How Much Will Medicare Cost Me?

"Nurse measuring blood pressure of senior woman at home. Looking at camera, smiling.?" by agilemktg1 is marked with CC PDM 1.0

Despite the common misconception, Medicare is actually not free.

Additional fees may also apply, based on which plan you choose- original Medicare or Medicare Advantage. The Advantage plan means enrolling in Part C, which will offer a wide range of premiums, deductibles, and out-of-pocket payments. Those who choose original Medicare often enroll in a Part D prescription plan as well, and typically apply for a Medigap supplement to help cover copays, coinsurance, and deductibles which will not be covered otherwise. For a more in-depth comparison of original Medicare and the Medicare Advantage plan, please refer to my next post.

Medicare can be broken down into Part(s) A, B, C, and D respectively.

Part A- Hospital Insurance

Premium

• Part A is funded by your payroll taxes.

• Assuming you/your spouse have worked 40 quarters by the time you have joined Medicare, you will be charged no additional fees for Part A.

• If you have worked only 30-39 quarters by this time, you will be charged a premium of roughly $259.

• If you have worked 30 quarters or less, you’ll be charged a premium of around $471.

  Hospital Inpatient Deductible and Coinsurance

• Pay $1,484 deductible for each benefit period.

• Payment by days spent under hospital care are as follows:

  • Days 1-60: $0 coinsurance per benefit

  • Days 60-90: $371 coinsurance per day of every benefit

  • Days 90+: $742 coinsurance per “lifetime reserve day” of every benefit.

    • Should you exceed 60 lifetime reserve days, you will pay full cost.

Part B- Doctors Insurance

Premium

• Standard cost is $148.50, although this can vary depending on state and year. Everyone who is enrolled in Medicare is required to pay this nominal fee.

  • The rate will also vary individually, meaning those who claim Social Security benefits will likely pay less than the standard, while those with a higher income will likely pay more.

    Deductible and Coinsurance

• Deductible of roughly $203 on average.

• After the value of this deductible has been reached, a beneficiary typically pays only 20% of Medicare approved amount (this 80/20 split cost rate is not universal, so make sure to determine what your plan offers).

Part C- Medicare Advantage

Premium

• Varies by plan, but many are referred to as “zero premium”.

  • Beneficiaries of Advantage are still required to pay the premium for Part B, but typically there will be no additional premium on these plans as the cost is included.

    Deductible and Coinsurance

• There is not a standard cost for services because this cost varies greatly with each individual plan.

• Because Advantage plans are not regulated by the government the same way traditional Medicare is, costs are determined by individual companies and plans.

"Healthcare Costs" by Images_of_Money is licensed under CC BY 2.0

Part D- Prescription Plan

• Varies by plan

• Throughout the year you will pay premium, yearly deductible, copayments/coinsusrance, and costs in the coverage gap.

• Drug costs will vary based on several factors:

  • Coverage (which drugs are covered by your plan)

  • Drug “tier” (determined by individual company and plan)

  • Pharmacy

  • Drug benefit phase (whether deductible has been reached or if you’ve reached catastrophic coverage phase)

  • Income

Premium

• The cost of a monthly premium will vary based on which plan you choose.

• The part D premium cost is in addition to your premium for part B those who opt for original Medicare alongside a part D drug plan. This means it’s compulsary you remember to pay two seperate bills in order to retain insurance benefits.

  • However, for beneficiaries of a part C Advantage plan or Medicare cost plan with drug coverage, it is possible your monthly premium will include the cost of drug coverage.

• Majority of people only pay their Part D premium, however you will be required to pay more if you enroll past the deadline.

  Deductible & Coinsurance

• The deductible for a prescription drug plan is completely separate from the deductibles for parts A and B.

• As of this year, no Medicare drug plan can exceed a yearly deductible of $445. However, this does not necessarily mean your deductible will be this high- some plans don’t even have a deductible!

• Once you and your plan have reached $4,130 spent on your drug plan (this is a combined cost and includes your deductible), you will not have to pay more than 25% of drug costs.

• Catastrophic coverage comes into play once you’ve spent $6,550, and in result exit the coverage gap.

  • This means that you will only pay a small coinsurance or copayment fee for the rest of the year, so long as the prescriptions are covered by your plan.

If you still have questions, don’t hesitate to contact me for assistance!

Will my COVID Vaccine be Covered?

"Syringe and Vaccine" by NIAID is licensed under CC BY 2.0

Due to the FDA’s recent authorization of the vaccine, you may be wondering whether or not your plan will cover the cost.

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Original Medicare will cover 100% of the cost for the COVID-19 vaccine.

That’s right, no cost-sharing for Medicare beneficiaries! Yay! However, it is imperative to note that members of Medicare advantage will have their claim rejected if billed under Part(s) C or D.

So what should I do if I am a Medicare Advantage member?

