You've got Medicare Plan Questions . . .
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Click here to learn about how Medicare advocates that you prepare for 2014:
I hope you will take me up on my offer for a quick and complimentary telephone consultation or a more in-depth "Needs Analysis" in your choice of your Sun City Home, or the Prarie View Lodge. I also travel throughout Chicagoland and can meet you at a mutually convenient public library.
I am Ellen Muradian of Huntley, IL and I would like to help you with your Medicare Health Plan (Medigap and Medicare Advantage, Part C) and Part D, Prescription Drug Plan. I would like to first answer this question from many Beneficiaries: "With all the changes in funding for Medicare Advantage, proposed legislation advocating Vouchers, annual payment cuts of 20% to the Medicare Approved Amounts for particular procedures, tests, etc., how can a Beneficiary be comfortable with their Medicare Plan?
First, let's address the annual media publicity every fall regarding automatic cuts to what Medicare pays to Doctors and Hospitals: This law was passed years ago in the same spirit of the more recent sequestration. However, every year that it has come, and presumably every year that it will come up in the future, Congress has overruled the automatic cut and even given small increases to Doctor and Hospital reimbursements.
Those payments have even had modest inflation adjustments.
Constituents remind their Representatives in Congress that Doctors and Hospitals will drop out of the Medicare system, and will go "private pay", if these payment cuts are made. Until Congress repeals or re-writes this annual automatic payment reduction law, we would anticipate that Medicare reimbursements will continue to have modest inflation adjustments every year. As a result, a Beneficiaries Medicare Supplement should serve them well.
In April of 2013, CMS (Centers for Medicare Services) announced that the Funding for Medicare Advantage Programs would have a 3.3% increase. Click here for a short report from the Non-Profit Group, the National Center for Public Policy Research:
A few years ago, when Medicare realized that Medicare Advantage (Part C) funding per Beneficiary was about 10% higher than the amount per Beneficiary for "regular" Part A and Part B, the decision was made to either freeze the Part C funding or to give modest annual increases. The idea was to allow regular medical inflation adjustments on Part A and B to gradually equal that of Part C, so that they would be uniform. Many people were pleasantly surprised to see this 3.3% funding increase in 2014 for Medicare Advantage, given the expectation that the funding increases would be modest, or even a zero amount.
In Illinois, Medicare currently pays $10,615 per year per Beneficiary, as seen in this state-by-state example:
In an unusual positive choice of words, almost to the point of seeming like an endorsement of Medicare Advantage, CMS used two words to encourage enrollment in Part C: "strong option". The context was that based on what CMS considered the success of Part C after the 2010 implementation of the Affordable Care Act, Medicare Advantage has had premium reductions and a 25% increase in enrollment. Currently, there are over 14 million Beneficiaries enrolled in Part C. To put this number into perspective, for every 3 Beneficiaries on a traditional Medicare Supplement (Plans A through N), there are 4 Beneficiaries enrolled in Medicare Advantage.
My personal experience is that based on our recent severe Economic Recession, and current sluggish economy, more Beneficiaries are looking for savings opportunities. Many of them compare their somewhat similar home and auto insurance to their Medicare Supplement which is also underwritten by an Insurance Company. The Beneficiaries find that they have a traditional deductible on their auto and homeowners insurance, yet they selected Plan F's highest price so that they had no deductible and even no out-of-pocket copays.
Beneficiaries recall that their group HMO or PPO plans are virtually the same as a Medicare HMO or PPO, as seen in the Medicare Advantage. They also realize that in large metropolitan areas like Chicagoland, there is no premium on Part C as Medicare uses their FICA taxes, paid when working, as the source to pay the underwriting insurance company, like Humana, Well Care, Health Spring, Aetna, etc.
In short, today's trend is to shift a Medicare Supplement Plan F over to a Plan G or a Plan N. Email me at the address below, and I'll give more reasons why:
1) Beneficiaries are now migrating to either the "Select" Plan F.
2) Are willing subjecting themselves to the $147 Part B deductible through Plan G (the premium savings is higher than the deductible).
3) Are voluntarily paying $20 to see their Doctor or Specialist, along with a $50 copay for an emergency room visit to transfer to a Plan N.
