A and/or Part B). If you have Medicare Advantage, you might get a different notice or form.

What makes a service medically necessary?

Medicare’s decisions about medical necessity happen at three levels, from most general to most specific

:

Laws. Federal and state laws can set requirements for what’s covered.
National coverage determinations, or NCDs. Using a public, evidence-based process, Medicare decides whether and how a certain item or service is covered for the whole country.
Local coverage determinations, or LCDs. If a particular item or service isn’t included in relevant laws or NCDs, Medicare contracts with local companies that make coverage decisions. LCDs don’t apply nationally — they’re geographically limited to certain areas according to Medicare’s contracts.

What does ‘medically unreasonable and unnecessary’ mean?

Medicare doesn’t pay for “medically unreasonable and unnecessary services and supplies to diagnose and treat a Medicare patient’s condition,” according to CMS

.

Here are a few examples of what CMS considers medically unreasonable and unnecessary:

Tests or therapies that aren’t related to a patient’s symptoms or conditions.
Getting more or longer services than necessary, such as staying in the hospital or continuing therapy too long.
Services provided at a hospital when they could have been provided in lower-cost settings.

Can I appeal if I’m denied based on medical necessity?

If a service or item is denied because it’s not medically necessary, you can appeal that decision.

You’ll receive a written notice that explains what was denied, the reasons for denial and how you can appeal. You then need to submit the necessary information before any appeal deadlines

.

If your appeal is denied, it’s not necessarily the end of the road. You can escalate the appeal to a higher level. As with the original denial, the written notice you receive about a decision on your appeal will include instructions for your next steps.

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

Source: nerdwallet.com

Apache is functioning normally

May 7, 2023 by Brett Tams

When you enroll in Medicare, it can be confusing. There are dozens of different terms and coverage categories that you will need to understand to ensure that you’ve got the coverage that you need.

Medicare is an excellent program, but there are plenty of medical expenses that the program doesn’t cover. Those left over bills could leave you with thousands and thousands of dollars of expenses.

Every year, the cost of health care continues to creep up. There are millions of seniors that have had their savings accounts drained because of surgery or they needed a specific treatment. You’ve reached a stage of life where you can finally sit back and enjoy all those years of hard work, but hospital bills can destroy that retirement dream.

There is nothing that you can do about those rising hospital bills, but there are a few ways that you can protect yourself and your finances from being the full weight of them. The best way is to purchase supplemental health care insurance to accompany your Medicare policy.

There are two main options to get additional coverage, either a Medigap policy or a Medicare Advantage plan. Both of them will fill in the gaps left behind by original Medicare, but they operate very differently. Each of them has various pros and cons that you will need to consider to ensure that you’re getting the best supplemental coverage available.

What is a Medigap Policy?

Before we start looking at Plan G specifically, let’s take a broad look at Medigap plans and why you should purchase one of these plans. Medigap plans are sold by private insurance companies, and they help fill in all of the gaps that original Medicare leaves behind (hence the name Medigap).

As long as you’re over the age of 65 and you are enrolled in Medicare, then you can purchase one of these plans. You will then pay monthly premiums to the private insurance company, and you will still be required to pay the premiums for your Part A and B Medicare coverage.

There are ten different plans that you can choose from, depending on which state that you live in. They are all denoted by a letter of the alphabet, from A to N. The plans are standardized by the government, which means that regardless of which company that you buy the plan from, the coverage is going to be the same. The only differences between the available companies is how much you’re going to pay every month.

Medicare Supplement Plan G

If you’re looking to get a lot of supplemental coverage, Plan G is an excellent choice to do that. Plan G is similar to Plan F in the coverage that it provides (the main difference is that Plan G doesn’t cover Part B deductibles, which Plan F will no longer be allowed to pay for), but there are a few distinct differences between the two types of plans. It’s important that you compare all of your options before you decide which plan is going to work best for you.

Plan G is one of the more comprehensive plans, meaning that it fills in more holes than some of the other basic plans. There are several key coverage areas of a Plan G that make it the perfect option for some applicants.

There are several important areas of coverage with a Plan G that can give you the additional coverage that you need. One of the most notable is the Part B excess charges, which several of the other plans don’t cover. Whenever you go to the hospital or doctor, and you get treated, there is a Medicare Part B approved amount that they have calculated. Legally, the doctor or hospital is allowed to charge 15% over that agreed amount. Without a Medigap policy, you would be responsible for paying for those excess charges yourself. If you have a plan that covers those bills, then you won’t have to pay anything out-of-pocket. In most cases, excess charges will be relatively small, but some treatments or services could put a severe strain on your bank account.

Another important area of coverage is the foreign travel emergency coverage. If you’re traveling, and something were to happen to you, then a traditional Medicare plan will not help you pay for any of those expenses. With a Plan G, then you will get coverage for up to 80% of the plan limits. If you plan on doing a lot of traveling in your retirement, it’s important that you have the safety net that you and your family will need. If not, a trip to the hospital could ruin your vacation.

Some of the other covered fees are the Medicare Part A hospice care coinsurance and the Part A deductible. Both of these are relatively small expenses, but they can quickly add up to serious bills. Those expenses, coupled with some of the others, could quickly drain your bank account when you need the money the most.

