medicare

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When is it Best to Buy a Medicare Supplement ?

by Kristin P. Sinclair – Charleston SC – April 5, 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
Charlotte NC, Rock Hill SC and Charleston SC
April 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 ?

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

Medicare Supplements are policies sold by private insurance companies designed to pay many of the health care costs not covered by Original Medicare. Some Medicare Supplements will feature additional benefits; these are value added features. Gym memberships, fitness opportunities at the local gym, or training at home with self directed memberships, plus optical and pharmacy discounts. Some Medicare Supplement plan designs have coverage for Foreign Travel emergencies. Emergency foreign travel expenses may be covered with certain plan designs.

Medicare Supplements are also known as MediGap policies. These plans help to fill in the gaps in Original Medicare. Medicare does not cover all of your medical costs. You can choose a Medicare Supplement to help fill some of these gaps. Medicare offers coverage for medical care that is medically necessary, your Medicare Supplement offers coverage for items that are medically necessary based upon the plan design you select. Medicare supplement Plans include: A, B, C, D, F, HDF, G, K, L, M, N.

Medicare Supplement plans are standardized plans. Which means the Federal Government has determined that plans with a particular letter designation will have a set of defined coverages. No matter which insurance company offers the product – the plan is identical. Once you have selected and accepted your Medicare Supplement Plan, then you will have your premiums applicable to your selected plan. You pay your premiums and you can keep your Medicare Supplement plan as long as you pay the applicable premiums for the coverage you have selected. The policy renews and can not be canceled unless you chose to cancel the policy. You can travel through out the USA and not worry about networks. This means you can normally receive care from any doctor and any medical facility that accepts Medicare.

When you have a Medicare Supplement you should also have a separate Prescription Drug Plan (PDP). Please note that Medicare Supplements also known as Medigap Plans normally do not cover the prescription medications which would be covered by stand-a-lone PDPs. These PDPs normally cover both Name Brand Rx drugs and Generic Rx drugs. If you have VA Benefits, then probably only will have coverage for your Generic Rx drugs.

Original Medicare alone is not enough coverage to protect your financial interests from health care costs. Let us help you find the Medicare Supplement that can help you with those costs today and tomorrow.

 

Updated in Charlotte NC and Charleston SC

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

(803)329-0615   February 1, 2018

KPS: More information is also available at Medicare.gov

 

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Let’s Talk Medicare in 2018

by Kristin P. Sinclair – A Accu Tax – January 2, 2017

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

Medicare Part A has a Hospital Deductible of $1,340 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 $335 per day for days 61 through day 90. Medicare would pay all Medicare approved costs above and beyond the $335 per day for days 61 through day 90.

Medicare Specialist Insurance Kristin Sinclair
Medicare Professional Kristin Sinclair

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 $670 per day. For example, if you were hospitalized for days 91 through 150, then Medicare would pay all Medicare approved costs except for $670 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; however, Medicare does not cover all of your potential medical expenses. You should also plan on additional Medicare insurance products.

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 inpatient for three full nights and days, and within 30 days after that admission, needed to receive Skilled Nursing Care related to that hospitalization, 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 $167.50 per day for day 21 through day 100. Medicare pays for no additional days after day 100 of Skilled Nursing Care. This too is a benefit period example.

Multiple hospitalizations during the year followed by Skilled Nursing home care these rates would repeat. One more example of why you need more than Medicare.

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 only Custodial Care. Again, Medicare normally does not pay for that level of care.

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 professional. 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 has become terminally ill. Therefore, it is most likely that death is anticipated within 6 months. Medicare pays for 95% of the Medicare approved costs associated with Hospice care. Medicare also helps to cover the costs of the medications which are indicated 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. Hospice is not the type of care that is to sought when a cure for your condition is the goal. Rather Hospice Care is desired to make the patient as comfortable and pain-free as possible during these final days of life.