Advantage beneficiaries must present their traditional Medicare card to the pharmacy to be billed, rather than using your Advatage card. Failure to present the traditional card rather than the Advantage will likely result in out-of-pocket charges.

New Year, New Plan?

"Medicare" by 401(K) 2013 is licensed under CC BY-SA 2.0

With all the new available Medicare products, you may have changed to your health plan during Annual Enrollment Period (AEP) this past fall. The first three months of the year are known as Open Enrollment Period (OEP) , meaning you have one opportunity to change your plan for the remainder of the year.

If you do have a new plan for this year, remember to…

• Review your plan materials to confirm plan benefits.

• Check that all your current doctors and providers are notified of your new plan, and remain in network. Otherwise, you make be over charged for services!

• Ensure your pharmacy is aware of your new plan.

• Utilize value-added benefits such as dental, vision, and hearing.

Need additional help?

I’m based in Nashville and an appointed agent for BlueCross BlueShield, Aetna, Cigna, United Health Care, Humana, Bright Health, Oscar, AmBetter, Mutual of Omaha and more. Feel free to contact me regarding any questions or concerns.

Medicare Annual Open Enrollment for 2020

Are you ready?

Do you have questions?

I have answers!

Initial Enrollment Period (IEP)

The best time to enroll in Medicare is when you first turn 65, unless you’re still working and have employer provided health insurance. The three months prior to the month in which you turn 65, the month of your birthday, and the three months after your birthday month is your IEP. During that time, you can enroll in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). In most cases, if you’re already signed up for Social Security benefits at the time you turn 65, you will automatically be enrolled for Medicare parts A and B. If not, you’ll need to either sign up for Medicare online or contact Social Security.

Since COVID has come along, the Social Security offices have been closed, forcing consumers to apply for Medicare exclusively online. Do not delay doing so, if you know you want Medicare. I have been seeing some people getting surprised at how long it takes to get their enrollment completed.

Annual Enrollment Period

This is the period from October 15–December 7. I can talk to you about plans and changes beginning October 1st, but no enrollments or changes can be made until October 15th. Any changes will take effect January 1.

What changes can be made?

• You can switch from Original Medicare to Medicare Advantage, or vice versa.

• You can switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.

• You can enroll in a Medicare Part D plan if you didn’t do so when you were first eligible (a late enrollment penalty may apply.)

What about Medicare supplements?

Medicare supplements are not limited to the same enrollment periods as Part D and Medicare Advantage plans. You can change your supplement plan at any time during the year, as long as you can pass the health questions or have a guaranteed issue scenario.

Questions? Concerns?

Want a review of your plan?

Let me know. I’m based in Nashville and an appointed agent for BlueCross BlueShield, Aetna, Cigna, United Health Care, Humana, Bright Health, Oscar, AmBetter, Mutual of Omaha and more.

Medicare Advantage Plans versus Fee-for-Service Medicare

The number of Medicare Advantage plans offered has increased 49 percent since 2017. Medicare Advantage plans usually offer perks that traditional Medicare cannot offer, such as vision, dental, or hearing benefits. 

As the number of plans offered has increased, the cost of the plans has decreased.  

I ran across a study (link below) from Health Payer Intelligence about the cost of Medicare Advantage plans that is relevant and timely. The fact is that when money is saved, it means people aren't getting as much treatment...and everyone wants to save money, but not usually by limiting their own treatment.

Medicare Advantage Plans Increase, Improve Quality Over FFS Plans

Telehealth is Here for Good

Dramatic Growth in Telehealth

Telehealth, also known as telemedicine, is the act of seeking virtual medical care by either telephone or video conferencing. It’s been around for several decades, but with the onset of the COVID-19 pandemic, the use of telehealth for non-emergency medical care has skyrocketed as efforts have been made to keep both medical workers and patients safe from exposure to the coronavirus.

Many Americans are connecting with a doctor electronically for the first time, but the practice has been growing for the past few years as coverage for it has grown. In 2015, only 5% of doctors reported using telemedical services, but its use grew to 22% of doctors in 2015. From 2015 to 2018, telehealth grew 340% as more private insurers and Medicare cover it.

BlueCross Blue Shield Embraces Telehealth

After embracing the use of telehealth in various applications in recent years, BlueCross BlueShield of Tennessee has announced that they will be the first major health insurer in the country to make a permanent commitment to its use. From mid-March to mid-May of this year, BCBS processed 50 times more telehealth claims compared to the same time last year.

As the state’s largest insurer, the announcement that BlueCross BlueShield of Tennessee is fully embracing telehealth indicates that the practice will continue to grow, with new applications that include in-network specialists such as occupational, physical and speech therapists, as well as ABA therapy and other behavioral health care.

If you haven’t used telehealth yet, chance are you will soon.

For questions or more information, please contact me. I cover the state of Tennessee and represent many health care providers.