Like the other Medigap plans, Plan G will also pay for inpatient hospital coinsurance and hospital fees for 365 days after your Medicare benefits have been used up. If you were to be diagnosed with a severe health complication, you could find yourself with an extended stay in the hospital. As you probably know, hospital bills can be massive. The longer that you stay, the bigger those bills are going to be. Even with a short stay, it can cost thousands and thousands of dollars. Thankfully, traditional Medicare helps pay for hospital stays, but a Medigap plan will ensure that you have additional coverage if you end up in the hospital longer than you assume you would be.

Enrolling in a Medigap Policy

The next step to getting supplemental coverage is enrolling in the Medigap plan that you choose. Luckily, purchasing one of these policies is easier than you may think. In fact, it’s as simple as purchasing any insurance policy.

The first thing that you will need to do is decide which company that you’re going to buy the plan from. Because the plans are the same from company to company, the only difference is how much you’re going to pay in monthly premiums. It’s vital that you compare several companies before you pick one.

The next thing is to determine when your open enrollment period is. This enrollment period is a six-month opportunity that starts the month that you turn 65, and during that time, the insurance company has to accept your application, regardless of your health or any pre-existing conditions that you have.

Another advantage of applying in this 6-month window is that the insurance company cannot charge you higher premiums for your plan, even if you’re in poor health. Taking advantage of your open enrollment could save you thousands of dollars every year. If you’re in bad health or have a lot of previous health problems, your open enrollment could be your only chance to get supplemental coverage.

After that window is closed, then your application is going to be treated like any other application. The company is going to ask you dozens and dozens of questions about your health and other determining factors to decide how much of a risk you are to accept. If you’re too high of a risk, then they will reject your application. Some companies are more liberal than others with their risk assessment, but it can still be hard to find an affordable policy.

If you’ve already missed the six months, don’t worry, there is still a great chance that you can purchase a Medigap plan at a reasonable rate. You can’t put a price on the peace of mind that having proper supplemental coverage will give you.

Any Questions?

If you have any questions about Medigap Plan G, or any of the other plans that you can buy, feel free to check out some of the other articles that I’ve written about supplemental coverage. If you are confused by the whole thing, feel free to contact me, or you can call a professional Medigap insurance agent. There are thousands and thousands of agents in the United States that have years of experience helping seniors get the Medigap coverage that we need.

You’ve finally reached a stage of life where you can sit back and enjoy all of those years of hard work. Don’t let some expensive medical bills ruin that.

Source: goodfinancialcents.com

Apache is functioning normally

May 5, 2023 by Brett Tams

If you’ve been to the doctor in the past 20 years (or even), then you probably know how expensive those trips can be. There is nothing that you can do about the rising cost of health care, but there are several ways that you can protect yourself from those massive expenses.

Thanks to Medicare, there are millions of seniors that are getting the health care coverage that they wouldn’t be able to afford otherwise. While it’s a great way to get health care, but it doesn’t cover everything. There are dozens of holes in the coverage that could leave you with a massive bill. Those bills can drain your bank account and turn your retirement daydream into a nightmare.

The two best ways to protect yourself is to purchase supplemental coverage, either through a Medigap plan or a Medicare Advantage policy. Both of them are excellent options for additional protection, but this article is going to focus specifically on Medicare Supplement Plan N.

What is a Medigap Policy?

Medicare Supplement Plans are sold by private insurance companies, and they help fill in the holes that your Medicare Part A and Part B doesn’t pay for. There are ten different policies, all of them are denoted by a letter of the alphabet, A through N. Each of them pays for different expenses or a portion of those expenses. Before you apply for one of these policies, it’s important that you compare all of the Medigap plans to decide which one is going to give you the protection that you need.

All ten plans are standardized by the government, which means that all the plans are going to have identical coverage, regardless of which company that you choose. The only difference between the companies is how much they are going to charge you every month. Some companies have higher premiums, while others are going to be more affordable.

After you purchase one of these plans, you will pay the monthly premiums to the insurance company. With a Medigap plan, you will still have to pay your traditional Part A and Part B premiums. Some people have confusion about who they pay the premiums to, or they assume that a Medigap plan replaces their original Medicare coverage. Even if you have a Medigap plan, you are still responsible for your Medicare payments. Not paying those premiums can lead to some serious fees.

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Medigap Plan N Coverage

As we mentioned, there are ten different policies, and all of them are different. There is no “one plan fits all” that will work well for every applicant. In this article, I’m going to detail the pros and cons of a Plan N, which is one of the popular options for supplemental coverage.

Plan N is one of the larger policies, which means it’s going to cover more of the holes left behind. There are several key coverage categories that you should be aware of if you are going to purchase this option. One of the first things that you should realize is that 100% of your Part B coinsurance fees are paid for, except for a $20 co-payment fee for a doctor’s visit and a $50 fee for emergency room visits. These are relatively small fees, as long as you don’t go to the emergency room a dozen times every year.

One of the key components of a Plan N is that it will pay for skilled nursing facility coinsurance and Part B coinsurance. Both of these coverage groups can save you thousands of dollars every year. If you end up needing any skilled nursing facility assistance, it can quickly become costly, but having the coinsurance coverage can keep more money in your pocket.

Another area that Plan N pays for is the first three pints of blood if you need it. Additionally, it will pay for hospital coinsurance and costs for an additional 365 days after you traditional Medicare coverage ends.