If you would like to learn more about Medicare and your Plan choices, read on . . . Here's the basics: The Part A (Hospitalization) Deductible for 2013 is $1,184. The updated change in this Part B Deductible for 2014 will be announced in September of 2013. For those Medicare Beneficiaries who have worked (paid into the Medicare Trust Fund through their FICA payroll deductions) there are no premiums for the Part A. Part B (Doctors, Testing, Lab, etc) have a premium which begins at $104.90 per month in 2013 and increases with a Beneficiaries' taxable income.
Like the above described time frame for the 2014 Part B Deductible, your monthly change in premium for your Part B, will also be announced in September of 2013. If a Beneficiary has a Plan C or Plan F Medigap Plan or a Medicare Advantage, the Part B Deductible of $147 is waived.
I am often asked by Medicare Beneficiaries about what choices and options are the best for their budget and expected health and drug expenditures. When Beneficiares attend seminars they usually just hear about 2 choices: Medicare Supplement to offset the $1,184 copay from Part A and the 20% from Part B, along with the zero premiums for Medicare Advantage for the HMO-POS, and various premiums, ranging from $59 per month to $109 per month for PPO's. Note that the HMO's and PPO's in Medicare Advantage have copays.
In only 4 quick clicks at www.Medicare.Gov a Beneficiary can see a listing, defaulted to total out of pocket cost, for each available Medicare Advantage in their county. For most of Chicagoland, Well Care ranks #1, as Find-a-Plan at Medicare.Gov shows that unlike the other Part C options, only Well Care caps its out-of-pocket maximum at $3,800. The other Medicare Advantage choices have no maximum out-of-pocket when a Beneficiary see a Doctor or is an inpatient at a hospital without using those pre-assigned Specialists and list of hospitals as dictated by the restrictions of their network.
This network issue is important because many Primary Care Physicians and especially Specialists do not stop to ask if their Referral is in your particular limited network before they give the Referral. When Beneficiaries or their family are hurried and not thinking clearly based on certain medical news, they often get the care or hospitalization first, only to have to pay 30% of the entire bill later. Based on the staggering hospital bills, even for routine surgeries and procedures, not having a cap or maximum on that 30% can be financially devastating.
As an aside, HHS (Health and Human Services), as seen at HealthCare.Gov has taken a lesson from the Medicare.Gov Find-a-Plan. In the same 4 quick clicks, someone who is yet on Medicare (typically not yet age 65) can observe their major medical choices. Although that traditional health insurance is defaulted to the total out-of-pocket, as is the same default at Medicare.Gov, the arrow for the drop down box can be changed to list in an order of premium. Most younger Spouses of Medcare Beneficiaries prefer to shop for major medical based on the premium since after their high deductible, the 70% or 80% of the bills then are paid.
Note that on October 1st, the HealthCare.Gov lists of available plans will change to reflect to what is predicted to be 20% to 50% higher premiums as the Affordable Care Act, beginning in 2014 will require all major medical plans to stop the process and procedure of asking medical or prescription questions. This "guaranteed issue" is the fundamental concept of Health Care Reform, although ironically Medicare Beneficiaries, with the exception of Blue Cross of IL, are still subject to being rejected based on medication usage, prior hospitalizations and even seemingly minor pre-existing health issues.
Note that although their is no official confirmation from Blue Cross of Illinois, there is talk in the media and from informed sources that Blue Cross of IL is considering changing from guaranteed issue. It is worth noting that in the vast majority of states, Blue Cross asks detailed medical and prescription questions and utilizes those answers to reject an application. In short, if Blue Cross of IL were to change their application in 2014 to ask medical questions, they would be adopting the same Medicare Supplement applications as are being used in almost all other states.
If you currently have a Blue Cross Medicare Supplement as so many Beneficiaries do, click here to determine if you are eligible for a recently announced rate reduction:
As an example a 70 year old on Blue Cross of IL Plan F (their most popular plan) can now save $228. I'll be happy to give you more details about how to take your anticipated health and physician utilization, potential hospitalization, and prescriptions into account to make a recommendation to consider the savings of:
1) Transfering to Blue Cross "Select" version of Plan F, if your hospital, like Provena, Sherman (expected in August of 2013), Vista, Advocate, etc is "selected" to be included in the network.