Special Enrollment Periods for Medicare

The Annual Enrollment Period (AEP) for Medicare is October 15 to December 7. During this period, anyone can make changes to their coverage, such as:

• Switching from one plan to another

• Switching from Original Medicare to a Medicare Advantage plan

• Switching from one Advantage plan to another

• Enrolling or dropping a Prescription drug plan

Changes made during the Annual Enrollment Period become effective the first day of the following year.

Can You Make Changes During Other Times of the Year?

The answer is - yes, under certain circumstances.

Medicare allows changes to your coverage during Special Enrollment Periods (SEP’s). Rules about when you can make changes, and the type of changes allowed, are different for each SEP. See the Medicare website for particulars and the full list, but here are the basic circumstances:

• Change of Address - you move to an area that’s out of the range of your plan or to where there’s better options, you move back to the U.S. from another country, you move into or out of an assisted living facility, you are released from prison.

• Loss of Coverage - you become no longer eligible for Medicaid, you lose coverage provided by your employer or union, you lose creditable coverage for drug coverage that’s as good as Medicare, you leave a Medicare Cost plan that provides drug coverage, you drop a Program of All-inclusive Care for the Elderly (PACE) plan.

• Change of Coverage - you are able to enroll in a plan provided by your employer or union, you enroll in a drug plan such as one offered by TRICARE or the VA, you enroll in a Program of All-inclusive Care for the Elderly (PACE) plan.

• Your Plan’s Contract with Medicare Changes - Medicare cancels or sanctions your plan’s contract, your Medicare Advantage Plan, Medicare Prescription Drug Plan, or your Medicare Cost Plan's contract with Medicare isn't renewed.

Special Election Period Available for Applicable Individuals Affected by COVID-19

The coronavirus has impacted just about everything in our culture, and Medicare is no exception. Centers for Medicare & Medicaid Services (CMS) has implemented an SEP for Medicare Advantage and Part D beneficiaries affected by COVID-19. The SEP is effective nationwide and runs from March 1, 2020 through June 30, 2020.

To be eligible, beneficiaries must reside in an area that Federal Emergency Management Agency (FEMA) declared an emergency or major disaster due to COVID-19 (see www.fema.gov/disasters for list). Beneficiaries who do not live in an impacted areas, but receive help with healthcare decisions from someone who does, is also eligible.

Need Help with Medicare?

As you can tell, there’s lots of rules with SEP’s, and Medicare in general can be very confusing. I’ll be glad to help if you need it.

Medicare Expands Telehealth Coverage to Include Coronvius

In response to the onset of the Coronavirus in the US, the Trump Administration announced the Coronavirus Preparedness and Response Supplemental Appropriations Act on March 17, 2020. The Act, which was made effective on March 6, and is considered to be temporary and grants patients access to care through telehealth during the COVID-19 outbreak.

Change Was Made to Limit Exposure to the Coronavirus

Medicare telehealth allows beneficiaries access to their physicians through virtual visits. Prior to the announcement, telehealth services for Medicare beneficiaries was limited to certain circumstances, such as beneficiaries in rural areas who lived a long distance from medical facilities. Since the Coronavirus is so easily transmitted, the change will limit the risk of exposure and the transmission of the virus for both healthcare professionals and their patients. The new change will allow beneficiaries to receive telehealth services in their home.

Scope of New Telehealth Coverage

With the change, beneficiaries will now be able to access a wide range of services from healthcare providers, including physicians, nurses, nurse practitioners, and psychologists. In an effort to alleviate the strain on emergency rooms and prevent the spread of the virus, beneficiaries will now be able to receive services such as routine office visits, mental health counseling, and preventive health screenings through telehealth. The complete list of services available through telehealth can be found here.

Will Medicare Pay the Same Amount for Telehealth Services?

Yes. Medicare will pay the same amount for telehealth services as it would if the service were furnished in person. If there are different rates for the service conducted in the office versus the facility (the site of service payment differential), Medicare will use the facility payment rate when services are furnished via telehealth. Regarding beneficiary out of pocket costs, the use of telehealth does not change the out of pocket costs for beneficiaries with Original Medicare. As a general rule, beneficiaries are still liable for their deductible and coinsurance. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

I hope this information helps. Please contact me with any questions.

Essential Health Benefit Coverage and the Coronavirus (COVID-19)

The outbreak of the coronavirus has brought trying times for all Americans, but particularly for seniors since they are at a higher risk for complications from the virus. Questions regarding coverage have added confusion to the mix. In response, the Centers for Medicare & Medicaid Services (CMS) recently published an FAQ (frequently asked questions) post to provide some answers.

The FAQ’s were posted on March 12, 2020, and can be found here. Additionally, I will try to provide some insights.

The Good News - You’re Covered for Diagnosis and Treatment

Essential Health Benefits (EHB) does currently include coverage for the diagnosis and treatment of COVID-19. Coverage detail may vary by plan, and some plans may require authorization, but at it stands now, “EHB generally includes coverage for the diagnosis and treatment of COVID-19“ according to the post. Additionally, many health plans have announced that they will be waiving any cost-sharing requirements for COVID-19 diagnostic tests, and many states are requesting or requiring that all health plans in their state do the same.