One of the most notable pitfalls of a Plan N is that the policy doesn’t cover any Part B excess charges, which can be a devastating coverage gap. When you go to the doctor or visit the hospital for any treatments or services, there is a pre-approved amount that Part B will pay. Legally, those doctors and hospitals are allowed to charge 15% above that amount. In most cases, those excess charges won’t break your bank, but depending on the procedure or service that you get, it could put a strain on your bank.

Deciding Which Policy is Best for You

When you’re trying to decide which plan is best for you, there are several factors that you will need to consider. Each plan has pros and cons, and getting the best supplemental coverage is one of the best decisions that you can make.

The first factor (and the most important) that you should consider is your finances. The purpose of the Medigap plan is to ensure that your family isn’t drained by medical expenses, but your supplemental coverage shouldn’t stretch your finances too thin either. Before you apply for any coverage, take a long and hard look at your budget and determine how much extra that you can spend. Everyone would love to have a Plan F, which fills in all of the left over expenses, but that coverage comes at an additional cost.

The next factor that you should take a look at is your health. If you’re in poor health and you have several pre-existing conditions, then a Medigap plan that is comprehensive is going to be a better investment. The worse that your health is, the more money that you’re going to spend on medical bills and other health care costs. On the other hand, if you’re in good health with a clean bill of health, then you can consider taking the risk to purchase a small Medigap plan that leaves more holes and saves you money every month.

These are only some of the different factors that you will need to consider. You will need to look at each plan in light of your specific circumstances. Every Medicare enrollee is different, and all of them are going to need a different supplemental plan.

Enrolling in a Medigap Plan

After you’ve decided which Medigap plan is going to work best for you, the next step is to enroll in a supplemental plan. Thankfully, it’s easier than you might think. After you have found the insurance coverage that you’re going to purchase the plan through, all you have to do is contact a Medigap insurance agent. The agent will walk you through the process.

It’s important that you take note of the Medigap open enrollment period. That’s a 6-month timeframe that beings the month that you’re going to turn 65. This 6-month window is one of the most important factors that you should take advantage of when you’re shopping for additional health care protection.

During your open enrollment period, the insurance company can’t decline your application, regardless of how poor your health is or any pre-existing health conditions that you have. Depending on your health, this might be your only chance to get accepted for Medigap protection.

Another advantage of the open enrollment date is that you’ll get the lowest available premiums for your Medigap plan, even if you aren’t in the best health. During the 6-month window, the insurance company can’t raise your premiums, even if you have a severe health problem. After that window is over, then your application is going to be treated like any other application, and they can jack up your rates based on your health. Applying during the open enrollment can save you thousands and thousands of dollars every year.

If you’ve already missed your open enrollment period, don’t worry, there is still a chance of getting affordable coverage. You might be more expensive, but you can’t put a price on the peace of mind that additional health care coverage will bring you.

Want More Coverage?

If a Plan N doesn’t give you all of the additional coverage that you need, then there are other options. If you want to get the most comprehensive coverage, a Plan F is going to be the best choice. Plan F covers every possible gap that is left by original Medicare. If you want to ensure that you have all the coverage possible, then you should consider buying a Plan F policy.

One of the worst things that you can do is not have enough insurance coverage. If you have subpar coverage, you could be responsible for, but having the proper Medigap plan will ensure that it doesn’t happen. The older that you get, the more that you’re going to spend on health care every year, and all of those bills could ruin your retirement savings account.

Questions or Concerns?

I know that shopping for Medicare supplemental coverage can be difficult. There are dozens of confusing terms and options that you will need to navigate. If you have any questions, you can read some of my other articles and hopefully, they will answer those questions. If you need help applying for coverage or need assistance picking a plan, you can contact Medicare directly using their official site (Medicare.gov), or you can call a local Medicare supplemental insurance company.

The best way to get an affordable Medigap plan is to work with an independent insurance agent. Unlike a traditional Medigap agent, independent brokers work with dozens and dozens of Medicare supplemental insurance agencies across the country. These agents can bring a personalized set of quotes directly to you.

Not only will working with an independent insurance broker save you money, but they will also save you time. If you tried to get all of those Medigap quotes by yourself, you could spend hours and hours calling agents. They can connect you with the best companies to meet your supplemental coverage needs. Additionally, they can give you unbiased advice on which policy is going to meet your needs.

You’ve worked for years and years to reach this stage of your life. Retirement is a special time of life when you can kick back and enjoy all of that hard work. Don’t let those increasing medical bills and hospital fees keep you from fulfilling your retirement dreams.

Hopefully, this explanation of Medigap Plan N has given you the information that you need to make an educated decision about your supplemental coverage. If you’ve decided that the broad coverage of Plan N is not the perfect policy, there are nine other options. If you want more information about the other Medigap plans, I’ve also detailed the pros and cons of the other policies as well.

Source: goodfinancialcents.com

Apache is functioning normally

May 3, 2023 by Brett Tams

Health care insurance is constantly changing, especially when it comes to Medicare. The coverage and amount can be confusing, but it’s important that you get the perfect health care coverage that you need.

Medicare is an excellent government program that helps millions of seniors get the health care coverage that they wouldn’t be able to afford through a private insurance company. The problem is that Medicare doesn’t cover everything. There are dozens of coverage areas that the program doesn’t pay for, and those bills could leave enrollees with a massive amount of debt or other expenses.

