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


Let’s Talk Medicare Part B in 2019

by Kristin P. Sinclair   March 3, 2019

We know that Medicare has several different parts. Today we will be focus on Medicare Part B after a brief paragraph on Part A of Original Medicare.

Medicare Part A has a Hospital Deductible of $ 1,364.00   per benefit period deductible. You might be wondering what a benefit period is ? Well it is a continuous or unbroken number of days within a calendar year. So a person in the hospital as an inpatient on different occasions during a year could face several Part A Hospital Deductibles. It is very important to understand the potential Part A Deductible financial responsibility you might face. Therefore, it is very important to understand that Medicare does not cover all potential health care costs.

However this article is about Medicare Part B. In Medicare Part B, you have premiums, one annual deductible amount that applies to all of Medicare Part B covered medical events for annual period in any given year. Followed by co-pays. Let us look at Medicare Part B more closely.

In 2019 the Standard Part B Premium is $135.50 each month for most Medicare Part B beneficiaries. Premium is not the same thing as a deductible.

As you receive medical care which is a Medicare covered event, you have a deductible amount you are responsible for, and that amount is $185.00 for first

dollar out of pocket exposure. If the first care received is considered a covered preventative care service no out of pocket would be expected. However, if the care is not for covered preventative care you would have the applicable out of pocket amount due for care received for your situation until you have paid the $185.00 annual deductible for 2019.

After the deductible is reached you have coinsurance amounts you are responsible for. Medicare would pay 80% of the Medicare covered services and you would be responsible for 20% of the Medicare covered services.

It is important to know that the original Medicare has no CAP on your financial exposure if you have a lot of health care needs. So it is important to know that Medicare alone is no enough coverage. We have other articles that help you understand additional options you have.

 

Updated in Rock Hill SC and Charlotte NC

by Kristin P Sinclair     A Accu Tax (803)329-0615

March 3, 2019

Let’s Talk Medicare Part A Spring 2019

New Medicare Cards are Coming!

by Kristin P. Sinclair – March 2, 2019

We know that Medicare has several different parts. Today we will be focus on Medicare Part A of Original Medicare.

Medicare Part A has a Hospital Deductible of $ 1,364.00   per benefit period deductible. You might be wondering what a benefit period is ? Well it is a continuous or unbroken number of days within a calendar year. So a person in the hospital as an inpatient on different occasions during a year could face several Part A Hospital Deductibles. It is very important to understand the potential Part A Deductible financial responsibility you might face. Therefore, it is very important to understand that Medicare does not cover all potential costs.

Another factor to consider with Medicare Part A. If a person were to be continuously hospitalized for a period greater than 60 days, then the beneficiary would be responsible for $ 341.00   per day for days 61 through day 90. Medicare would pay all Medicare approved costs above and beyond the $341.00 per day for days 61 through day 90.

With Medicare Part A if a person were to be continuously hospitalized for a period greater than 90 days, then day 91 through day 150 Medicare would pay costs after the beneficiary paid their cost sharing of $682.00 per day. For example, if you were hospitalized for days 91 through 150, then Medicare would pay all Medicare approved costs except for $682.00   per day. Note that Hospitalization days 91 through 150 are called Lifetime Reserve Days. Once these days are used they do not become available again. Each of the 60 Lifetime Reserve Days in Original Medicare are only available to be used one time. So please remember that while Medicare provides fabulous coverage; Medicare does not; cover all of your potential medical expenses.

You should also plan on additional Medicare insurance products. You do have choices and We will discuss those options in a different article.

Medicare will also pay for needed blood, only after the Medicare Beneficiary has paid for the first three pints of blood. This is an additional example of how fortunate we are to have Medicare Part A when we need to start receiving those benefits. Again, Medicare alone is not enough coverage.