Please note that for non-Medicare health plans, the co-pays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

You’re Also Covered for Quarantine and Hospitalization

According to the post, “Medically necessary isolation and quarantine required by and under the supervision of a medical provider during a hospital admission are generally covered as EHB.“ Plan vary regarding cost-sharing, and some plans may require pre-authorization, but you’re covered.

Self-quarantine in a home does not require coverage as an EHB, but certain medical benefits involved in the home quarantine may be covered as part of EHB if they are required by and done under supervision of a medical professional.

The Trump administration announced on March 16 that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement on a temporary basis in order to combat the pandemic. Medicare will pay for office and hospital telehealth visits and include a wide range of providers including nurse practitioners, clinical psychologists and social workers. Telehealth visits will be reimbursed for the same amount as in-person visits.

Will a COVID-19 Vaccine be Covered?

A coronavirus vaccine is still 12-18 months away from being available, but it will be covered if it’s recommended to be by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). A health plan is not required to cover the cost of the vaccine until the beginning of the plan year that is 12 months after the recommendation, but many plans may voluntarily provide coverage before the required date. They may also cover the cost sharing portion of the benefit.

Please stay safe and keep your socializing at a distance during these trying times. I am available, so please don’t hesitate to contact me with any questions or concerns that you may have. Rules regarding coverage are subject to change, and I’ll continue to keep you informed.

What is a Medicare Select Plan?

If you Google “Medicare Select plan,” you will see numerous results followed by various letters (medicare select plan f, medicare plan b, etc.). What are Medicare Select plans, and what do the letters mean?

The simple answer is that a Medicare Select plan is a Medicare Supplement (Medigap) policy that offers the same benefits as a Medicare Supplement plan, except a Select plan limits your coverage to a network of doctors and hospitals for inpatient, non-emergency stays. The various letters define the benefits offered in the plan and correspond to the same letters in the ten standardized Medicare Supplement plans. 

Advantages of a Medicare Select Plan

• Lower Premiums - premiums for Medicare Select plans can be significantly lower than the premiums for a regular Medigap plans with the same benefits (a Medicare Select Plan N versus a regular Medigap Plan N).

• Same Benefits as Medicare Supplement - plans with the same letters have the same paid benefits, but you are limited to which hospitals you may use.

Disadvantages of a Medicare Select Plan

• Not Available Everywhere - Medicare Select plans are not available in all states. Insurers only offer Medicare Select plans if they have an agreement with a network of medical providers in a given area.

• Must Remain In-Network - in most non-emergency circumstances, the insured won’t receive benefits if they use an out-of-network provider.

• Referrals Required - Medicare Select enrollees generally need to get a referral from their primary care doctor in order to see a specialist or other provider in the network.

Is a Medicare Select Plan Right for You?

You may want to consider a Medicare Select plan if:

• Your preferred healthcare provider is in the carrier’s network

• You need or want lower premiums

You may want to consider a traditional Medicare Supplement plan if:

• You want wide, national access to doctors

• Your preferred healthcare providers aren’t in the Select carrier’s network

• You travel frequently

If you have questions, feel free to contact me. As an independent broker, I have lots of options available and can help choose the best plan for you.

Using the New Medicare Planning Tool

In October of 2019, the Centers for Medicare & Medicaid Services (CMS) released the first major update to their Medicare Plan Finder in over a decade. In order to appeal to a more tech savvy clientele, the overhaul was designed to make the tool both easier-to-use and more mobile-friendly. Initially it hit a few bumps in the road, and there were complaints about misinformation and things not working correctly, but those problems are being addressed.

The Medicare Plan Finder is the most used tool on Medicare.gov, and the updated tool creates an entirely new experience for consumers. After creating an account and logging in to the site, users can now enter their zip code and easily find and compare plans available in their area.

What’s New

With the new tool, users can:

• Compare pricing between Original Medicare, Medicare Part D prescription drug plans, Medicare Advantage plans

• Compare up to three Part D or three Medicare Advantage plans in a side-by-side view

• Enter a personal drug list and find the Part D plan that best meets their needs

The new Plan Finder also offers Webchat for customer support, and it has feedback buttons for reporting customer experience.

Easy to Compare Plans

In the side-by-side comparison, plans can be filtered by:

• Star Rating

• Carrier

• What the plan covers (Dental, Vision, Hearing, Transportation, Fitness).

Plans can also be sorted by:

• Lowest yearly deductible

• Lowest drug and premium cost

• Lowest monthly premium

Prescription Drug Lists

One big difference with the new tool is the change in prescription drug lists. Before, drug lists could be created with a drug list ID and a password date. Now, users must enter their Medicare number in order to create a drug list, which means that people who are not yet enrolled in Medicare cannot preview the search tool without having to submit their drugs every time. Many people don’t like this change, but CMS is unlikely to switch back to their old ways.

