Medicare Insurance Products

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Medicare Specialist Insurance Kristin Sinclair

Kristin Sinclair: Your Medicare Insurance Professional. 

Kristin understands how important it is that Medicare Supplements once issued are guaranteed for life.  Once issued and accepted by you these supplements cannot be cancelled by the insurance company as long as you pay your premiums on time.

Kristin can help you find the Medicare Supplement product that fits your coverage needs and your budget. Over 90% of the Physicians Nationwide accept Original Medicare.  Medigap Policies are also known as Medicare Supplements work with the Original Medicare. You will be able to rely on your Medicare Supplement to help make your coverage more  complete.  Coverage that travels with you anywhere n the Good Old USA !  Enjoy the opportunities that a life of working helped make possible.

Kristin’s team has been providing clients with insurance coverage since 1987.  You can apply for Medicare Supplement coverage year round – no need to wait for an annual enrollment period.  Contact Kristin today for a Medicare Supplement that fits your needs

 

 


2019 Medicare Part D Insurance for The Coming Annual Period

Kristin P Sinclair  – A Accu Tax Oct 8th 2018 – Rock Hill, SC – Charlotte, NC

Stand Alone Medicare Part D plans have a monthly premium, that you pay to have the plan service your prescription drug coverage needs for the annual period. You want to pay the premiums in a timely fashion when due. Choosing a plan that you can afford is one of goals that you want to achieve. Your premium costs do not go toward your out of pocket costs when you tally your drugs copays and coinsurance figures. Premium paid is one set of costs. Out of pocket costs for copays and coinsurance is a separate set of figures.

Medicare Part D has an annual enrollment period. From Oct 15th through Dec 7th. When you change your plan during this annual enrollment period the new coverage begins Jan 1st in the upcoming year.

If you move from one coverage area to another, say from South Carolina to North Carolina, during the annual period, you have a Special Enrollment Period to change to a plan in your new State. You will not automatically have a new plan in your new state, you need to be proactive getting this done before your SEP period has ended.

If you become eligible for extra help and receive a Low Income Subsidy to help offset a portion of your costs you have Special Enrollment Periods during the year to make some changes if your RX needs change and a formulary change is needed.

You can see the government has created protections for you as a medicare beneficiary.   But as a general rule, once you choose a plan that will be your plan for the annual period. Take the opportunity to do your research each year. Choose the plan that is most suitable for your situation, and factors you know to be the case at the present moment in time.

Each year you could see some changes to your plan. You will receive An Annual Notice of Change. ANOC describing what is changing on your plan. This notice is a good reminder to gather your medication list and review the changes coming to your current plan for the upcoming annual period.

Review medications covered on the formulary. That is the list of medications that your plan covers. This formulary also provides the cost sharing tier detail as well.

Review your local pharmacy choice, your mail order pharmacy choice. Which Tier your medications will fall into. Since medications can move from one tier to another from one annual period to the next, it is prudent to review how the formulary and tier structure will affect you in the upcoming annual period.

Schedule an appointment with a trusted resource to get some idea of plan costs, RX costs, and idea of the stages you should plan for. Call your Insurance agent, schedule an appointment to review your RX and plans that cover the medications you are taking. Kristin can be reached at:   803-329-0615. Call to schedule an appointment. While sitting down with your computer go to: www.Medicare.gov this is a great resource, but wait until the annual enrollment period to get into the program that www.Medicare.gov offers for your research. They have a lot of data they are populating into the data base. Allow them time to help you do your comparisons.

For Plans that have a deductible in 2019, $415.00 is a number you will see on many plans with a deductible. Not all plans have deductibles, some plans have deductibles on only certain tiers on the formulary. So have pencil and paper ready when you do research. Make note of things important to you.

Medicare Part D is designed to have various stages. An initial stage you will have copays or coinsurance cost sharing after any applicable deductible has been met. Most people do not leave the initial stage during the annual period. Taking generic alternatives and opting for 90 mail order can help your dollars go further. When your plan offers various tiers and mail order incentives to save.

It could be possible that you have spent $1,000.00 out of pocket, but the true cost of medication cost have reached a figure of $3,820.00. After the total drug costs reach $3,820.00 that is when the coverage gap, also known as the donut hole begins. While you are filling your medications in the coverage gap stage, the cost sharing changes. 37% coinsurance for generic drugs or 25% coinsurance for name brand drugs. The drug manufacture also pays 25% toward your medication cost for the name brand drug as well. And the other costs are paid by the plan as well.