There is nothing that you can do about the rising cost of health care, but there are a few ways that you can offset those expenses and protect your savings from being drained. The best way to ensure that you aren’t left with a massive amount of bills and other health care costs is to purchase a Medigap plan.

What is a Medigap Policy?

A Medicare supplemental plans are sold by private insurance companies, and they fill in the gaps that are left behind by traditional Medicare plans. There are 10 ten Medigap plans that you can choose from, and all of them have different coverage amounts or bills that they cover. Each of the plans is denoted by a letter of the alphabet, from A to N.

Unlike a Medicare Advantage plan, Medigap plans don’t replace your traditional Medicare coverage. Instead, they work in tandem with your Parts A & B coverage. You will still be responsible for paying your Medicare premiums. It’s important that you realize that Medigap Plan C is not the same thing as Medicare Part C. It can be confusing, but they are two completely different policies with very different benefits.

Medigap plans are standardized by the government, which means that regardless of which company that you choose, the coverage is going to be the same. Each company is required to cover the same expenses, the only difference between companies is how much you’re going to pay for the plan. Some companies are going to have additional benefits, but mostly they are all the same. Because they are all the same, it’s vital that you get dozens of quotes before you pick the one that is going to work best for you.

The best way to do that is to work with an independent insurance agent. Independent brokers work with dozens of highly rated companies across the nation. I highly suggest that you work with an independent agent. If you wanted to get those quotes yourself, you could spend hours and hours calling companies to get those quotes.

Medicare Supplemental Plan C

Now that you know the fundamentals of Medigap plans, let’s look at the specifics of Medigap Plan C. Plan C is not the most comprehensive policy available, but you should still consider purchasing one of these plans. You should look at all of the possible options before you decide which Medigap policy is going to work best for you.

Medicare Supplemental Plan C is going to give you more coverage than both Plans A & B, but there are still some gaps that it doesn’t cover. If you purchase a Medigap Plan C, you get insurance protection from several key categories. One of the most notable is that you will get Part A hospital coinsurance and costs for an additional 365 days after your Medicare coverage has been exhausted. If you’ve ever spent the night in the hospital, then you know that it can be an expensive stay. In fact, just a few nights in the hospital can turn into thousands and thousands of dollars. Having some extra protection could make a huge difference in keeping more money in your bank account.

Another category of coverage is Medicare Part A hospice care coinsurance or copayments. More than likely, these coinsurance fees are not going to be massive, but depending on the hospice care that you need, it could end up being a huge expense, and that’s where your Medigap Plan C would come in.

With a Medigap Plan C, you will also get foreign emergency travel, which is very important. If you plan on doing a lot of traveling in your retirement, then this is one of the most important parts of your supplemental protection that you can get. More than likely, if something were to happen to you, your original Medicare plans would not give you any support for the hospital fees. If something tragic were to happen or you were to get sick while you were outside of the United States, you would have to pay for all of those bills out-of-pocket, which can quickly ruin your vacation. If you have a comprehensive supplemental plan, then it will help pay for 80% of those bills.

Your Medigap Plan C coverage will also pay for the first three pints of blood during a medical procedure. After the first three pints, your original Medicare should pay for any additional blood needed after that, which means that all of those expenses should be covered.

Some of the other less expense is the Medicare Part A deductible (which you probably wouldn’t be paying anyway), skilled nursing facility care coinsurance, and Medicare Part B copayments and coinsurance. All of these can add up to serious bills the more that you need them, but by themselves, they are not going to break your bank.

Is a Medigap Plan C Right for You?

It’s vital that you get the right type of supplemental coverage. Because there are ten different options, it can be confusing trying to decide which one is best for you. There are several different categories and factors that you should look at to ensure that you’re getting the perfect health care coverage.

The first thing that you should look at is your health and any medical problems that you may have. The older that you get, the more that you’re going to spend on medical bills and health care costs. If you’re in poor health or you have some severe health complication, then you can expect to be at the doctor a lot, which is going to translate into expensive bills. Medigap insurance will help pay for those bills and give you the additional coverage that you need.

The next factor to consider is your budget. As a senior, you might be living on a fixed budget, which means you may not have a ton of money to spend on additional insurance coverage. The purpose of Medigap plans is to protect your savings account, but you shouldn’t break your bank every month to have the coverage. Spend some time looking at your finances to decide how much you can comfortably spend on supplemental protection.

Enrolling in a Medigap Plan

Purchase one of these supplemental policies is very easy. A Medigap insurance agent can walk you through the process and help you get the coverage that you need. The application process will not take long, but what’s important is WHEN you apply for your plan.

Before you apply, you need to be aware of your Medigap Open Enrollment Period. This is a 6-month window that starts the month that you start you turn 65. During this period, the insurance company can’t decline your application, even if you have multiple health problems. If you’re in very poor health, this could be your only chance to get supplemental coverage.

Additionally, during the Open Enrollment period, they can’t raise your monthly rates because of your health. After the window has closed, then your application will be treated like any other application, which means that you could get much higher premiums because of your health. If you want to save money, it’s important that you sign up during the first six months.

Have any Questions?

I know that shopping for health care coverage can be challenging and confusing. There are dozens of terms and coverages that seem to make no sense. That’s why I am here to help. I’ve reviewed all of the Medigap options, which can give you the information that you need to make an informed decision about your health care option.

