What's the worst thing about turning 65?
For some people, it's having to navigate the wild and weird world of Medicare for the first time. It can be daunting, frustrating, and abundantly confusing. Maybe you’ll have more questions than answers. It’s not something that a lot of people find fun to deal with.
To be fair, while most seniors have no idea what’s “in” Medicare until they start to head toward that magical age, others have been dealing with Medicare for a while. If you’re a caregiver or family member helping an elderly person, or someone who works in the insurance industry, you've seen the Medicare nightmare up close and personal.
The alphabet soup and confusion around Medicare health coverage is, by many accounts, pretty insane. As a government program, this model has endured for many decades, but as a bureaucracy, its language is a frustrating language of inside baseball jargon and overcomplex representation (what is a DMEPOS fee schedule??). That makes it harder for the end customers, America's seniors, to figure out what they're getting when they go on Medicaid at the age of 65.
These are supposed to be your golden years. They're not supposed to be a time when you have to learn a whole new insurance landscape, and basically become your own medicolegal accountant. People just don't have the stamina to dig into these details, which are well beyond what any of us learned in high school or even beyond. In some ways, the landscape of Medicare is actually deliberately obfuscated, or at least it seems that way to a great number of people.
We're here to help with Medicare from our offices in Las Vegas, NV area. We help seniors pick out supplemental plans and navigate this government program well. That takes particular attention to detail and dedication to listening to our customers and figuring out their unique situations. We have what it takes to make Medicare “not scary!” Get access to resources and get questions answered on our web site. We have coverage sheets, data on sign-ups, and more along with our trained staff who are ready to help you take the first step and every step after that.
Our philosophy of personalized needs assessment and tailored explanation of benefits means putting Medicare to work for you. Everyone is different and has different needs – we can help you to sort through Medicare Advantage and supplements plans and come out with the right solution. Call us and we will help to get you started.
If you've been following along with our series, you're now experts in Original Medicare. You now that Original Medicare is composed of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Alone, they cover your Medicare covered medical expenses at 80-20 coinsurance split, but only after the deductible has been met. This is good enough coverage for a small group of individuals, but for those who need help with prescription coverage and want more comprehensive medical coverage, Original Medicare just isn't enough.
You need to be enrolled, or be enrolling into BOTH Medicare Part A and Medicare Part B to be eligible for any Medicare Advantage Plan or Medigap Policy..
When you hear the term "Part C" being mentioned, know that the conversation is about Medicare Advantage Plans. Medicare Advantage Plans are often mentioned as Part C because they take the place of Original Medicare; Medicare Advantage encompasses both Medicare Part A and Medicare Part B in one plan, usually with added benefits like vision or dental.
Medicare Advantage Plans can come in multiple forms. In Nevada they are:
How Does Medicare Advantage Cost So Little?
Medicare Advantage Plans are provided by private insurers, and take the place of Medicare. What happens is that Medicare pays participating private insurers a set dollar amount to take medical responsibility for beneficiaries. This is good for Medicare, as it is a much more efficient way to manage care, and this is good for beneficiaries because private insurers can usually offer much more benefits than what Original Medicare is can cover.
Be aware that under a Medicare Advantage Plan, you are going to be required to get services and supplies from a set network of providers.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.
Extra services that may be covered under Medicare Advantage Plans in Nevada include:
Medicare Advantage Plans typically work off of copayments to protect the Medicare beneficiary from financial hardship, and many of those copays can be as low as zero dollars. They also offer there members a maximum out-of-pocket to protect them from overly expensive medical expenses. Meaning that once a member reaches a certain dollar amount with regards to their medical expenses, they would no longer pay medical for the rest of the plan year.
This is a much more affordable option to Original Medicare, as Original Medicare does not offer any stop loss protection.
Comprehensive Medicare Solutions contracts with all the major insurance carriers in Nevada and can help any beneficiary with their insurance decision. Our advisors work with clients on a one-on-one basis to help them find the best tailored plan option for their needs. Reach out to one of our Comprehensive Medicare Solution Advisors if you are interested in learning more any Medicare Advantage Plan in Nevada.
At Comprehensive Medicare Solutions, we help our clients to navigate the complex medical environment of the Medicare federal healthcare program. We understand the kinds of assistance that individuals and businesses need in working with the Medicare system and its unique complexities and idiosyncrasies.
One of the best ways to understand the complexity and frustrating alphabet soup in the Medicare world is to read Medicare transmittals. These routine bulletins are put out by the Centers for Medicaid Services (CMS) routinely as a way to instruct whoever is working with Medicare, in a practical sense, about changes.