What does this mean, well you might be taking an expensive generic drug and while you are in the coverage gap, you will pay 37% of the cost. You might be taking an expensive name brand drug and while you are in the coverage gap, you will pay 25% of the cost.

Some plans offer some additional cost sharing while in the gap. Those plans are often going to have a higher premium. And when you consider this plan design, look at the total annual costs for the factors that you can plan for. A years total cost can vary significantly based upon the plan chosen, sometimes a lower premium and use of mail order can help make your dollars go further. The medications you are taking, the formulary on the plan chosen, need to work for you, so do your research. Choose wisely grasshopper. Decide when higher premiums are going to offer a plan that saves you money. Or could a plan with a lower premium actually by years end actually have saved you more on out of pocket costs. It depends.

Once your out of pocket cost for the medications filled through the local pharmacy or through mail order, reach $5,100.00, you enter into the next stage which is called the catastrophic coverage stage. During this stage you will pay the greater of $3.40 copay for generic, (including brand name treated as generic) , $8.50 copay for name brand medications, or you could pay 5% coinsurance. If you do enter the catastrophic coverage stage, you will be in the stage until the years end. When the new annual period begins, the various stages will start again.

Kristin P Sinclair A Accu Tax

Rock Hill, SC Charlotte, NC

 

Some other thoughts, people who receive extra help to offset their RX out of pocket costs might have cost sharing that is different than others also receiving extra help, there are different types and levels of extra help. It is possible for a plan to cost different amounts for people on LIS. In the same state or area of service for a plan.

Most Medicare Part D beneficiaries do not receive extra help in the form of LIS, Low Income Subsidy however, for those who need extra help it is certainly good it is available. A Person would need to look into this to determine if they qualify annually.

Look at Star Ratings for the plans you are reviewing. If the plan is new, it will not yet have a star rating. If the plan has been around for several years, it will have a star rating for you to review.

High Income Medicare Beneficiaries. Premium Adjustments Add to the premium of your Medicare Premiums, Add to the Premium of your Medicare Part D Premiums.

Kristin P Sinclair  – A Accu Tax – October 10th 2018 – Rock Hill, SC –  Charleston, SC

When you are a high income tax payer you may have additional premiums added to your Medicare premiums, as well as your Medicare Part D premiums. Both on a stand a lone plan as well as on the Medicare Part C plan with the Part D in your MAPD plan.

Most people roughly 95% of Medicare Beneficiaries will not pay this additional premium, however that also means somewhere close to 5% of Medicare Beneficiaries will pay these additional sets of premiums.

This means most people will continue to pay only the Part D premium their plan charges. If you have to pay the extra amount in addition to the Part D plan premium, Social Security will use your reported IRS income to determine how much extra you have to pay. The extra amount is based on your yearly income .from two years prior income tax return reporting documents. Social Security will send you a letter if you have to pay an extra amount in addition to your monthly Part D plan premium. The charts below show the amount you’ll have to pay each month. In 2018 these figures will be adjusted for 2019.

Below are examples of the Part D premium differentials for 2018.

If your filing status and yearly income in 2016 was

Individual tax return

File joint tax return

File married & separate tax return

You pay each month (in 2018)

$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000 above $170,000 up to $214,000 not applicable $13.00 + your plan premium
above $107,000 up to $133,500 above $214,000 up to $267,000 not applicable $33.60 + your plan premium
above $133,500 up to $160,000 above $267,000 up to $320,000 not applicable $54.20 + your plan premium
above $160,000 above $320,000 not applicable $74.80 + your plan premium

The figures above are premiums differential for year 2018 for medicare part D premiums.

So what should you expect for 2019. We are still waiting for congress to announce figures for 2019 to determine what figures will be applicable for the coming annual period.

Social Security Income-Related Monthly Adjustment Amount Notice

What is it? If you’re in a higher-income household, this notice tells you about income-related Medicare Part B and Part D premium adjustments for the coming year. It includes the information in the December BRI notices.

When should I get it?   November

Who sends it? Social Security

What should I do if I get this notice? Keep the notice.

