medicare

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When is it Best to Buy a Medicare Supplement ?

by Kristin P. Sinclair – Rock Hill SC – January 15, 2020

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, January 15, 2020
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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Questions for Home Health Care Provider Interviews

by Donn J. Sinclair, MBA – January 10, 2020

When recovering from an injury or illness, your Medicare coverage and your Medigap or Medicare Supplement may pay some of the Home Health Care costs that you incur. When selecting a home care agency for you or a loved one, there are important questions to ask when interviewing home health care agencies.

  • Private duty home care – what year did the agency first offer that service ?
  • State licenses – are the agency staff and home health care agency properly licensed in your state ? More specifically, properly licensed to provide care level your physician ordered ?
  • Which home health care agency staff member coordinates with the patient’s physician to implement the physician developed plan of care ? The plan is evaluated and updated by the agency on what schedule ?
  • What daily notes are maintained to monitor the progress of the patient ?
  • Who and how is quality of care supervised and updated ? How frequent are unscheduled agency supervisory visits on the agency staff?
  • What are the home health care agency ongoing training mandates for their caregivers ? Who supervises the training ?
  • How and by whom are after normal business hour emergencies handled ?
  • Does the home health care agency have on staff nurses, social workers, physical therapists, and other qualified professionals available to provide needed in home care ? If not, with which providers does the home health care agency have an established working relationship ?
  • How do you obtain a written copy of the home health care agency’s privacy policy, ethics code, and mission statement ?
  • What screening techniques are used to screen caregivers ? Do these include reference checks, driving records, credit checks, and criminal background investigations ?
  • Are the home health care agency caregivers W-2 employees or W-9 subcontractors ? Are there any home health care agency incidents of failure to file payroll tax reports, or incidents where the agency failed to pay taxes on a timely basis ?

When it comes to selecting a home health care agency, you should follow the Boy Scouts motto “Be Prepared”. Make certain that you and your loved ones get the care they require and deserve. Also make certain that Medicare and your Medicare Supplement pay as they should for the care received.

 

Donn J. Sinclair, Winthrop MBA

in Charlotte NC and Rock Hill SC

January 10, 2020   (803)329-0609

 

DJS: More information is available at Medicare.gov

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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 – August 15, 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.

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Medicare and Yes, I Have Choices

by Kristin P. Sinclair – Charlotte NC – January 10, 2020

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
January 10, 2020

* 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 – April 19, 2020

In order to have a Medicare supplement you first also need to make certain that You will have Medicare Parts A and B on the day Your Medicare Supplement begins. You need to live in the state where your Medicare supplement begins. When You move, You need to notify Your Medicare supplement provider of the plan to move, when You plan to move, Your new address. And plan to have that supplement update Your rates to Your new address service area, or plan to set up a new plan when the seemless transition of coverage is not possible.

When You are making a move from one state to the next You will benefit from what is called a Guarantee issue period. If You have a need to establish a new policy for Your new state location. Of Course Social Security and Medicare also need to know that You are moving are have moved as well. Time is critical when making a move.

When You are simply traveling there is not need to make a change, Your coverage moves with you anywhere in the United States.

When You are choosing Your Medicare supplement You need to keep several things in mind, Your rates will increase. Your rates will increase based upon the claims experience of the company offering Your supplemental coverage as well. If You live in an area that has been hit with a large amount of claims for people with the same company that You have selected You should anticipate that rates will increase in the next year of so. If You live in an area, where as a general rule, folks with the same plan You have selected love to exercise, and have made a deliberate choice to live a healthy lifestyle Your rates might not change as quickly as could happen otherwise. Your rates will not change simply because You have had a large amount of claims or a small amount of claims. You are in an area, with many other policy holders who collectively affect how rate changes occur.

Once You have selected a policy, with the benefits You feel are correct for Your situations, and the policy has been issued and approved by the insurance company; You have accepted the policy and You pay the premiums when they are due, You will benefit from the policy You accepted until You decide to make a change.

You are selecting what is called a standardized policy with a letter designation; when You select a Medicare supplement. Each letter designation has certain benefits that are part of that policy. When a choice is made, and an application is submitted you are applying for coverage. You are applying for coverage with certain benefits and with a Medicare Supplement, when Medicare makes changes Your supplement will make changes to supplement the Original Medicare. As Original Medicare increases cost sharing, Your policy changes to help fill in the gaps based upon the plan You selected. So when the Original Medicare increases cost sharing and Your policy changes You will see a premium change which could take place for various reasons.

Updated by Kristin P. Sinclair: A Accu Tax

in Charleston SC and Rock Hill SC

April 19, 2020 (803)329-0615

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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 – January 13, 2020

IRAs Rock Hill Charlotte Tax Services Help

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

January 13, 2020

Rock Hill, SC 29730

 


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