Read through some of these broadsides and you'll see a lot of things about National Coverage Determinations (NCDs) or FFS (Fee for Service) or MACs (Medicare Administrative Contractors) – long and confusing acronyms that have to do with elements of Medicare services like a regional auditor or a particular technology tool, or someone with a specialized role or responsibility. It's bad enough that there are so many of these fancy names, but when they're made into acronyms, it's even harder to understand what's being talked about. What’s a module developer? What does CMS do with MLN? How does the file get updated?
You also see a lot of multistage instructions without a lot of contacts. Sometimes there are specific step-by-step processes that one of the stakeholders has to follow, and it's easy to get lost in the weeds, because all of these steps are listed without really explaining the background. In many cases, it's too complicated to be easily included in every communication, so CMS just assumes a level of familiarity.
Medicare is a bureaucracy. Some people would say it's the quintessential bureaucracy. Reading through these transmittals sometimes feels like reading legal poetry of the stream of consciousness variety.
How do you understand something that changes so much and has so many moving parts? The Medicare world is a world unto itself, and understanding it takes a great deal of tenacity and patience.
We have the expertise to help guide clients through Medicare advantage plans, Medicare supplemental coverage and Medicare drug price plans. We'll show you why some options are better than others, and what you can expect from a given plan, as well as how to work with the Medicare system, instead of just eyeing it warily from a distance. Talk to Comprehensive Medicare Solutions in southern Nevada about how to tackle all of the practical aspects of working with Medicare, and tell us about your goals. We’ll help you to get there.
Why is Medicare Part B so important?..
If you have been following our series, you know what Medicare Part A is, and know what it does and does not cover. We mentioned that Medicare Part A is part of Original Medicare, and Original Medicare has two parts. Those parts are Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Medicare Part B (medical insurance) is a valuable asset and is available for beneficiary enrollment during the first 3 months before the beneficiaries birth month, the beneficiaries birth month, and 3 months after the beneficiaries birth month. If you ever wanted to enroll in a Medicare Advantage Plan or Medigap policy, you are going to need to have both Medicare Part's A and B.
Medicare Part B covers beneficiaries with 2 types of services:
Typically, Part B will cover things like:
Medicare Part B needs to be applied for. It's not like Part A..
Unlike Medicare Part A, where majority of Americans get automatically by paying taxes to Medicare for 40 quarters (10 years), Medicare Part B needs to be applied for.
Some beneficiaries will automatically qualify for Medicare Part B, but the majority will need to sign up for Part B. Those that want to know how to apply for Part B can apply here.
There is a late enrollment penalty if you choose to not enroll into Medicare Part B during your initial enrollment period
Part B does have a premium, but it is a standardized premium set by Medicare. It does not vary from state-to-state, but it does vary based on income. When applying during your 7 month for your Part B benefits, premiums will be deducted automatically from one of these:
The standard Part B premium amount in 2020 is $144.60. Most people will pay the standard premium amount, but like mentioned earlier, if your income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago.
Some individuals may qualify for state funded assistance in the form of Medicaid or other, and typically will have some or all of their Part B premium.
Social Security can help determine if you qualify for extra help.
For those who don't know, and think that Original Medicare is sufficient enough insurance for there medical needs, there is a deductible and coinsurance responsibility to the beneficiary. In 2020, the Part B deductible was $198, and is subject to benefit periods. After the beneficiary met there deductible for the year, they are then responsible to pay 20% coinsurance of the Medicare-approved amount for:
Most individuals find themselves in a scenario where Original Medicare doesn't cover enough and it becomes too expensive to go to the doctor. It also doesn't cover prescription drugs. This is when beneficiaries decide to consider Medicare Advantage Plans or Medigap Policies. These plans help fill the gaps where Medicare leaves off, and they also offer this coverage at a much more affordable rate.
Our team of experts can help you get started in the initial phase of getting Part B and finding the right coverage that fits your specific needs. Feel free to reach out to us any time for question.
Part of our four part series about: Original Medicare, Medigap Policies, and Medicare Advantage Plans
Medicare Part A, also known as hospital insurance, is part of Original Medicare. Original Medicare consists of two parts: Medicare Part A and Medicare Part B (Part B will be covered in a later post).
Medicare Part A Covers:
Click on medicare.gov website to take advantage of that tool.
Medicare Coverage is Based on 3 Main Factors:
There are services Medicare Part A doesn't cover
Medicare Part A does not cover physician visits, physical therapy, speech therapy, occupational therapy, and durable medical equipment.
With ONLY Medicare Part A, you do not qualify for any type of Medicare Advantage Plan or Medigap Policy.
If you only have Medicare Part A (hospital insurance), you can still qualify for a Stand Alone Prescription Drug Plan. Great news about that is that you can still get help with the cost of your medication through a private insurer. Locally in the Southern Nevada Valley, there are many options available to individuals to enroll into a Stand Alone Prescription Drug Plan.