What should I do if I disagree with the decision? Social Security will send you a letter if your Medicare prescription drug plan premium will change based on your income. This letter will tell you what to do if you disagree. For more information, call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

What if my income has changed? If your income has changed and this change will make a significant difference in your income level, call Social Security. Let them know you have new information and may need a new decision about the extra amount you’ll be charged each month. Your income may have changed due to any of these reasons:

  • You married, divorced, or your marriage was annulled
  • You became a widow/widower
  • You or your spouse stopped working or reduced work hours
  • You or your spouse lost income from income-producing property due to a disaster or other event beyond your control
  • You or your spouse’s employer pension plan was reorganized, terminated, or experienced a scheduled cessation
  • You or your spouse got a settlement from an employer or former employer because of the employer’s closure, bankruptcy, or reorganization

Do I have to pay this extra amount?

You must pay both the extra amount and your plan’s premium each month to keep Medicare prescription drug (Part D) coverage.

To get more information.

If you have questions about your Medicare prescription drug coverage or how much you have to pay, call your plan, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

If you have questions about the extra amount you are being charged based on your income, visit socialsecurity.gov, or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against.

Visit Medicare.gov/about-us/nondiscrimination/ accessibility-nondiscrimination.html, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.

If you owe the premium and fail to pay the premium you will loose your coverage. That would be a tragedy that you need to avoid. Plan ahead for obligations.   Remember that it is possible that this higher premium will be adjusted the following annual period. Since the adjusted amount is determined by the income from 2 years prior tax return. Unless a higher income is a predictable norm for your situation, many people would see a change as income changes. Sometimes high incomes can be isolated events affecting a household in only specific situations such as selling stock realizing a gain, to allocate the funds for some thing needing to be funded. Life happens, and the government is willing to listen to the circumstances.

Remember the government will take into considerations when events are an anomaly. And it is possible that the income related adjustment could be adjusted when you present the circumstances and the facts surrounding the income increase which is outside of the household norm.

Kristin P Sinclair   A Accu Tax

Rock Hill, SC   Charleston, SC

Visit www.medicare.gov to do additional research on your situation. If you had higher income in 2017 this will impact you in 2019. Look for your notification to arrive in Nov 2018.

2018 Medicare Part D

by Kristin P. Sinclair – A Accu Tax – October 9, 2018 – Rock Hill, SC

2018 Medicare Part D is PDP or Drug Coverage, and Medicare Part D has different stages. Some plans will have a deductible of $405.00 and then co-pays and co-insurance begins based upon your specific plan design, and cost sharing formulas. Some plans do not have a deductible to be met, and those plans could have a higher monthly premium or possibly some other format which helps to limit your exposure. But all Medicare Part D providers must meet specific guidelines and must have a plan that has been approved by Medicare. And must offer coverage for the 100 categories of medications that Medicare has determined that Medicare beneficiaries need to have coverage options for.

The initial Co-pays and co-insurance will apply until the true cost of medication covered by the Part D plan have reached $3,750.00 in 2018. Then the beneficiary goes into the next phase the Coverage Gap or Donut Hole. Your cost sharing then is a 65% discount off the cost of name-brand medication in the formulary. With your cost sharing you pay the other 35% for your medications while you are in the coverage gap. For generic drugs on the formulary you get a 56% discount of the price while in the donut whole, this means you pay the remaining 44% of the cost of your generic medication in the formulary while in the donut hole.

With your Medicare Part D Plan once your share of the out of pocket costs for the medications paid reaches, $5000.00 you enter the next stage which is called the Catastrophic Coverage Stage. In this stage, you will pay, $3.35 for generic drugs or 5% of the drug cost, and you will pay, $8.35 for name brand drugs or 5% of the drug costs on the monthly basis. Anyone who entered the catastrophic phase would see that phase throughout the balance of the annual period.

There are people who qualify for LIS or Low Income Subsidy and receive extra help from the government due to the limited amount of income and assets they have. Folks with LIS see different cost sharing levels than those who do not qualify for LIS benefits.

It is worth noting, that most Medicare Part D beneficiaries never leave the 1st stage or the co-pay stage during the annual period which occurs after any applicable deductible has been paid. Please also note that while those folks who do reach the gap or donut hole stage, those folks would pay 35% of the cost of your name brand medication while in the gap stage of coverage, the drug manufacture is also paying 35% of the cost of that same medication for your benefit. That additional amount the drug manufacture has been paying for you counts toward your out of pocket exposure, and can get you the Catastrophic stage sooner.

So Very Important – Your Formulary Choice
Why is it important to have your medication covered by your formulary for the annual period ? It is important so that you can minimize your out of pocket exposure when possible. If a medication is not covered by your formulary it is possible you could be responsible for all costs. An exception to your formulary could be agreed upon between your Medical care practitioner and your Medicare Part D provider. The exception requires your medical practitioner to provide supporting reason that an exception is a necessary option for your care and well being. Often the Medicare Part D Plan will want you to start with any available generic alternative at the more affordable rate. If necessary then to start a step by step method prior to using the more expensive medications exception. Once again your Doctor is going to be very involved in any request for an exception to a formulary.