Updated in Rock Hill SC and Charlotte NC

by Kristin P Sinclair     (803)329-0615

January 2, 2018


Medicare Premiums for High Income Households

by Kristin P. Sinclair – A Accu Tax – April 4, 2018

If your household includes high income wage-earner(s) then your Medicare Premiums could also include Income Related Monthly Adjustment Amounts (IRMAA). Qualifying high-income also includes Interest, Dividends, or Capital Gains and other forms of ordinary income as well. These additional premiums are based upon your income from the two prior tax years.

If you have questions about your Part A or Part B bill amount or Part A or Part B insurance, then call Social Security at 1-800-772-1213. You can also write or visit any Social Security office. TTY users should call 1-800-325-0778.

  1. If you have questions about your IRMAA Part D bill amount, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  2. If you need help paying your Medicare costs, call or visit your State Medical Assistance (Medicaid) office, and ask for information on Medicare Savings Programs. You can also contact your State Health Insurance Assistance Program (SHIP). To get the phone numbers for your state, visit Medicare.gov/contacts, or call 1-800-MEDICARE.
  3. For more information about this bill, visit Medicare.gov and type “CMS-500” in the Search box. • CMS does not discriminate in its programs and activities. To request this publication in an alternate format, please call 1-800-MEDICARE or e-mail AltFormatRequest@cms.hhs.gov. TTY users should call 1-877-486-2048.

What if I don’t pay my Part A or Part B premium?

You’ll lose your coverage, and you must still pay the total premium amount you owe. You can only reapply for Medicare during the General Enrollment Period from January 1 through March 31 each year. If you reapply, your coverage will start on July 1 of that year, and you may have to pay a higher monthly premium amount for Part A as well as a lifetime late enrollment penalty for Part B.

What is IRMAA and why do I pay for it?

This charge may include an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra amount you must pay for Part B and Part D coverage because you have a higher income. If you have IRMAA Part D, then you are billed monthly and it is included in this bill. Your Part D plan premium is different, and you must pay the plan premiums to your Medicare drug plan. If you have IRMAA for Part B, it is included in your Part B premium amount. Your IRMAA can change each year. For more information about IRMAA, visit www.SocialSecurity.gov. What if I don’t pay my IRMAA Part D amount? You’ll lose your Part D coverage, even if it is part of your Medicare Advantage plan (like an HMO or PPO) or employer coverage. If you sign-up for Part D later, then you will still have to pay any IRMAA for Part D you owe from prior years. You may also have to pay a monthly penalty for as long as you have Part D coverage.

If Medicare is billing you additional premium for your Medicare Part B or your Medicare Part D, then a good reference tool to use to understand these extra premium charges are CMS-500 Form.

UNDERSTANDING THE “MEDICARE PREMIUM BILL” FORM (CMS-500) can be found on the website: www.Medicare.gov

Updated by Kristin P. Sinclair: A Accu Tax

in Charleston SC and Rock Hill SC

December 1, 2017 (803)329-0615

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2018 Medicare Part D

by Kristin P. Sinclair – A Accu Tax – December 12, 2017

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 and Charleston SC
by Kristin P Sinclair (803)329-0615
December 12, 2017

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11 Questions for Home Health Care Providers

by Donn J. Sinclair, MBA – March 15, 2018

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.

  1. Private duty home care – what year did the agency first offer that service ?
  2. 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 ?
  3. 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 ?
  4. What daily notes are maintained to monitor the progress of the patient ?
  5. Who and how is quality of care supervised and updated ? How frequent are unscheduled agency supervisory visits on the agency staff ?
  6. What are the home health care agency ongoing training mandates for their caregivers ? Who supervises the training ?
  7. How and by whom are after normal business hour emergencies handled ?
  8. 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 ?
  9. How do you obtain a written copy of the home health care agency’s privacy policy, ethics code, and mission statement ?
  10. What screening techniques are used to screen caregivers ? Do these include reference checks, driving records, credit checks, and criminal background investigations ?
  11. 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 Charleston SC

December 5, 2017   (803)329-0609

DJS: More information is available at Medicare.gov

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