If the Medicare Beneficiary was a hospital admitted as an inpatient for three full nights and days, and within 30 days after the hospitalization, needed to receive Skilled Nursing Care related to that hospitalization which has just occurred, then Medicare Part A would pay the first 20 days of Medicare approved Skilled Nursing Care. Skilled Nursing Care may be received in a Skilled Nursing facility or in your home. In the event that additional days of Skilled Nursing Care were needed, then Medicare would pay all but $ 170.50   per day for day 21 through day 100. Medicare pays for no additional days after day 100 of Skilled Nursing Care. Medicare does not cover Long Term Care.

Skilled Nursing Care is a higher level of care than Custodial Nursing Care. Medicare does not pay for Custodial Nursing Care. You might not have been aware that most people who reside in a nursing home are actually receiving for the most part Custodial Care. Again, regarding Custodial Care, Medicare normally does not pay for that level of care. Those with assets will be paying for Custodial Care with their Assets until the spending down has occurred.

Please note that your health care professional and Medicare might determine that ongoing Skilled Nursing Care could help further your at-home recovery. This would help you become more self sufficient again. Skilled Level Home Health Care would only be indicated if the Medicare Beneficiary were homebound, and leaving the home is extremely difficult. Plus care is needed by trained medical professionals such as a nurse, an occupational therapist, a speech therapist, or a physical therapist. Plus the care must be provided by a Medicare Approved Home Health Agency and trained professional care providers. This care is intermittent which means you need Skilled Nursing Care just not continuously.

Sometimes, the level of care a person requires is the type of care which is provided by Hospice or Palliative Care. This care would only be indicated once the Medical Professionals offering your care have determined that the Medicare Beneficiary health status has reached a level of terminal illness therefore likely that death is anticipated within 6 months. You sign a statement saying you are seeking Hospice Care rather than Medicare services to seek treatment for the condition. Medicare will normally pay for 95% of the Medicare approved costs associated with Hospice care. So the Hospice Patient could have a 5% responsibility for the respite care received. Medicare does not cover the costs associated with Room and Board when in home care is sought, nor when Room and Board costs would be a factor when hospice care is being offered in another facility such as a nursing home. Often a patient would receive care in a Hospice Facility that has a mission in their charter to assist with care at end of life.

Medicare also helps to cover the costs of the medications which are indicated for palliative and comfort care during the period of Hospice care. The Medicare Beneficiary would be responsible for a $5 co-pay for the medications used to help alleviate pain during this end-of-life period for the medications covered by Medicare Part A. It is possible that help will be needed by the Medicare Part D provider for the medication items that are covered by that formulary rather than Medicare Part A. Hospice care is not the type of care that is to be sought when a cure for your condition is the goal. Rather Hospice and Palliative Care is desired to make the patient as comfortable and pain-free as possible during these difficult final days of life. To help the patient have a peaceful period during the end of life period that Hospice Care and Palliative Care is being sought.

Since Medicare does not cover the full costs associated with Hospice Care this is an additional example of the need for additional insurance to help lessen the financial responsibility for family members and the medicare beneficiary during Hospice Care.

Updated in Rock Hill SC and Charlotte NC

by Kristin P Sinclair     (803)329-0615

March 2, 2019                     

2019 Medicare Part D Insurance for The Coming Annual Period

This article is being updated. Please check back again later.

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, October 9, 2018
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, October 9, 2018
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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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

 

September 1, 2018

Rock Hill, SC 29730

 

Take Advantage of the “Welcome to Medicare” Visit

by Kristin P. Sinclair – A Accu Tax – November 5, 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 November 2018, November 5, 2018

Rock Hill SC

Medicare Part B: Let’s Review Some More Detail

by Kristin P. Sinclair – A Accu Tax – November 5, 2018

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, November 5, 2018

Kristin P Sinclair

@Sinclair Financial Solutions

803-329-0615

Medicare and Yes, I Have Choices

by Kristin P. Sinclair – Charlotte NC – November 5 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
November 5 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 ?

This post currently being updated. Full post will be re-added by June 15th.

 

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Part B covers 2 types of services, and it’s great to have those protections

by Kristin P. Sinclair – A Accu Tax – November 3, 2018

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment

Part B covers things like:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
  • Inpatient
  • Outpatient
  • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

2 ways to find out if Medicare covers what you need

  1. Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  2. Find out if Medicare covers your item, service, or supply.