These are good reasons to review your current medication(s) on an annual basis prior to the Annual Enrollment period of October 15th through Dec 7th. This is the time to choose the Medicare Part D Plan which best meets your medication needs for the up coming annual period. Your preferred pharmacy location should be convenient and included in your plan preferred pharmacy provider list. Since medications can change during the annual period, discuss your formulary with your health care practitioner(s). It is possible that an affordable alternative is already included in the formulary you have selected. Your Medicare Part D Plan is an important part of providing for your overall healthcare needs. Always take the time to choose wisely grasshopper!

Updated in Rock Hill SC
by Kristin P Sinclair (803)329-0615

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When is it Best to Buy a Medicare Supplement ?

by Kristin P. Sinclair – Rock Hill SC – October 9, 2018

The very best time to buy your Medicare supplement is during your Open Enrollment Period(OEP). Normally this period lasts for six months starting with the first day of the month you are 65 or older and are also enrolled in Medicare Part B. For those under age 65* there may be additional Open Enrollment Periods in certain states.

During your Open Enrollment Period an insurance company cannot refuse to sell you any Medicare Supplement Policy they offer; charge you a higher rate than that company might charge someone in good to excellent health; or make you wait for your coverage to begin. Please note that the insurance company may make you wait for up to six months for pre-existing condition coverage. That is a condition that you would have prior to your Medicare Supplement coverage starting. This period of time is called a pre-existing condition waiting period. After six months, your Medicare Supplement Policy will cover any pre-existing conditions.

If you make a change from one Medicare Supplement to another after becoming Medicare eligible, and you have not had a lapse in coverage with your prior provider; then you will have underwriting.   you can shorten, the period where a waiting period would be applicable. It is possible to shorten or eliminate any pre-existing condition waiting periods if you have Creditable Coverage before you apply.

An insurance company cannot subject you to any pre-existing condition waiting period if you have been covered by your employer health plan which is Creditable Coverage; if you are still working full time and opted to delay Part B until you have decided to move your coverage to include your Medicare Part B coverage, or if you have had at least six months of Creditable Coverage. Please note that you cannot have had a 63 day break in coverage between your Creditable Coverage and your Medicare Supplement coverage.

You need to include your letter of creditable coverage with your application unless you are new to Medicare Part B.

It is also important to keep in mind that your Medicare Supplement rights are based upon when you enroll in Medicare Part B. For those age 65 and older, your Medicare Supplement Open Enrollment Period begins when you enroll in Medicare Part B. This period cannot be change or repeated. Thus, if you have employer or union group health coverage that is as good or better than original medicare, then you may want to wait until later to enroll in Medicare Part B. Most group health coverage provides benefits similar to Medicare Part B; and also having Medicare Part B might be an unnecessary duplicate expense. Worse yet, your Medicare Supplement Open Enrollment Period might expire before you need it.

In summary, for those age 65 and over, when you are first eligible you have the right to buy any Medicare Supplement Policy offered in your state. This gives you more choices, and normally lower monthly premiums. So during the Open Enrollment Period, a person with health issues can buy a Medicare Supplement for the same lower prices as those with no health issues.

 

Kristin P. Sinclair (803)329-0615
Rock Hill SC

* For those under age 65 that have Medicare Coverage due to a disability, and suffer End-Stage Renal disease there may be limitations to their coverage options.

KPS: More information available at Medicare.gov

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New Medicare Cards on the Way!

New Medicare Cards are Coming!

by Kristin P. Sinclair – A Accu Tax – September 6, 2018

You might have yours already, if not they are being mailed in stages. It is expected that over the next month or so, Medicare Beneficiaries who are residents in North Carolina, South Carolina, Georgia, and Florida will be getting new cards.

So something to think about, is your address current with Social Security and with Medicare? You certainly want your important mail to get to You. And You definitely would not want someone else to get your mail.

3 things to know

Your new card will automatically come to you. You don’t need to do anything as long as your address is up to date. If you need to update your address, visit your My Social Security account. Visit your local office, or call to schedule your appointment. Find out what you need to have with you to provide proof you are you…..

Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.

Your new Medicare Number is a unique combination of numbers and letters. Your new number uses numbers 0 thru 9. And Letters.