If you still have questions about Medigap coverage, please feel free to contact me or reach out to a Medigap, insurance agent. Your health is the most important thing in your life, and it’s important that you have coverage to protect your finances. Medical bills shouldn’t turn your retirement dream into a retirement nightmare.

Source: goodfinancialcents.com

Apache is functioning normally

April 27, 2023 by Brett Tams

Did you know that the average American has a nearly 70% chance of needing some form of long-term care upon reaching age 65? But did you also know that you may be able to prepare for the event by purchasing long-term care insurance? That’s why we’ve prepared this guide of the 7 best long-term care insurance of 2023.

Before getting into our reviews of the seven best long-term care insurance providers of 2023, scan the table below to see which company you think will work best for you:

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Our Picks for Best Long-Term Care Insurance

Dozens of insurance companies offer long-term care insurance, but below is our list of the top seven, and what each is best for:

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Best Long-Term Care Insurance – Company Reviews

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Maximum Benefits: Varies by provider

Benefit Period: Varies by provider

Waiting/Elimination Period: Varies by provider

GoldenCare, also known as National Independent Brokers, Inc, is a privately held long-term care insurance brokerage firm, and one of the leading such firms in the industry. They provide policies from the top-rated insurance companies in the industry. The company is based in Plymouth, Minnesota, and has been in business since 1976. Their plans are available in all 50 states.

The list of companies they work with includes the following:

GoldenCare also offers critical illness insurance, Medicare supplements and Medicare Advantage plans, prescription drug plans, life insurance, annuities and final expense policies.

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Maximum Benefits: Varies by provider

Benefit Period: Varies by provider

Waiting/Elimination Period: Varies by provider

Like GoldenCare, LTC Resource Centers is also an insurance brokerage specializing in long-term care insurance. Based in Cape Coral, Florida, the company has been in business for more than 40 years. They provide long-term care insurance, short-term care, linked or combination products, Medicare supplements, life insurance, critical illness, and annuities.

A specialization they offer is what is known as asset-based long-term care. It’s a strategy that uses a whole life insurance policy or annuity to provide long-term care coverage, which eliminates the need for an expensive, dedicated LTC policy. A pricing comparison is presented in the screenshot below:

As a broker, they work with multiple long-term care insurance providers. That means to get detailed information you’ll need to set an appointment with a long-term care insurance specialist and make the request. The company’s licensed to operate in all 50 states.

Maximum Benefits: Up to $400 per day or $10,000 per month

Benefit Period: Up to 5 years, or unlimited lifetime benefit

Waiting/Elimination Period: 0, 30, 60, 90, 180 or 365 days

Mutual of Omaha is one of the top individual providers of long-term care insurance. They offer some of the best plans in the industry, including lifetime benefits coverage, multiple elimination periods, and inflation protection. They are a full-service insurance company providing coverage in all 50 states, providing virtually all types of insurance policies.

Mutual of Omaha also offers premium discounts. For example, you can save 15% when you purchase a policy for both you and your partner. You can also save 15% if you’re in good health. There’s even a 5% discount if you are married but your spouse does not purchase a policy.

Maximum Benefits: Up to $7,000 per day, up to a $250,000 lifetime maximum

Benefit Period: Up to maximum daily or lifetime limit

Waiting/Elimination Period: One-time deductible of $4,500 up to $21,000

Like Mutual of Omaha, New York Life is a large, well-established and diversified insurance company. In addition to long-term care policies, they also offer virtually every other type of insurance policy available. Also like Mutual of Omaha, New York Life is a mutual insurance company, which means it’s owned by its policyholders, not shareholders. The company partnered with the American Association of Retired Persons as a preferred provider of long-term care insurance policies.

New York Life provides their NYL My Care long-term care policy. The basic parameters are as follows:

Like other direct insurance providers on this list, New York Life also offers annuities and whole-life insurance policies with long-term care riders.

Maximum Benefits: Up to $750,000 maximum lifetime benefit

Benefit Period: Up to 7 years

Waiting/Elimination Period: 90 days

Nationwide is one of the leading providers of long-term care insurance in America. With a maximum lifetime benefit of up to $750,000, they provide the highest lifetime maximum benefit on our list. They also offer a single, simple, 90 calendar-day elimination period. You can choose between two years and seven years for a maximum benefit period.

The policy will also cover home healthcare, hospice, adult day care, household services, home safety improvements, and even family care. And in a unique twist, nationwide also provides international benefits. If you live out of the country during the benefit period, the policy will pay 50% of the maximum monthly benefit.

Maximum Benefits: Up to $250,000 maximum lifetime benefit

Benefit Period: Up to maximum lifetime benefit limit

Waiting/Elimination Period: 90 days

Brighthouse Financial is an insurance provider that offers two types of products, annuities and life insurance. Either is available with a long-term care rider. The company has $254 billion in assets, serving about 2 million customers.

Brighthouse Financial provides long-term care insurance through its SmartCare plan. It’s a combination plan that adds a long-term care provision to a whole life insurance policy. You’ll get the benefit of long-term care if it’s needed, but you’ll also have a life insurance benefit to pay to your beneficiaries if it’s not, or if there are any funds left over after your long-term-care stay.