If you are an individual that wants to know more about what Medicare Part A does and does not cover, please feel free to contact one of our agents here at Comprehensive Medicare Solutions. We can give you resources on what kind of coverage is available to you, and we can help guide in the direction on how to enroll into Medicare Part's A or Part B, Stand Alone Prescription Drug Plans, Medicare Advantage Plans, or a Medigap (Supplement) Policies.
Information about Medicare Part B, Medicare Advantage Plans, and Medigap (Supplement) Policies in further series..
Surprise! Medicare Advantage Plans are not free.
When it comes time for folks start looking for plans, they get shocked when they see some Medicare Advantage Plans that have $0 premiums. A lot of questions get asked behind those zero premium costs, and the "It's too good to be true" mentality sets in. The reality is that it is real, it's not a trick. It's a great thing for members to see, but it's also important for them to understand why carriers are able to offer plans with no premium.
Medicare Advantage Plans, also known as Medicare "Part C" or "MA Plans", are offered by private insurance companies that take over the care of Medicare beneficiaries. Each private insurance company that offers Medicare Advantage Plans must follow the rules set by Medicare to insure complainant care for its beneficiaries. By joining a Medicare Advantage Plan you still retain your Medicare Part's A and B, but the difference is that you go to approved physicians and facilities for care, unlike Original Medicare. The benefit of this is that copays are much lower than Original Medicare.
Through the agreement that the private insurance carriers and Medicare agree upon, Medicare will pay a fixed amount for members coverage each month based on the average cost of medical expense typically filed in the service area. These companies must follow Medicare’s coverage rules to be eligible for participation, and Medicare Advantage Plans have yearly contracts with Medicare that must be filed before the Annual Election Period (AEP) for that specific year. The plan must notify you about any changes before the start of the next enrollment year.
Medicare pays private Insurance carriers an agreed amount to provide care for Medicare Beneficiaries
Medicare would never contract with private insurance companies if it was not in the best interest of the Medicare beneficiary. Medicare Advantage plans have many benefits that Original Medicare does not, and in many cases provide a more affordable way to receive care.
Check with your local Advisor to see what Medicare Advantage Plans are available in the area.
No denying to anyone, mental health is important. During these times, it's more important now than ever. What could be some big triggers of stress? Well, it could be the Covid-19 Pandemic or it could be the protests/riots that have been spotting up all around the world this last week.
Whatever the case may be, it's so important now that Medicare beneficiaries get the mental health care they need. Mental health disorders affect about 20% of older adults in the U.S., according to the Centers for Disease Control and Prevention (CDC). Unfortunately, nearly one in three of those seniors does not receive treatment.
Some Good News!
Those of you that are on a Medicare Advantage plan, you have mental health resources available to you. At least in Southern Nevada, it may differ if you are on another states Medicare Advantage plan.
The unfortunate side effect to having poor mental health is that it can lead to diseases like:
As Advisors, we always tell our members to take advantage of their benefits. If you have mental health resources available in your plan details, why don't you use it?
There's no shame in worrying about mental health. It's actually an important component to being healthy.
So do yourself a favor, if you're feeling anxiety please reach out to a professional. It might do you some good to speak out what's on your mind.
You can find out what mental health benefits are provided by calling the number on the back of your insurance card; and if your insurance carrier doesn't have what you're looking for, reach out to Comprehensive Medicare Solutions.
We deal with ever carrier in Southern Nevada, and we can help you with any Medicare question you may have.
Call Us or Send Us a Message
The decision Medicare Beneficiaries must make when it comes to picking an insurance, do I go with Medigap or Medicare Advantage? Now both types of policies have great benefits, but it is ultimately up to the member to determine what features they're looking for when it comes to a new policy.
Are You Looking For Affordability or Portability?
What is a Medigap Policy?
About two-thirds of the 61 million seniors and disabled Medicare beneficiaries choose traditional Medicare, Parts A and B, which cover hospitals, doctors, and medical procedures. About 80% of these beneficiaries supplement their insurance with Medigap (Medicare Supplement) insurance, Medicaid, employer-sponsored insurance, and/or stand-alone Medicare Part D prescription drug policies.
Medicare Supplement insurance plans are provided by private insurers and are not connected/endorsed in any way by the United States Government. Instead, Medicare funds Medicare plans to provide benefits.
Traditionally, Medicare Supplement Plans are the more expensive options when it comes to picking a plan, but it has some amazing features. When you have a Medigap plan to supplement your Original Medicare, you are covered for any hospital or doctor visit/procedure in the United States that accepts Medicare. These means that you can travel anywhere across the U.S. for medical services. You do not need a referral for services. a Medigap (Supplement) Policy is great for someone who travels a lot or that has specific providers they see that are in different states.