The letters S, L, O, I, B, and Z are never used.

 

Watch out for scams

Medicare will never call you uninvited and ask you to give personal or private information to get your new Medicare Number and card.

Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card.If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call us at 1-800-MEDICARE (1-800-633-4227).

When you visit your insurance agent in October or November to review your drug plan options you will want to have your new medicare card with you if it has arrived. As well has a current PDP card as well. And a list of the medications that you are taking. Your Medicare Number is referenced on your application for your Medicare Part D plan coverage even though you have a unique ID number for your drug coverage with your insurance company.

When your new medicare card arrives, feel free to call your insurance company to inquire how they update their records when new medicare cards numbers are issued. Find out if they need you to update them, or if they are updated by Medicare. You want to be the person in the know. You want to feel confident that you are in control.

 

Guard your card and protect your personal information

To help protect your identity, Medicare is mailing new Medicare cards. Your new card will have a new Medicare Number that’s unique to you, instead of your Social Security Number.

Don’t share your Medicare Number or other personal information with anyone who contacts you by phone, email, or by approaching you in person, unless you’ve given them permission in advance.

Medicare, or someone representing Medicare, will only call and ask for personal information in these situations:

  • A Medicare health or drug plan can call you if you’re already a member of the plan. Theagent who helped you join can also call you.
  • A customer service representative from 1-800-MEDICARE can call you if you’ve calledand left a message or a representative said that someone would call you back.
  • Only give personal information like your Medicare Number to doctors, insurers acting onyour behalf, or trusted people in the community who work with Medicare like your StateHealth Insurance Assistance Program (SHIP).
  • Be familiar with how Medicare uses your personal information. If you join a Medicareplan, the plan will let you know how it will use your personal information.If someone calls you and asks for your Medicare Number or other personal information, hang up and call Medicare at 1-800-MEDICARE (1-800-633-4227).

Medicare Part B: Is it covered?

by Kristin P. Sinclair – A Accu Tax – September 1, 2018

what-is-a-fixed-annuityIs your test, item, or service covered?

Medicare coverage for many tests, items and services depends on where you live. This list only includes tests, items and services that are covered no matter where you live. If your test, item or service isn’t listed, talk to your doctor or other health care provider. They can help you understand why you need certain tests, items or services, and if Medicare will cover them.