The policy will cover adult day care, hospice, and home healthcare, in addition to nursing homes and assisted living facilities, and skilled nursing care.

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Maximum Benefits: Varies by provider

Benefit Period: Varies by provider

Waiting/Elimination Period: Varies by provider

CLTC Insurance Services, or California Long Term Care Insurance Services, is a long-term care insurance aggregator, based in San Francisco. Aggregator is a fancy word for an online insurance marketplace. As an aggregator, CLTC will give you access to a large number of long-term care insurance companies. You can then choose the one offering the plan that will work best for you. The main limitation of this provider is that they offer policies only in the state of California.

In addition to long-term care insurance, they also offer annuities and life insurance policies, both with long-term care riders. These types of policies eliminate the need for a dedicated LTC policy, since the cost of long-term care is paid out of the proceeds of the annuity or life insurance. CLTC also offers critical illness insurance.

Long-Term Care Insurance Guide

What is Long-Term Care?

When an individual reaches a point where they can no longer care for themselves, long-term care becomes necessary. That care can be provided by anyone from family members to nursing homes.

The need for long-term care generally applies when the individual can no longer perform one or more of the six activities of daily living (ADL). This can include inability to dress, groom, go to the bathroom, bathe, eat, or even to move about freely.

In most cases, long-term care becomes necessary after a major health event, like a heart attack or stroke. But it can also be the result of an ongoing, degenerative health condition or simply advancing age.

In most cases, long-term care is provided by a family member. But institutional care may be necessary if the individual is unable to perform several ADLs, which may overwhelm the ability of family members to provide ongoing care.

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How to Purchase Long-Term Care Coverage?

We recommend contacting any of the seven best long-term care insurance providers in this guide. Otherwise, do a search and identify insurance companies that offer long-term care coverage. But be aware that not all insurance companies offer it, precisely because of the many variables. It involves.

When purchasing a policy, be aware of the following:

Like life insurance, it’s best to purchase LTC insurance when you’re young and healthy. That’s when the premiums are lowest.
Consider purchasing a long-term care insurance alternative, like a life insurance policy or an annuity with a long-term care rider (see below). It’s generally much less expensive.
Pay close attention to the maximum benefit paid, whether daily, monthly, annually, or lifetime. It should approximate nursing home costs in your area. (Be aware that these costs vary greatly from one state to another.)
Pay close attention to the benefit period. While the typical number of years an individual needs long-term care coverage is three years, there’s no way to tell what you may need. If you can afford the higher premium, it may be best to go with the longer benefit period, say, five years or longer.
Be aware of the elimination period. The standard is 90 days, but it can be as long as one year. This is not a minor factor, since nursing home care at $8,000 per month could cost you $24,000 with a 90-day waiting period before benefits kick in. The waiting period you choose should match the amount of liquid assets you expect to have available to cover it.
When you take a policy, be prepared to pay the premium for the rest of your life. If you take a policy at 60, stop making the payments at 80, then you need long-term care at 85, you’ll get no benefits from the lapsed policy.

According to the website Consumer Affairs, long-term care insurance premiums look something like this:

Now, the screenshot above reflects only sample averages for very specific policies at ages 55 and 65. The actual premium you will pay will be based on a combination of factors, including your age at the time of purchase, any health conditions you have, as well as the dollar amount and term of the benefits your policy will include.

Finally, given how complicated long-term care insurance is, it wouldn’t be overkill to have the policy reviewed by an attorney before accepting it. If so, an attorney who specializes in elder care will be your best choice.

Who Needs Long-Term Care Coverage?

The short answer to this question is everyone. The unfortunate reality is that people turning 65 have an almost 70% chance of needing some type of long-term care services during their lifetimes. Approximately 37% will require institutional care. And statistically, women and single individuals are more likely to require long-term care than men and married individuals.

If you’re unsure if you need long-term care, check out Jeff’s post, Long term care insurance: do you really need it?.

Though it isn’t well-known outside the industry, there are two basic types of long-term care coverage available. The first is a standalone long-term-care insurance policy.

Like a life insurance policy, medical underwriting will be performed. The insurance company will consider your age, your health condition, your family health history, your occupation, requested benefit levels, and other factors in approving your application and setting the premium level. This is the more costly of the two options.

The other is a hybrid policy. Most commonly, this is life insurance with long-term care benefits. You’ll purchase a basic life insurance policy, then add a long-term care rider to the policy. This will increase the premium on the life insurance policy, but it will be much less expensive than a standalone long-term-care policy.

Meanwhile, you’ll also have a death benefit from the life insurance policy, in addition to long-term-care coverage. But the policy may also include using some or all the death benefits to pay the long-term-care benefits. Your beneficiaries will receive only the amount of the unused death benefit upon your death.

Most of the best life insurance companies offer life insurance policies with this rider.

Another variant of this option is to use an annuity with long-term care rider. Annuities are designed to provide an income stream, very similar to a pension. But similar to a life insurance policy with a long-term care insurance rider, you can also add the rider to an annuity.

Again, it will be less expensive than purchasing a standalone long-term-care policy. And the long-term-care benefits may reduce any death benefit in your annuity. But the provision will be much less expensive than purchasing a standalone long-term-care policy.

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Finding the Right Policy

Long-term care insurance is one of the more complicated insurance types. It also includes more potential variables than other policies. For example, not only will you not know if you will need the coverage at all, but you won’t know when, to what degree, what level of care will be required, or how long it will be needed.