2) Voluntarily subjecting yourself to the $147 Part B deductible by transferring from Plan F to Plan G. At all ages, it makes economic sense to make this switch as the premium savings are always in excess of $147. Plus, if you are in good health, you should be able to see your Doctor or Specialist at least once per year for "real" medically necessary reasons (not routine well care and physicals) without incurring this $147 charge. Here's why: The Medicare Approved Amount for a Doctors Office Visit is usually less than $147. Plus, we will recall that to the delight of my Beneficiaries, Medicare recently had a legislation revision which focused on preventative care, routine care and physicals being at no Part B charge as they were in the past. Hence, your transfer to Medigap Plan G decision does not have to based on seeing your Primary Care Doctor for what Medicare now does not charge for.
3) Plan N is a simple and straight forward calculation. I'll give you the reduction in premium for any of the 42 Medigap plans as seen on Medicare.Gov Find-a-Plan's web site, and we'll just take $20 per office visit off the cost, along with $50 per emergency room visit, only when you are discharged directly from the emergency room. If you become an inpatient even at another hospital as a direct result of that emergency room visit, then that $50 emergency room charge for the Plan N is waived.
4) Do you have this dilema: You enjoy the peace of mind which comes from having no copays with your Plan F. However, now that Medicare doesn't charge for well care, you are concerned that all those premiums, often over $4,000 per year, and $8,000 per couple, is not being wisely spent? Medicare allows another variation in it's standardized lists of Plans: A $2,110 deductible with the same "no copays" for Plan F. The premium is typically reduced by 60% - 70%, as this "High Deductible" Plan F" is similar to what a Beneficiary most likely had on their health insurance plan from their Employer, often called a HSA (Health Savings Account), which offered IRS sanctioned tax deductibility. Based on some simple math, after two or three years on this up-front deductible variation of the Plan F, a health Beneficiary has saved enough premium to offset the deductible. If the Beneficiary begins to incur diagnostic testing, has more Doctor Office Visits, etc., at least with Blue Cross of IL, they can switch back to the non-deductible version of Plan F.
Medicare usually announces the Part D Drug Plan deductibles and copayments in the late summer or early fall of every year, so check back then for the 2014 figures. For 2013, most Part D companies have 3 plans, with the lowest cost plan having the Medicare standardized $325 deductible and the "in and out" thresholds of the doughnut hole out-of-pocket amounts. Seniors often complain that the already complex Part D is always getting more difficult to understand.
My goal is to give you a simple, yet complete, personalized and customized explanation either in the comfort of your Sun City home, or at one of my public seminars, or if you will allow me to treat you to Culver's Restaurant (on Rt. 47 across from the main entrance of Sun City) to breakfast or lunch. For now, the short version is this:
Some of the lower premium (as low as $15 per month) Part D plans have the same deductible of $325 deductible. When your co-pays + your $325 deductible (again, only for the lower premium Part D Plans), combined with your Drug Plan's portion of Drugs (left over after your copay) totals $2,970, you enter the Doughnut Hole. Next, (while in the metaphorical hole) you then pay 100% of all your Drug Costs, although at only 47.5% for the retail cost of Brand Drugs at the Insurance Company's negotiated lower wholesale cost, and 21% of the retail cost Generics. Note that this insurance company "retail" cost is almost always lower than your "walk-up" rate at the pharmacy as the insurance companies get volume discounts.
Note that if you will have a "stand-alone" Part D in 2013, your costs between your deductible and the beginning of your Doughnut Hole are the same if your Part D is part (as in, included inside of) of your Medicare Advantage Plan, which is Part C of Medicare. Medicare Beneficiaries typically have this stand-alone Part D when they have a Medicare Supplement instead of the Medicare Advantage.
Here's one reason why Seniors get confused when the read about the Medicare Rules of their Part D Prototype vs. what all the insurance companies actually offer: 25% is still the co-pay (after the $325 deductible, but before the Doughnut Hole), based on how the Part D was structured when it was first introduced in June of 2006. However, shortly thereafter, insurance companies began to compete with each other by offering fixed dollar amounts for each Tier of Generics or Brands.