  • Abdominal aortic aneurysm screening one time test covered by Medicare
  • Advance care planning annual opportunity to review with your Doctor Annual Wellness Visit
  • Air-fluidized beds & other support surfaces When Your Doctor orders such as medical needed
  • Alcohol misuse screening & counseling
  • Ambulance services
  • Ambulatory surgical centers
  • Anesthesia
  • Artificial eyes & limbs
  • Bariatric surgery under certain circumstances
  • Blood after the first thee pints
  • Blood processing & handling
  • Blood sugar (glucose) monitors
  • Blood sugar (glucose) test strips
  • Bone mass measurement (bone density)
  • Braces (arm, leg, back, and neck)
  • Breast prostheses
  • Canes
  • Cardiac rehabilitation programs
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular disease screenings
  • Cataract surgery
  • Cervical & vaginal cancer screenings
  • Chemotherapy
  • Chiropractic services
  • Chronic care management services
  • Clinical research studies certain studies with cost sharing
  • Colorectal cancer screenings
  • Commode chairs
  • Concierge care
  • Continuous passive motion (CPM) machine
  • Cosmetic surgery for certain situations when medically necessary
  • Crutches
  • Custodial care if it is part of the skilled care your Doctor has determined is medically necessary
  • Defibrillator (implantable automatic)
  • Dental services part of inpatient hospital care when medically necessary
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Diabetes supplies & services
  • Diagnostic tests
  • Dialysis (children)
  • Dialysis (kidney) services & supplies
  • Doctor & other health care provider services
  • Durable medical equipment (DME) coverage
  • EKG or ECG (electrocardiogram) screening
  • Emergency department services
  • Enteral nutrition supplies & equipment (feeding pump)
  • Eye exams
  • Eyeglasses/contact lenses
  • Federally Qualified Health Center Services
  • Flu shots
  • Foot care
  • Foot exam
  • Glaucoma tests
  • Glucose control solutions Well the Medical Community can Guide You, You make the solution.
  • Health education & wellness program an example would be a Cardio Rehab program
  • Hearing & balance exams when determined to be medically necessary
  • Hepatitis B shots
  • Hepatitis C screening test
  • HIV screening
  • Home health services for skilled intermittent care
  • Hospice part of Medicare Part A
  • Hospital beds Durable Medical Equipment
  • Inpatient hospital care Medicare Part A
  • Insulin
  • Kidney disease education
  • Kidney transplants (adults) If the Adult is a Medicare beneficiary Part A and Part B are factors
  • Kidney transplants (children) If the Child is a Medicare beneficiary Part A and Part B are factors
  • Laboratory services (clinical)
  • Lancet devices & lancets
  • Lung cancer screening
  • Macular degeneration eye exam and a few other medical conditions as well, not preventative.
  • Mammograms a schedule exists review with your Health Care Provider for your benefits.
  • Manual wheelchairs & power mobility devices Durable Medical Equipment
  • Mental health care (inpatient) Medicare Part A
  • Mental health care (outpatient) Medicare Part B
  • Mental health care (partial hospitalization)
  • Nebulizers & nebulizer medications Medicare Part D
  • Nursing home care Limited period of time when parameters are met, oop cost sharing exists
  • Obesity screening & counseling
  • Osteoporosis drugs for women
  • Outpatient hospital services Medicare Part B
  • Oxygen equipment & accessories
  • Physical therapy/occupational therapy/speech-language pathology services
  • Pneumococcal shots
  • Prescription drugs (outpatient) Medicare Part D
  • Preventive visit & yearly wellness exams
  • Prostate cancer screenings
  • Prosthetic devices
  • Pulmonary rehabilitation
  • Radiation therapy
  • Second surgical opinions
  • Sexually transmitted infections (STI) screening & counseling
  • Shingles shot Medicare Part D Review with your Insurance provider
  • Shots (vaccinations) Medically necessary Review which are covered with your Medicare Part D
  • Skilled nursing facility (SNF) care Up to 100 Days when parameters are met with cost sharing
  • Sleep apnea & Continuous Positive Airway Pressure (CPAP) devices & accessories
  • Sleep study
  • Smoking & tobacco use cessation (counseling to stop smoking or using tobacco products)
  • Substance-related disorders
  • Surgery (estimating costs)
  • Surgical dressing services
  • TDaP shot (tetanus, diphtheria, & pertussis shot) Medicare Part D
  • Telehealth
  • Therapeutic shoes or inserts For Certain Medical Conditions when Medically Necessay
  • Traction equipment
  • Transitional care management services After Hospitalization under certain situations briefly
  • Urgently needed care
  • Walkers Durable Medical Equipment
  • X-rays

 

This lists shows many, but not all, of the items and services that Medicare might cover..

Medicare.gov has a search engine that you can populate the field with your item to look up and

you can see what is covered by what part of the Medicare system. A, B, D etc. And this search engine can also provide detail as to what is not covered.

 

For more information, view the official medicare.gov website https://www.medicare.gov/

 

Kristin P Sinclair

@Sinclair Financial Solutions

803-329-0615

 

August 22, 2018

Rock Hill, SC 29730

 

Take Advantage of the “Welcome to Medicare” Visit

by Kristin P. Sinclair – A Accu Tax – August 21, 2018

Screenings, shots, and referrals can be achieved. You will find you will be a very important part of your well being, be willing to talk and share information with your health care provider.

Do yourself a favor and have a written down set of notes that you can provide your health care provider about family history of health concerns. Your doctor will likely have this information added to your records. Make a copy; you will want to share this detail with your various medical care providers.

Provide your health care provider detail about your exercise patterns. And ask your provider to help when you know that you need guidance on your exercise journey.

Provide your health care provider a list of the RX medication(s) you are taking, as well as your over the counter vitamins and minerals, and herbs you are taking and what schedule to have in place to take the above.

 

Yearly Wellness Visit

Yearly, covered every 12 months. If things have changed you need to share this with your Doctor. If you are out walking more days and enjoying the trees and flowers and listening to the birds sing to you let your Doctor know that. Share with your Doctor all the things you are doing to help make you healthier. If you need advice to help you reach your goals, you need to also let your Doctor know that you feel you need help to achieve your goals. Your Doctor can advise you it you want to alter the schedule to walk after a meal.

Your annual wellness visit is a chance to share information and gain information. It is a chance to talk about what has changed.

And every day of the year you have an opportunity to make changes which can be shared as you wear out one pair of tennis shoes and replace them with new pairs. Your out of pocket costs for new tennis shoes that you use wisely, and new insoles for your shoes are a small price compared to some other choices.