Because of all these variables, the cost of a long-term care insurance policy can be all over the place. But it may be better to pay a little bit more for a more comprehensive policy than to price-shop for the least expensive plan.

Before deciding to purchase a long-term-care insurance policy, first review Jeff’s Podcast episode: Long Term Care Insurance – How much do you need? Given how complicated long-term-care insurance is, it’s best to go in with as much knowledge as possible.

How We Found the Best Long-Term Care Insurance Companies

We used the following criteria to determine the best long-term care insurance companies of 2023:

Maximum Benefits: Given that the cost of long-term care can easily run into hundreds of thousands of dollars, we favored companies with the most generous lifetime benefits.
Benefit Period: One of the most basic problems with long-term care is the uncertainty. There’s no way to know in advance what level of care you might need, or how long it might be necessary. For that reason, we favor the companies that provide the most flexibility in this area.
Waiting/Elimination Period: Just as most insurance policies have deductibles, long-term care insurance uses the waiting period in much the same way. The standard delay on benefits is 90 days. But we prefer companies that offer longer waiting periods, since this will represent an opportunity to lower the cost.

Speaking of cost, as much as we would like to provide a list of average costs per provider, this information simply is not available. That’s because long-term care insurance is highly customized. There’s nothing approximating a “one-size-fits-all” policy, as each policy premium is determined by a multitude of factors.

These include your age at the time you purchase the policy, your general health condition, your family health history, the length and amount of coverage you need, and many other factors. The only way to get a reliable premium figure will be to contact one of the companies above and get a quote.

Best Long Term Care Insurance FAQs

What is long-term care insurance?

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Long-term care insurance is a type of coverage that will provide benefits to pay for your personal care when you’re no longer able to do so for yourself. While the typical long-term-care scenario involves a nursing home, it also applies in lesser situations. That can include assisted living arrangements, home nursing care, and even family care. The policy will begin paying benefits when you qualify for care based on inability to perform several of the ADLs.

What does long-term care insurance cover?

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As mentioned earlier, long-term care insurance benefits begin to apply when you are unable to perform activities of basic living. Depending on the type of policy you have, you’ll receive benefits for a stay in a nursing home, an assisted living facility, skilled nursing care, an adult day care, hospice, and even home care provided by your family.

Some policies will even provide for the cost of modifying your home to better accommodate your capabilities, or the purchase of certain helpful equipment.

How long does long-term care insurance work?

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A typical long-term-care insurance policy will pay benefits between two and five years, though some will go as long as seven, and a few providers offer lifetime benefits. You should be aware that you will need to qualify for whatever coverage term you prefer, and the longer the term, the higher the premium will be.

Is long-term care insurance worth it?

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It really depends on your perceived need for the coverage, and your ability to pay the premiums. Need can be determined by your family history. If you have multiple family members who require long-term care, having the coverage for yourself will be highly desirable. But if you’re in excellent health, and there’s little history of a need for care in your family, you may want to pass on the coverage.

And of course, given the high cost of the premiums, your ability to afford coverage can never be ignored. But if you have very limited financial means, Medicaid may provide benefits for long-term care. However, to qualify your total assets must generally be below $2,000.

Summary of the Best Long-Term Care Insurance Companies

Let’s wrap up this guide by giving you one more look at our list of the seven best long-term care insurance companies of 2023:

Long-term care insurance isn’t inexpensive. But given the unusually high likelihood that will be needed at some point in your life, it’s a policy worth having if you can afford it. And if you can’t, consider taking an annuity or a whole life insurance policy with a long-term care provision.

Source: goodfinancialcents.com

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April 27, 2023 by Brett Tams

What Medicare Assignment Is and How It Impacts You

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If a doctor or other healthcare provider accepts a Medicare assignment for a particular service, a patient covered by Medicare will likely have to pay less out of pocket for that service. Accepting Medicare assignment means the healthcare provider has agreed to charge no more than the amount Medicare approved for that service. It also means the doctor agreed to bill Medicare rather than charging you directly. Providers who don’t accept assignments can charge 15% more and require immediate payment from the patient. A financial advisor can help you develop a financial strategy to pay for your healthcare.

Medicare Assignment Basics

Medicare is the government-sponsored national healthcare plan for about 63 million Americans over age 65. Original Medicare is the fee-for-service plan that includes Medicare Part A, which covers hospital costs. And it also includes Medicare Part B, which pays for other healthcare services, including doctor’s office visits.

Almost all doctors accept patients covered by Medicare. And almost all doctors who take Medicare patients accept Medicare assignments. Doctors who accept Medicare assignments are also known as assignment providers, participating providers and Medicare-enrolled providers.

A Medicare assignment provider agrees to charge no more than the Medicare-approved price for a specific service. The doctor or other provider also agrees to bill Medicare directly, rather than charging the patient on the day of service. This means that if you go to a Medicare-participating provider, you won’t usually have to pay anything at the time of service. And you will likely pay less out-of-pocket when all is said and done.

While Medicare assignment is relevant to people covered by Original Medicare, it doesn’t affect people covered by Medicare Advantage plans. These plans have their own rules.