Something for Everyone

With approximately 10,000 people joining the ranks of Medicare each day, the new tool is designed to be modern and easy to use. However, for beneficiaries who prefer paper and a phone call to an online experience, Medicare will still offer the Medicare & You handbook and customer service over the phone at 1-800-MEDICARE.

If you have questions or need guidance, please feel free to contact me by phone or email.

Medicare and Working Past Age 65

According to the United States Department of Labor, Bureau of Labor Statistics, more than 23% of Americans aged 65 or older are working either part-time or full-time. By 2024, It is projected that 13 million people aged 65 and older will be working. Although they make up a small percentage of the overall work force, the age groups 65 to 74 and 75-and-older are projected to have faster rates of labor force growth annually than any other age groups. 

The Reason People Aged 65 and Older Are Working

A combination of reasons are precipitating the change:

• There are more people age 65 or older - baby boomers are a large group of Americans born between the years 1946 and 1964. By the year 2024 they will have all reached ages 60 to 78. More older people leads to more older people in the work force.

• People over age 65 are healthier and have a longer life expectancy than previous generations. A longer life expectancy means people need more money for retirement.

• People over age 65 are better educated, which increases their likelihood of staying in the labor force.

• Changes to Social Security benefits and employee retirement plans are creating incentives for Americans to work longer.

Insurance Options for Workers 65 and Older

If you enrolled in Social Security before your 65th birthday, you will automatically be enrolled in Medicare Parts A and B. That’s usually a good thing, but if you're still working at age 65, you should know that you may or may not want to enroll in Part B right away. While Medicare Part A is free for most people, Part B requires a premium, so it’s important to consider your options. For example, you may have good health insurance through your employer and want to keep it, or your spouse may be on your employer plan, which may require you to keep it.

One thing you don’t want to do is pay for two plans. If you do enroll in both employer coverage and Medicare Part B, the employer plan becomes the primary payer in cases where there are more than 20 employees. In this situation Medicare only pays for covered services that the employer plan doesn’t… which means that you’re paying two premiums but getting little in return for your money.

Size of Company Matters

If your employer has 20 or more employees and you are 65 or older, you have the right to delay enrolling in Medicare until you stop working or the coverage terminates, whichever happens first. When you do stop working or coverage ends, you have a special enrollment period of up to eight months to sign up for Medicare without incurring any late penalties. 

If your employer has 20 or fewer employees, your employer is allowed to decide when Medicare-eligible employees must drop the employer plan and sign up for Medicare. If the employer requires you to enroll in Medicare, then Medicare becomes primary and the employer plan provides secondary coverage. If you fail to sign up for Medicare when required, you will essentially be left with no coverage. 

When It’s Time to Enroll

When you turn 65, you may want to enroll in Medicare Part A during your Initial Enrollment Period (IEP).   this time. There is no premium for Part A as long as you or your spouse worked and paid Medicare taxes for at least 10 years.

When you decide to stop working, you can enroll in Medicare Parts B and Part D during your Special Enrollment Period (SEP) and avoid any late enrollment penalties. In order to avoid a gap in coverage, plan to enroll in Part B about 2 months before you plan on retiring, because processing can take up to 6 weeks.

Medicare is definitely confusing because there’s so much to know. If you have any questions, please feel free to contact me. I am licensed for all of Tennessee and am a broker appointed with Aetna, Blue Cross, Cigna, Humana, and United Health Care, to name a few.

Medicare ‘Part B’ Premium Will Increase 7% in 2020

On November 8, 2019, the Centers for Medicare and Medicaid Services announced that the Part B premium, which covers doctors’ visits and outpatient care, will increase from $135.50 per month to $144.60 per month beginning in January, 2020. The increase of $9.10 per month follows a $1.50 per month increase that took effect at the beginning of 2019.

The $144.60 premium applies to beneficiaries who file their taxes individually and are taxed on $87,000 or less and for those filing jointly, $174,000 or less. Upper-income retirees who pay higher premiums will also see an increase in premium rates, with the wealthiest couples paying a total of nearly $1,000 per month in Medicare Part B premiums.

Additionally, the deductible for Part B coverage will go from $185 to $198 in 2020, an increase of 7%.

Each year, CMS adjusts the Medicare premiums, deductibles, and copayment rates according to the Social Security Act. The increases for 2020 are largely a response to rising spending on physician-administered drugs, which results in higher costs.

The announcement came nearly a month after the Social Security Administration set a modest 1.6% cost-of- living adjustment to benefits in 2020, which works out to approximately $24 a month for the average retired worker. Since Part B premiums are typically deducted from monthly Social Security checks, the higher Medicare Part B premium will cut into retirees’ monthly Social Security payments.

Questions? Give me a call.