Did you know that when you take a walk in a park and enjoy the trees and flowers which bring you oxygen and clean the air that you breath you can make a tremendous difference in how you feel and look at your day.

Did you know that when you take a walk you are helping your body bring precious supplies of nourishment to your brain. And you also make additional changes as well which can make your next annual wellness visit reason to celebrate. As you see others out enjoying the great opportunities each day it can make it possible to share a hello with others. Enjoy the smile you feel as you enjoy your accomplishments.

Then after your exercise, enjoy the opportunity to relax, and clear your mind. Enjoy the feeling of being awake and relaxed, and simply enjoy being in the moment for a little while before you begin the rest of your day.

Kristin Sinclair

@ Sinclair Financial Solutions

803-329-0615

 

Updated August 2018

Rock Hill SC

Medicare Part B: Let’s Review Some More Detail

by Kristin P. Sinclair – A Accu Tax – August 15, 2018

medicare

Abdominal Aortic Aneurysm Screening

This is a one-time covered test.

So if you and your Doctor Feel that you need to have this test done again sometime after the initial testing, this would be an example of you having some out of pocket costs for the testing.

There is a potential way to get several items reviewed and supply your Doctor with the results. Many of you have heard of Life Line Screening. You can have several tests done for a low fee. All in the convenient location of where the Life Line Screening is being done in your area.

 

Bone Mass Measurement (Bone Density Screening)

Medicare covers this test once every 24 months when certain criteria are met.

So sometimes you need to be proactive in taking care of yourself before an issue becomes medically necessary. Something you can do to be good to yourself. Just like you know you need to exercise your body to remain healthy, you exercise your wallet when you purchase those tennis shoes you will wear when you take your walks. You will sometimes want to exercise your wallet and get some cost efficient tests done and share the results with your Health Care Providers.

Bone Mass Measurement also called Bone Density Screening, this too is an example of one of tests you could have done at a Life Line Screening location. And supply your doctor with the results.

 

Cardiovascular Disease Screening

Medicare covers screening blood test for cholesterol, lipid, and triglyceride levels every 5 years.

I have some news for you. If you apply for a life insurance policy at certain levels of coverage the insurance company is likely going to have a paramed exam completed that will likely include a blood test. You can request a copy of those lab results and supply that information to your health care provider. And likely your Doctor will very much appreciate having this information available before a time frame of 5 years has come and gone

 

Diabetes Screening

Medicare Part B will cover these tests if your Doctor determines you are at risk.

For instance if you have hypertension, if you have high cholesterol, high triglyceride levels.

For instance if you are obese, if you have a history of high blood sugar, or high glucose levels.

If you are 65 or older and have a family history of diabetes, or are over weight, or if you had gestational diabetes during pregnancy, or gave birth to a child 9 lbs or in weight.

Your Doctor might want to run tests more often than Medicare covers those tests. Your Doctor office will let you know if additional out of pocket funds are due. You will determine what you want to pursue. One of those things to pursue will likely be those marvelous tennis shoes just waiting for you to use them more often. You are worth what you need to make yourself more healthy.

 

Flu Shot

When You have Medicare Part B, one of the annual benefits available to you is the annual Flu Shot. It might not have an out of pocket charge to you if, your provider Your Doctor or another qualified health care provider, accepts assignment. Yes, it is getting to be that time of year again.

 

Pneumococcal shots

Medicare Part B will cover this shot(s) if your provider accepts the Medicare assignment you would not have additional out of pocket (oop) costs. Did you know that there is more than one type of pneumococcal shot. One shot is covered one year the other type is covered one year later. So you will want to discuss this schedule with your doctor. A good time to (discuss) these things is during you Annual Wellness Visit. Your Doctor can provide you with a nice schedule that you will want to keep and use a guide for your future visits that you will schedule. Talk with you Doctor to find out which shot they feel you might need and when it will be time to schedule that event.

 

Updated in Rock Hill, SC

Kristin P Sinclair

@Sinclair Financial Solutions

803-329-0615

Medicare and Yes, I Have Choices

by Kristin P. Sinclair – Charlotte NC – August 15 2018

Other items to include in your decision making when it comes time think about health care.
Which Health Care practitioners(s) you wish to offer your health care during the year. Does the provider accept Medicare, if yes, then they will accept your Medicare supplement as well.