How Medicare Assignment Affects Your Cost

Doctors and other providers who don’t accept Medicare may charge as much as 15% more than the Medicare-approved amount. The exact percentage varies by state. If you go to a non-accepting provider, you may have to pay the extra over the Medicare-approved amount, plus the 20% share of the cost Medicare passes on to all Medicare-insured patients.

For example, consider a visit to an occupational therapist who charges $120 for a treatment session. The Medicare-approved cost of the service is $100.

If the therapist accepts the Medicare assignment, they will charge you $100 and bill Medicare. After Medicare pays $100, you’ll owe 20%, or $20 for coinsurance. That’s if you have already met your Part B deductible. If not, Medicare may not pay anything, up to the amount of the deductible, and you may be responsible for the entire bill.

If the therapist does not accept Medicare assignment, they may charge 15% more than the Medicare-approved amount, or $115. Plus they may ask you to pay the entire amount. If that happens, you have to file with Medicare to get reimbursement.

Whether you or the provider sends the invoice to Medicare, Medicare will pay only 80% of the approved amount, or $80. Your out-of-pocket costs in this case will be $120 minus $80, or $35 instead of $20.

Finding Medicare Assignment Providers

Nearly all healthcare providers accept Medicare assignments. One way to check is to use Medicare’s online tool. You can filter these searches for, among other things, whether the provider accepts Medicare assignments.

You can also ask the provider whether they accept Medicare when you visit. In addition, you may also request information in advance detailing how much they’ll bill Medicare for the service and how much you’ll be expected to pay at the time of the visit.

Bottom Line

Medicare assignment means a doctor or other healthcare provider will charge no more than the Medicare-approved amount for a particular service. This usually means lower out-of-pocket costs for patients who are covered by Medicare. It also means the provider will bill Medicare rather than expecting the patient to pay the full amount at the time of service. Nearly all doctors accept Medicare assignments. But to be sure, you can check Medicare’s provider search tool for more information or ask before your next doctor’s visit.

Healthcare Tips

Consider discussing how you plan to pay for your healthcare with a financial advisor. Finding such an expert doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area. And you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
Healthcare costs can be a significant issue for retirees. How big an issue? Median out-of-pocket retiree healthcare costs for 2018 came to $4,311, according to one study. That means after Medicare or other insurance paid everything it would pay, the retiree had to come up with that much in cash to pay for healthcare in that one year alone. That’s why having a plan to pay for healthcare is an important part of retirement planning.

Mark Henricks
Mark Henricks has reported on personal finance, investing, retirement, entrepreneurship and other topics for more than 30 years. His freelance byline has appeared on CNBC.com and in The Wall Street Journal, The New York Times, The Washington Post, Kiplinger’s Personal Finance and other leading publications. Mark has written books including, “Not Just A Living: The Complete Guide to Creating a Business That Gives You A Life.” His favorite reporting is the kind that helps ordinary people increase their personal wealth and life satisfaction. A graduate of the University of Texas journalism program, he lives in Austin, Texas. In his spare time he enjoys reading, volunteering, performing in an acoustic music duo, whitewater kayaking, wilderness backpacking and competing in triathlons.

How Coverage Works

Who Qualifies?

Adults Over 65

Individuals with Disabilities

Who Does NOT Qualify for Medicare

How to Enroll

Medicare is Not Medicaid

What is Supplemental Insurance and What Does It Cover?

What is Medicare Advantage and How Does It Work?

How to Find the Best Coverage

Different Types of Medicare Advantage Plans

Who is Eligible for a Medicare Advantage Plan?

Getting Quotes on Medicare Advantage Plans

What Is Medicare?

When Are You Eligible for Medicare?

Are You Automatically Enrolled in Medicare at Age 65?

How to Enroll in Medicare

Bottom Line

Retirement Planning Tips

Who can sign up for Medicare Easy Pay?

How do you sign up for Medicare Easy Pay?

What information do you need to sign up for Medicare Easy Pay?

How long does it take to activate Medicare Easy Pay?

What if there’s a problem with the payment?

How do I know whether a service will be covered?

What makes a service medically necessary?

What does ‘medically unreasonable and unnecessary’ mean?

Can I appeal if I’m denied based on medical necessity?

What is a Medigap Policy?

Medicare Supplement Plan G

Enrolling in a Medigap Policy

Any Questions?

What is a Medigap Policy?

Medigap Plan N Coverage

Deciding Which Policy is Best for You

Enrolling in a Medigap Plan

Want More Coverage?

Questions or Concerns?

What is a Medigap Policy?

Medicare Supplemental Plan C

Is a Medigap Plan C Right for You?

Enrolling in a Medigap Plan

Have any Questions?

Our Picks for Best Long-Term Care Insurance

Best Long-Term Care Insurance – Company Reviews

Long-Term Care Insurance Guide

What is Long-Term Care?

How to Purchase Long-Term Care Coverage?

Who Needs Long-Term Care Coverage?

Finding the Right Policy

How We Found the Best Long-Term Care Insurance Companies

Best Long Term Care Insurance FAQs

What is long-term care insurance?

What does long-term care insurance cover?

How long does long-term care insurance work?

Is long-term care insurance worth it?

Summary of the Best Long-Term Care Insurance Companies

Medicare Assignment Basics

How Medicare Assignment Affects Your Cost

Finding Medicare Assignment Providers

Bottom Line

Healthcare Tips

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