In the past few years, and a preliminary glance at what is to be introduced on Oct 1, 2013 for the calendar year of 2014, virtually all Part D Plans no longer offer the 25% copay. Instead, they offer fixed dollar amounts, which range from zero to $4 per month for Generics and around $36 - $42 for Brands, with additional discounts for Drugs-by-Mail.
Note that most insurance company's offer a choice of 2 different types of Part D Plans: with and without the $325 deductible coverage. The deductible is typically chosen, even by those Beneficiaries who are only on Generics when the Beneficiary needs to be enrolled in some Drug Plan, even one with the lowest possible premium, in order to avoid the 1% per month cumulative penalty incurred when and if they later enroll in a Part D, typically went they need a Brand rather than a Generic.
How can a Beneficiary avoid the above described Part D cumulative penalty, while still enjoying a zero premium? For many Seniors, the answer is the Part C, Medicare Advantage, which has has virtually the same stand-alone Part D embedded inside this Part C. The word "virtually" is used because the typical difference in copays is only on the highest Tier 4, although some companies 5 Tiers.
As an example, a stand-alone Part D has a 25% copay at the highest Tier for the most expensive Speciality Drugs, whereas a Part C has a corresponding 33% copay. Therefore, if a Beneficiary is on a costly Specialty Drug, they should calculate their higher out-of-pocket Drug cost via the Part C vs. a stand-alone Part D, which usually is made along with a Medigap Plan.
Other than the extra costs from a Part C Plan for Specialty Drugs, the copay costs for Drugs are closely similar between the stand-alone Part D vs. the Part D "inside of" the Part C. Generics have a fixed amount for co-pay which can be as low as $10 for 3 months, and even at a zero copay when getting certain lower cost non-narcotic Generics by mail.
Naturally, Brands have higher copays, averaging around $40 per month, but they are fixed, and therefore predictable. My complimentary consultations can help you decide on whether the fixed copays with no deductible through Part C, Medicare Advantage is a better choice for your particular situation . . . even in a short phone consultation, I can help you make the right customized calculation and comparison.
If we chat by phone, ask me for this 2014 update: Medicare has recently allowed virtually all "preventive" care to be at no cost vs. the 20% Part B of the past. In the past, many of my healthier Customers enrolled in their most expensive option of the Plan F of Medicare Supplement because they didn't want an out-of-pocket cost, even for preventative care, blood and tissue diagnostic testing, etc.
Now that Medicare was ended the 20% copay for what Medicare defines as "preventitive", even those Beneficiaries who are going to their primary Doctor(s) or Specialist(s) many times per year are now beginning to leave Plan F for Plan N instead. As an example based on monthly savings, for a 70 year old on Blue Cross Medicare Supplement Plan F, their premium is $207, but the Plan N option is only $145, a savings of $63, or $756 per year.
To calculate the break-even on the flat copay of $20 for Doctor/Specialist visits, we just divide the $756 by $20 to arrive at the more economical conclusion that that a Beneficiary can see their Doctor or Specialist up to 37 times. Clearly, that calculation is a powerful argument to switch from a Plan F to a Plan N, but the Plan N also includes the Part A Hospitalization Deductible of $1,184.
In our example, Blue Cross of IL is guaranteed issue, so as long as the scheduled hospitalization (not applicable to an emergency room visit which results in an immediate hospitalization) can be made on the 1st of the next calendar month, a Beneficiary can transfer back to the Plan F up until the last day of current month.
Also, ask me about the extra savings through the "Select" version of Medicare Supplement. In this example, the 70 year old on Blue Cross Medicare Supplement can lower their $207 per month premium to $182, a $25 per month saving, or $300 per year. The word "Select" means that Blue Cross has "selected" hospitals which will waive the Part A Hospitalization of $1,184. With the exception of emergencies and travel more than 30 miles from your home, if you "elect" (again, not counting emergency room visits which turn into corresponding inpatient hospitalizations) a non-select hospital, the Beneficiary on Plan N would have incur the $1,184 Part A Deductible.