Seniors, BlueCross, and Nashville YMCA Membership - an Update

Many Nashville area seniors were recently disappointed to learn that the Tennessee State Alliance of YMCA’s had decided to discontinue the popular Silver Sneakers program. The program is the nation's largest fitness program for seniors, and the decision was destined to affect as many as 10,000 Nashville seniors and 44 Nashville area YMCA facilities, according to an article in the Tennessean. Negotiations had been ongoing since January of 2019, but officials said they could find no way to make the program align with their individual membership pricing models. The move would affect 350 other YMCA facilities scattered throughout Tennessee, many in rural areas.

Think of Silver Sneakers as a network of gyms, and the YMCA pulled out of that particular network.

Good news was announced this week for members of BlueCross Blue-Shield’s Medicare plans: they will be able to keep their free access to YMCA facilities. As announced in a Tennessean article dated October 18, 2019, BlueCross will offer American Specialty Health’s Silver&Fit program as an alternative to the Silver Sneakers program beginning January or 2020. In addition to offering free Y access, the Silver&Fit program also offers access to other fitness centers, plus home fitness kits, online fitness classes, and other wellness resources. Silver&Fit has had a presence in Tennessee YMCA’s since 2014.

I’m a Medicare agent for BlueCross, as well as all the other major players in the Tennessee market. Please call me if you would like to know more.

Photo courtesy of Library of Congress

Medicare Enrollment Dates for 2019-2020

The season is upon us for enrolling in Medicare or changing your Medicare coverage.

Here’s the Important Dates to Know

Annual Enrollment: October 15, 2019 to December 7, 2019

During Annual Enrollment, you can:

1. Switch between Original Medicare (Parts A (hospital) and B (outpatient)) and Medicare Advantage plan

2. Add or drop Medicare Part D (prescription drug)

3. Switch from one Medicare Advantage plan to another, or from one Medicare Part D plan to another

General Enrollment: January 1, 2020 - March 31, 2020

During General Enrollment, you can:

1. Sign up for Medicare Part A and/or Part B if you didn't when first eligible and if you're not eligible for a Special Enrollment Period. A late enrollment penalty may apply. Coverage goes into effect on July 1, 2020.

2. People who enroll in Medicare Parts A and B during the general enrollment period also have the option to enroll in Part D or a Medicare Advantage plan from April 1 - June 30.

Medicare Advantage Open Enrollment: January 1, 2020 - March 31, 2020

During Medicare Advantage Open Enrollment, you can:

1. Switch from one Medicare Advantage plan to another. Your plan change takes effect one month after you enroll.

2. Switch from Medicare Advantage to Medicare Parts A and B plus a Medicare D plan. Your plan change takes effect one month after you enroll.

Initial Enrollment: 3 months before the month you turn 65 and ends 3 months after the month you turn 65

In additions to these dates, remember that in your Initial Enrollment Period, you can:

1. Sign up for a Medicare D Drug plan

2. Sign up for a Medicare Advantage plan

3. Sign up for a Medicare Supplement plan

In order to enroll in a Medicare Advantage plan or Medicare supplement, you will need to have both Parts A and B.

It’s all a bit confusing, but I’m here to help. Please feel free to contact me with any questions.

The image "open enrollment" by MedicareMall.com is licensed under CC BY-ND 2.0

The Open Enrollment Period for Medicare - What You Need to Know

The Medicare Annual Enrollment Period (AEP) is the time-frame when you can make changes to your Medicare Plan each year.

Here’s what you need to know:

Q: When is it?

A: The annual Medicare Open Enrollment period begins on October 15th and continues until December 7th. I can talk to you about plans and changes beginning October 1st, but no enrollments or changes can be made until October 15th. Any changes will take effect January 1.

Q: What can I change during the Open Enrollment Period?

A:  You can make changes to various aspects of your coverage, including:

• You can switch from Original Medicare to Medicare Advantage, or vice versa

• You can switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another

• You can enroll in a Medicare Part D plan if you didn’t do so when you were first eligible (a late enrollment penalty may apply)

Q: Anything new this year for people in Tennessee?

A: There is movement in the Tennessee market, and we are seeing carriers improve their Medicare Advantage plans. It’s exciting to see consumers get more for their money from one year to the next - it hardly ever works that way in the insurance world!

Q: Do I have to do anything if I don’t want to make changes?

A: If you’re already enrolled and happy with your plan, you don’t need to do anything. However, please be aware that premiums can change and plans can be discontinued by the insurance companies. If your premium is changing or your plan is being discontinued and cannot be renewed, you will receive a notice from your carrier prior to open enrollment. Let me know if you have questions.

Q: What if I’m dissatisfied with the changes I make during AEP?

A: If you are enrolled in a Medicare Advantage plan and are dissatisfied with it, you can make changes during the Medicare Advantage Open Enrollment Period (MA OEP), which runs from January 1 to March 31. During this time, you can switch from one Medicare Advantage Plan to another or switch to Original Medicare with or without a Part D prescription drug plan. Only one switch can be made during OEP per year, and changes made during the Medicare Advantage Open Enrollment Period will take effect on the first day of the following.