Medicare coverage is based on 3 main factors

  1. Federal and state laws.
  2. National coverage decisions made by Medicare about whether something is covered.
  3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

 

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

Kristin P Sinclair

@Sinclair Financial Solutions

803-329-0615

November 3, 2018

Rock Hill, SC 29730

 


Asset Allocation in Your IRA

by Donn J. Sinclair MBA   November 3, 2018

Asset allocation refers to the mix of investments inside your IRA portfolio. That is, how much of your IRA portfolio you invest in stocks, bonds, cash, and other asset classes. The IRA could be a Traditional IRA, IRA Rollover, Roth IRA, SEP-IRA, or SIMPLE-IRA. Your allocation should also consider your investments within each asset class and your temperament for risk.

Finding Your Mix
The concept behind asset allocation is very simple: Don’t put all your eggs in one basket. But the implementation may be somewhat complex. The mix of assets you choose for your IRA depends largely on your personal financial situation and your time horizon. Personal financial considerations include: will you and/or your spouse continue to work seasonally or part-time during retirement; how much you have saved to date for retirement; whether your retirement savings are post-tax or pre-tax(IRA, 401k, etcetera).   Your time horizon is the length of time you have to invest before you need your retirement funds. Several financial goals may require that an IRA portfolio have several time horizons; and these different goals may actually be in conflict.

Your Risk Tolerance

This is your financial ability and emotional willingness to take risk in pursuit of reward with your IRA. Calculating your risk tolerance requires you to examine your income, your assets, your responsibilities, and your ability to cope with stock and bond market ups and downs. When you pursue IRA financial goals as a household, then you must also consider your spouse’s risk tolerance.

Rebalance Your IRA Portfolio

Once you calculate an IRA asset allocation that feels right for you, then periodically you should monitor your allocation. A portfolio that starts out with 60% stock funds and 40% bond funds may shift to 50% stock funds and bond funds, if bond funds outperform stock funds for a length of time. Conversely, if bond funds outperform stock funds, then your asset allocation portfolio may be overweight in bond funds. Should your IRA get out of alignment, then you may rebalance your portfolio by selling or exchanging assets in one category, and buying or exchanging assets in another. Within your portfolio be aware of any rebalancing costs. You should establish regular time periods to review your IRA portfolio, and rebalance your asset allocation as necessary.

 

Changing Times and Course

As you get closer to your financial goal and you time horizon shortens, then your ideal asset allocation could change. Generally you should pursue a more conservative asset allocation when you have less time to reach your financial goals. Life changes including: having children, caring for aging parents, loss of employment, and adverse health may also impact your financial goals and risk tolerance.

 

A Few Words About Risk and Reward in Your IRA

You should carefully consider any savings and investment vehicle’s objectives, risks, expenses, and rewards. Not all savings and investment vehicles may be appropriate for everyone. Every individual is unique, has their own set of financial circumstances, and comfort level with saving and investment risk. Also, prior to any decisions or IRA investing, you should carefully read the available material to better understand the specifics of your selected IRA savings or IRA investment vehicle.

You should consult your tax advisor or www.IRS.gov for more information. The above information is intended as educational information and not as investment advice. This is a great time to check and update the beneficiary designations on your Traditional IRA, Roth IRA, and any IRA Rollover.

 

Donn J. Sinclair, MBA    November 3, 2018    (803)329-0609

@Sinclair Financial Solutions is independently owned and operated. Donn J. Sinclair, MBA is SC insurance licensed in CT, GA, IL, NC, SC, and VA (NIPR NPN#1722815). SC Real Estate License #76530, and NRDS #554027312. Securities offered through Fortune Financial Services, Inc,3582 Brodhead Road, Suite #202, Monaca, PA 15061;branch office of record located at 948 Myrtles= Drive Rock Hill, SC 29730, Member FINRA/SIPC. @Sinclair Financial Solutions and Fortune Financial Services, Inc are separate entities. Updated in Charleston SC and Rock Hill SC