As seen on page 91 of this month's Del Webb Sun City Lifestyle magazine, the most popular hospitals, like Provena are on the Blue Cross Select List. Note that Sherman has signed off its acquistion by Advocate, and is expected to be on the Select List by May 1st. If Sherman is your preferred hospital, let me know and I'll inform you as soon as they are included on the Blue Cross Medigap Select List.
Finally, the above described "out of" the doughnut hole has increased slightly in 2013 to $6,600 of your total out-of-pocket costs, when you then pay only 5% of your Drug Costs, which again are lower than a retail "walk up" rate, as the prices have been negotiated by your Insurance Company based on aggregated group volume discounts.
Part D has many components, and many moving parts of the "Doughnut Hole". This does not necessarily make the process too difficult to completely understand. Instead, the situation can be viewed by understanding that Medicare advocates that their Beneficiaries conduct what they refer to as their "Annual Medicare Review" from Oct 15h through Dec 7th. The link at the top of this page shows Medicare's rationale to complete this yearly update on your options.
During this Annual Election Period, you have the ability to evaluate whether you would like to receive your Part D on a stand-alone basis, through Part C (often at no monthly premium for the increasingly popular HMO-POS), or even to temporarily forgo the Part D.
I can assist you in calculating your late-entry Part D penalty, which is about 32 cents per month (adjusted annually for inflation) vs. paying the lower Generic co-pays. I only give your choices and options and you or your Advisor (Son, Daughter, etc) can then decide.
We will again in 2014 have a Medicare Advantage Plans in the Chicagoland area which do not include the Part D. Many Beneficiaries ask if they can enroll in this MA-only (as opposed to a MAPD) instead of their too-expensive Medigap. The rules still state that this MA-only requires a Beneficiary to provide proof that they already have what Medicare refers to as a "credible" Drug Plan, as do Military Veterans.
I am planning on conducting Educational Seminars this 2014 AEP season at the American Legion, VFW, and individual presentations for Veterans. Many insurance companies market and target their MA-only Plans to Veterans because without this zero premium Plan, they would be subject to the 20% Part B co-pay when an ambulance takes them to the legally mandated "closest available" emergency room.
If you know any Veterans, please share my "Free Info" email address as seen below. In conclusion, I offer old fashioned "House Calls" to my fellow Sun City Residents, so I look forward to receiving your email requests for either additional information, complimentary answers by phone to your particular situation, or to receive a more detailed report or all of your new options regarding the "2014 Medicare Changes".
Now that you have the above overview of the Medicare Part C and D changes, you hopefully are motivated to attend one of my seminars, or request more free details by email? If so, again by way of electronic introduction, similar to the top of this page, I am a Registered Nurse, Ellen Muradian, and I am a Resident of Sun City, Del Web in Huntley, IL. After having enjoyed a successful career as a Registered Nurse at Advocate Lutheran General Hospital for several decades, I have channeled my medical passion and interest in helping Seniors. Along with other Agents in my Agency, we are certified by Humana, Health Spring, Coventry, Well Care and and other insurance companies.
If you would like a quick overview of the changes to Part D, Prescription Drug Plan, then click here:
As you can determine from the above site, most changes to your Medicare Plan are mostly normal and typical inflation adjustments, along with gradual easing on the out-of-pocket expenses for PartD.
Do you already have the Plan F Medicare Supplement? You might want to consider the savings of switching to the lower cost Plan C, typically over $100 per year, especially if your Doctors or Specialists do not charge you the 15% "excess charge". Does your Doctor accept "assignment"? More simply, does your Doctor or Specialist charge 15% above the Medicare Approved Amount? You would probably know this because instead of paying the usual and typical Part B (Part A is for in-patient hospitalization only) of 20%, your bill would be for 35% of the approved amount.
Why is this important? You might be experiencing an example of overpaying for something you don't need. Unless you know that your Doctor purposely charges 35% of the Medicare Approved Amount (rather than the usual 20%), then you should consider saving hundreds of dollars over time by transferring from Plan F to Plan C.