Additionally, if you didn’t sign up for Medicare A and B when you were first eligible, you can do so during the period from January 1 to March 31, with coverage effective July 1.  A late enrollment penalty may apply.

Q: May I change my Medicare supplement during AEP?

A: Medicare supplements are not limited to the same enrollment periods as Part D and Medicare Advantage plans. You can switch your supplement at any time during the year, as long as you can pass the health questions or have a guaranteed issue scenario.

Questions? Concerns?

Want a review of your plan?

Let me know. I’m based in Nashville and an appointed agent for BlueCross BlueShield, Aetna, Cigna, United Health Care, Humana, Bright Health, Oscar, AmBetter, Mutual of Omaha and more.

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How do HSA's Work with Medicare?

Let’s start with some definitions.

An HSA is a Health Savings Account. If you’re reading this post, you likely know that an HSA allows individuals to contribute pre-tax dollars to cover medical costs in a high-deductible health plan. You must have a high-deductible health plan in order to have an HSA and be compliant with IRS rules. Money contributed to an HSA is not taxed as long as it is used to pay for qualified medical expenses. An HSA can either be managed by an employer or by a bank, credit union, or insurance company.

Medicare Part A is hospital insurance and covers inpatient hospital care, limited home health services, skilled nursing facility care, and hospice care. If you’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board, you are automatically eligible for Medicare Part A at age 65. You may also be eligible before age 65 if you have certain disabilities. The Part A deductible in 2019 is $1364, which does not qualify as a high deductible.

Medicare Part B is medical insurance and covers covers medical services and supplies such as outpatient care, preventive services, ambulance services, and medical equipment. You must enroll in Medicare Part B and pay a small premium. The deductible for Part B in 2019 is $185 and doesn’t qualify as a high deductible.

Can I Contribute to an HSA and Be Enrolled in Medicare Parts A and B?

No. If you are enrolled in Medicare Part A and/or B, you can no longer contribute your pre-tax dollars to your HSA. It is a tax violation to have both an HSA and Medicare at the same time.

What if I Want to Work Past Age 65 and Keep Contributing to my HSA?

If you want to continue working past age 65, there are ways to continue contributing to an HSA by opting out of Medicare Part A and not enrolling in Part B.

How do I opt out of Medicare Part A if I’m automatically enrolled?

If you are eligible and work for a company with at least 20 employees, but have not yet filed an application for either Social Security or Medicare benefits, you don’t need to do anything. You can postpone applying for Social Security and Medicare until you decide to stop working.

If you’re already enrolled in Medicare Part A, you can opt out by completing form CMS-1763 and submitting it to the SSA.

However:

• If you’re already enrolled in Social Security and want to opt out of Medicare A, you will have to pay back all of your Social Security benefits

• If you’ve have not applied for Social Security benefits yet but have already signed up for Part A, you can withdraw your application for Part A by contacting the SSA.

• If you work for a small employer and the company’s group health plan is secondary to Medicare Part B, you will have to agree to pay what Medicare B would normally cover. (This is generally not a good option for most people.)

What Happens Later When I’m Ready to Retire?

It is very important to know that you must stop contributing to your HSA 6 months before you enroll in Medicare A. This is because Social Security’s retirement benefits are retroactive 6 months.

Still Confused? I Can Help

The ramifications of HSA’s and Medicare are complicated. If you have questions or comments, please let me know. I’m an independent Medicare agent and will do my best to help find the best solution for you.

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What's the Difference Between a Medicare Annual Wellness Visit vs. an Annual Physical?

There are Two Main Differences:

Medicare will Pay for an Annual Wellness Visit, but not an Annual Physical.

The purpose of an Annual Wellness Visit is to establish your baseline health condition and prevent medical problems before they occur. It is fully covered by Medicare as a cost-saving way to keep you healthy.

When making an appointment, be sure to specify that you want to schedule an Annual Wellness Visit in order to prevent getting a costly bill afterward.

Typical things covered in a Wellness Visit:

• Check height, weight, BMI, blood pressure, etc.

• Complete and review a Health Risk Questionnaire that may identify personal risk factors that may affect your physical and mental health

• Look for signs of cognitive impairment

• Discuss risks based on your personal and family health history

• Assessment and update prescriptions taken

• If recommended by your doctor, Medicare also covers preventive services such as preventive cancer and cardiovascular screenings, cholesterol testing, bone density measurement, flu shots, alcohol abuse counseling, etc.

Once your current baseline health condition has been established, you and your doctor can then develop a person wellness program based on your unique health factors.  

If your Wellness Visit exceeds the services covered because your doctor recommends additional testing or treatment, Medicare beneficiaries will typically owe a copay or other charges.

An Annual Physical is Much More Comprehensive than a Wellness Visit

A typical annual physical includes all the services of an Annual Wellness Visit, plus additional services based on your health condition.