What is a Medicare Advantage Plan?
Available from private, Medicare-approved insurance companies. Medicare Advantage Plans are labeled under (Part C) and include all of Medicare Part A, Medicare Part B, and in some cases even include Prescription Drug Benefits (Part D).
In Southern Nevada, Medicare Advantage Plans are marketed and provide by Major Insurance Carriers. Local, they may have no premium or a lower one compared to the significant premiums for Medigap and prescription drug insurance policies. Just like Medigap Policies, Medicare Advantage plans cover hospital and doctor visits/procedures, but with little to no copays. In most instances they include prescription drug coverage and they also cover many services that are not covered by Medicare.
Locally, Medicare Advantage plans operate at HMO's or PPO's. A little more than one-third of Medicare beneficiaries choose one of these plans.
Medicare Advantage Plans require its members to stay in network when receiving care. If they choose to elect services out of network or without a referral, the member would be subject to 100% of the cost of the service. It's important to be aware of this when considering a Medicare Advantage Plan, but typically when members receive care within network, they are responsible too little or no copay's for services. This is why Medicare Advantage Plans are so appealing, they have little to no out-of-pocket expenses.
Ultimately, It Is A Big Decision When Figuring Out What Type of Medicare Policy Is Right For You
Good news is that there are many reasons why a person could change their plan. Take the time and evaluate your needs, then get in contact with Comprehensive Medicare Solutions. We are contracted with every major insurance carrier in Southern Nevada and are happy to help Medicare Beneficiaries find the right plan that fits their needs.
Feel free to contact us at any time. Click here to leave us a message or call us
One In Every 3 Medicare Beneficiaries Has Diabetes
In the United States, 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For many of them, insulin is critical for their health management. Unfortunately, the costs of insulin can be too much to afford and leaves beneficiaries to go without treating their condition.
According to cms.gov, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year.
What this means to Medicare beneficiaries is that access to a insulins will be at much predictable cost rather than subject to a percentage projection. Beneficiaries will have access to a broad set of insulins at a maximum of $35 copay for a month. Typically individuals that take insulin would be subject to the coverage gap sometime during the year and would be responsible for 25% of the cost of their insulin at that point. What will happen starting the 2021 plan year, is that insulin will no longer be subject to the coverage gap and instead will be at the predictable cost of no more than $35 for the whole year.
Sited by the Centers for Medicare and Medicaid Services, for the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries rather than leaving seniors paying 25 percent of the drug’s cost in the coverage gap. Both manufacturers and Part D sponsors responded to this market-based solution in force and seniors that use insulin will reap the benefits.
Individuals taking insulin could see an average savings of $466, or 66%
It is anticipated that beneficiaries will have Part D and Medicare Advantage Plan options in all 50 states that will provide this benefit. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021.
Plan benefits will not be available for any 2021 Medicare plan until October 2020, but when it comes to that time, please feel free to reach out to us. We are contracted with every single plan in Southern Nevada and will be more than happy to discuss any changes to your existing plan or any other plan that you are interested in.
Give us a call or send us a message, we give unbiased answers to your Medicare questions.
In the last couple of months, U.S. healthcare providers nationwide have began ramping up telehealth solutions in order to continue serving patients despite lockdowns and stay at home orders. According to a new survey from Updox, the place for virtual care and complete healthcare communications, conducted online by The Harris Poll among more than 2,000 U.S. adults aged 18+, nearly half of Americans (42%) have reported using Telehealth services since the pandemic first began. The survey shines light on consumer preferences of telehealth both now and post-COVID.
According to the survey, 65% say telehealth visits are more convenient than in-office appointments, and 63% say they don’t have to worry about being exposed to other potentially sick patients.
Americans who like using Telehealth services also like it because it’s easier to schedule an appointment via Telehealth than an in-office appt (44%), and because follow-ups/communications post-appointment are more streamlined (38%).
This Doesn't Mean The End of Face-To-Face Appointments
It's important to understand that after stay at home orders are lifted and we work on returning to regular life, we will have to make some changes. Healthcare providers understand this and it is expected that Telehealth will rise substantially by the year 2025.
Traditional doctor visits will not go away, preventative care will not change. What will change is the ease of seeing and making a doctors appointment. The future is bright and the healthcare system will not go away.
All Major Medicare Plans in Southern Nevada Offer Some Form of Telehealth for Members
Contact your healthcare provider to see how they conduct virtual visits. There are options for you, don't let stay-at-home orders keep you from receiving care.