If either your Doctor or Specialists later decide to charge the 15% excess charge, Blue Cross has guaranteed issue so that you can switch your Medigap on the first of any given month, with no Annual Election Period. If only one of your Doctors charges the excess, and you only see them once or twice a year, you might still be better off financially by staying in the Plan C. After a quick chat with you regarding your expected Doctors visits, diagnostic testing, procedures, etc., I can quote your exact savings.
More importantly, in addition to the cost savings, you would have the benefit of having a RN as your Agent and Advocate. Click here to discover how I can provide you with the comfort and peace of mind that your Medicare Part A and Part B medical treatment, hip/knee replacement, organ transplants will not be legally withheld, especially in your final years. Click here for details:
Many Seniors remember, as a Wisconsin Senator, Paul Ryan (former Republican Vice Presidential Candidate) sponsored legislation to have a pre-set financial allocation per Beneficiary given to Medicare, in a similar fashion to how about $10,000 per year is currently allocated per Beneficiary in Medicare Advantage. Seniors are now asking me how the new PPACA ("Patient Protection and Affordable Care Act") will affect their out-of-pocket expenses for Hospitalizations, Doctors, and Prescriptions. I hope you will allow me to provide these answers to you. I find that while some Seniors just want quick answers by phone, many prefer a more relaxed approach in the comfort of their home.
I am happy to address your concerns by phone if that is your preference. As an alternative, I would like to invite you to a free, no-obligation seminar in November at the Meadow View Lodge. In this half hour presentation, I can answer all your questions about your 2013 Medicare Changes. For your customized invitation or a personalized presentation in your Sun City home, email me at:
Along with Certified Financial Planner, Scott Slagle, I will be conducting an Educational Seminar at the Prairie Lodge in Del Webb's Sun City on Saturday, October 12th, at 10 AM and Noon.
We will have Coffee and Pastries, but more importantly, I hope that you will either bring a fellow Medicare Beneficiary, or tell them to meet you there as we strive to save you a substantial amount of money and give you the peace of mind which comes from having your Medicare Plan questions answered.
I will also be offering complimentary Lindt Chocolates, hoping that as you will give me a minute or two to explain what I refer to as the "sweet deal" now offered by Blue Cross Medicare Supplement. Here's the short version:
Did you know that half of Blue Cross Medigap rates have been reduced? As my ad in this month's Del Webb, Sun City Lifestyle magazine shows, a 70 year old can now save $288 per year! Stop by and enjoy a chocolate with me and I'll help you apply for your saving.
My Partner at our Parent Company, Financial Solutions, Scott Slagle, specializes in "Legacy Planning" as we have a special low cost relationship with a local Attorney who can magnify your net worth to benefit your family or Charities. This Attorney makes complimentary house calls to Sun City Residents, so give some thought to your status of your Wills (do they need updating based on family changes or other circumstances), your Durable Power of Attorney, Health Care Wishes and Health Care Power of Attorney, Written "Do Not Resusitate" Directive, etc. Our Attorney does not work for a large firm, and therefore, charges surprisingly low fees. Ask me for details . . .
For those Investors with a less risky tolerance, ask Scott or I about payout annuities and Target Date Mutual Funds. As Mortgage Brokers, we would like to explain the advantages of our "no closing cost" Refinance, which can lower your interest rate to 3.5%, the lowest rate in over 50 years!
Ask us about a "Cash Out" option for your home equity as many Retirees are investing in pay-out annuities for extra income. Scott and I also hope to see you at the Fall Expo, as we will have updated Directories of Doctors and Hospitals. This can be your type of Medicare Plan check-up as you might be curious if your hospital is in the Blue Cross "Select" Plan F, which can save up to hundreds of dollars per year.
At the Fall Expo, I can also look up your Doctors and Hospitals to determine which Medicare Advantage they participate in. At this Fall Expo, we will be drawing the name at 6 PM of the lucky winner of our prize give away of a New state-of-the-art laptop, valued at over $400. Our second prize will be a 7 inch Android Tablet PC, valued at over $100, so we look forward to seeing you there.
If you have any questions, please email me at Ellen_the_RN@yahoo.com. Please remember that I offer quick and free phone consultations to those who are just curious about a nuance of financial services, or have those who want to limit their involvement to the phone, yet ask a few questions. Either way, I hope to hear from you!