Additional services potentially covered in an Annual Physical:

• Lung exam

• Head and neck exam

• Abdominal exam

• Neurological exam

• Reflex exam

• Blood and Urine lab tests 

As a general rule, an Annual Physical includes more in-depth services where the doctor has to “physically” touch you, test you, or take samples from you.

Both are Important

Even if you are in good health, an Annual Wellness visit is important for maintaining your health because it helps diagnose and address health concerns early. Annual physicals are important as a more in-depth health exam addressing specific needs.

I hope this post helps. Please contact me with any questions.

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Blue Cross Blue Shield + Tennessee - What's the Latest?

Where We Are Now

As many former policy holders know, BlueCross BlueShield dealt an unwelcome blow to many Tennesseans in 2017 when they stopped offering ObamaCare coverage for residents of Nashville, Memphis, and Knoxville. The Chattanooga-based company is the state’s largest insurer and was initially the only provider to offer coverage across all of Tennessee, so the withdrawal left many policyholders scrambling for coverage.

Good News

The good news is that new proposals indicate that Blue Cross may be poised to reenter the Nashville and Memphis markets in 2020. This news come after they reentered the Knoxville market in 2019. Additionally, Cigna is planning to expand their coverage to include Chattanooga and Jackson and surrounding counties in 2020.

According to Tennessee Department of Commerce and Insurance office, the five major insurance companies in Tennessee have proposed the following (as reported by the Tennessean):

• BlueCross BlueShield of Tennessee: Proposed coverage adds Memphis and Nashville areas to be available Statewide. Proposed 2020 rate request seeking an average increase of 1.4%.

• Bright Health: Coverage continues in Knoxville, Memphis and Nashville areas. Proposed 2020 rate request seeking an average increase of 2.93%.

• Celtic/Ambetter Insurance: Coverage continues in Chattanooga and Memphis areas with proposed coverage expansion into Nashville and Knoxville areas. Proposed 2020 rate request seeks an average decrease of 1.6%.

• Cigna: Coverage continues in Knoxville, Nashville, Memphis, and Tri-Cities with proposed coverage expansion into Chattanooga and Jackson and surrounding counties. Proposed 2020 rate request seeking a premium decrease of 5.7%.

• Oscar Health: Coverage continues in Nashville and Memphis. Proposed 2020 request seeking an average decrease of 8.3%.

Blue Cross originally cited heavy financial losses for the reason they dropped coverage for much of Tennessee in 2017, and the withdrawal prompted many to fear a collapse of the Affordable Care Act in the state. However, the new proposals, which show that providers are hoping to either cut premiums or hold increases to a minimum, seems to indicate a stabilization of the market.

The proposals are not final yet, but it does appear that the market in Tennessee is more competitive compared to a few years ago, which should translate to more choices and more attractive premiums.

I’m based in Nashville and an agent for BlueCross BlueShield, Cigna, Bright and Oscar, and am pursuing a contract with AmBetter. I will do my best to answer your questions and keep you informed. Please feel free to contact me with any insurance questions.

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Medicare & The IRMAA Cliff

What is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount and is often described as a tax on Medicare. If you’re an individual with income over $85,000/year, or part of a couple with income over $170,000/year, IRMAA will increase your Medicare premiums for Parts B and D.

The good news is that 95% of Medicare recipients will not face this higher cost. Some might say having to pay IRMAA is a good problem, but those who pay the higher fee rarely see it that way.

The amount you pay is based on your MAGI, or modified adjusted gross income from two years ago. The income brackets top out at $500,000+ for individuals and $750,000+ for couples.

With IRMAA, going just $1 into a higher income bracket could result in paying thousands more in Medicare premiums. This is known as the “cliff” and just a few dollars more in income can result in a significantly higher premium. Also, since IRMAA uses joint income for determining premiums, one high-earning spouse can force both spouses into a higher premium bracket.

What to Do

Plan with foresight and know the ramifications of your financial actions. Make sure that you and your financial advisor are aware that large stock trades, the sale of a house or business and other transactions may result in a jolt in your Medicare premium.

If your income drops significantly to due a one-time, life-changing event, you have the right to appeal for a lower premium by filing form SSA-44. Social Security considers any of the following situations to be life-changing events: the death of a spouse; marriage, divorce or annulment; retirement or reduced work hours for one or both spouses; loss of income-producing property due to natural disaster; or loss of a pension. Filing the form is particularly important during your first year of retirement.

One-time cash windfalls such as the sale of a vacation home, a large portfolio distribution or a Roth IRA conversion, do not qualify as a life-changing event and will result in a higher premium two years later.

I’m a licensed Medicare insurance broker in Tennessee and appointed with Aetna, Blue Cross, Cigna, Humana, United Health Care, and many more carriers. If you have questions on IRMAA or any other Medicare issue, please feel free to call me. Thanks.

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