Next question, when the health care provider accepts Medicare, do they accept the Medicare Advantage plan you are considering. Well, you need to verify that before you make you plan decision. Health Care providers have the option to either accept a Medicare Advance Plan as an insurance option, or possibly they could make a choice to not accept Medicare Advantage plans. Many Advantage Plans are Network Based.  Many Advantage Plans have a geographic area that offer the particular plan design. The Providers that accept the Medicare Advance Plan will usually be geographically accessible to that specific plans area.

Original Medicare is a Federal Program, Insurance products which work with the Original Medicare follow both Federal and State Guidelines.  Original Medicare will provide coverage with in the United States. Medicare Part A offers coverage to help with the costs for a Medically necessary  in patient hospital stay(s), with applicable Deductible and Co-Insurance cost sharing. When you select  a  Medicare Supplement plan, you are selecting a plan to help fills the gaps in Original Medicare.
Medicare Part B is the out patient care portion of medicare, Medicare Part B has an annual deductible and co-insurance cost sharing as well, the Medicare Supplement plan you select will offer coverage  to help fill gaps in the Original Medicare.

Helping to fill the gaps in the Original Medicare is going to reduce your out of pocket costs associated with health care.

Medicare Advantage Plan often you must use providers who accept your plan, and the plan could have limits on where you can travel and still have access to benefits if not in an emergency situation. And If you travel away from home for a period of greater than 2 months, you might need to change your plan, because of the amount of time you have chosen to be away from home.  Medicare Advantage plans have specific geographic regions, states, or counties that they offer coverage. MA will have annual contracts with Medicare, they must be as good as Original  Medicare and they will have Out of Pocket limits annually which can change per annual period.  Often the MAPD (Medicare Advantage Prescription Drugs) will be one policy choice for Hospital, Out patient and Drug plan coverage.

Stand Alone Prescription Drug plans are approved  Federally,  Center for Medicare Services, and  are State specific.  Stand Alone Medicare Part D covers the medications which are not administered under Medicare Part A or Medicare part B, Medicare Part D medications will usually be the medications you fill at your preferred local pharmacy or the mail order service your Part D provider has in place for your benefit as a potential cost saving opportunity when you seek a 90 mail order alternative. Using your plans  Preferred Mail order provider might offer you savings through out the Annual Period. A Medicare Part D plan will help round out your coverage when you select a Medicare Supplement.

From Oct 15th though Dec 7th each annual period you have what is called the annual Enrollment period, also called the Open Enrollment period. This is a time that you will review various Medicare Part plan and various Medicare Part C plans to decide what change you will make for the coming year. If a change is indicated.

However, Medicare Supplement or MediGap plans do not have the Annual Enrollment Period.
You can keep your plan as long a you pay your premiums. You have the opportunity to change your Medicare supplement plan any time of the year. As long as you can pass any underwriting requirement which might be applicable.

If you move to another state, you have guarantee issue rights so long as you make your change within 63 days of the change of residents.  Always keep a record of which plan you have and keep your letters you receive from your plan pertaining to your rights. Medicare has protections in place for your benefit.  We live in a mobile culture. It is great that we have the protections available to us, especially after our life time of work. We certainly deserve the protections that Medicare makes available to us.

 

Kristin P. Sinclair (803)329-0615
Charlotte NC, Rock Hill SC and Charleston SC
August 15 2018

* For those under age 65 that have Medicare Coverage due to a disability, and suffer End-Stage Renal disease there may be limitations to their coverage options.

KPS: More information available at Medicare.gov

 

 

 

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What Are Medicare Supplements ?

by Kristin P. Sinclair  – A Accu Tax  – September 12, 2018

Medicare Supplements are policies sold by private insurance companies. Medicare supplements are designed to help pay many of the health care cost not covered by Original Medicare.

Medicare Supplement plans are standardized. Meaning the basic plan design with a Letter Designation such as Plan F or High Deductible Plan F, Plan G,  Plan L or Plan N, has a standard set of benefits for that particular Letter used to describe what basic standard features are in the plan. Some companies will offer Value Added Benefits above and beyond the Supplemental Benefit.

Some companies will not have a plan which has added Value Added Benefits above and beyond the Supplement Benefit. Some companies will indeed have Value Added Benefits, so as a consumer you will want to ask your agent about things which you as a consumer are interested in to determine a plan which might be suitable for you needs.

 

Updated in Charlotte NC and Charleston SC

by Kristin P. Sinclair   A Accu Tax – Rock Hill SC

(803)329-0615   September 12, 2018

KPS: More information is also available at Medicare.gov

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