Traveling out of the country? Ask about Short Term Medical insurance...
Good health is a key component
to a wonderful life at any age. Start with the right plan for your best life after 65!
COVID 19 has brought about some changes that could help Medicare Beneficiares in this crisis. No copayments on many services, new and exteneded SEP (Special Enrollment Periods) and more. If you have questions or concerns. Give us a call at 585-524-3797
By now you have most likely heard about the Inflation Reduction Act, IRA.
No matter what side of the political fence you are on there is some good news for Medicare beneficiaries..
The two most imminent and important changes, which take effect January 1, 2023, include:
1)Limiting the member cost-share of covered insulins to $35
2) Introducing $0 member cost-sharing on Part D vaccines including Shingrix.
"It limits the member cost-share on covered insulins to $35."
This means members won’t pay more than $35 for a one-month supply of each insulin product covered by their plan, no matter what cost-sharing tier it’s on, even if their plan has a deductible that hasn’t been met.
While some members already benefit from plans that offer $35 insulin, this legislation ensures that all seniors who use insulin benefit from this out-of-pocket cost limit.
Members receiving LIS (Low Income Subsidy) will continue to pay the CMS statutory maximum cost share for insulin, which is less than $35.
It eliminates member costs and improves access for Part D vaccines including Shingrix which many plans have not covered in full.
While the legislation goes into effect January 1, 2023, don't be surprised if the actual rollout of these benefits takes a little longer to implement. You can find information from your agent or broker or go online to Medicare.gov (if you're brave..) and the current information will be posted.
I'm happy to talk through any of these upcoming changes with you. Just give me a call at 585-524-3797
Medicare rules and guidelines change year to year. I find that sometimes even the most basic information eludes my clients who are busy doing life...So here's a few things that have changed. You might be aware of these...but if you're not...here's a head's up!
Here's something else you might not know!
There are new rules for the MSP, Medicare Savings Program. This is a program for folks whose income meets certain thresholds. Be sure to ask if you qualify. You could get your Part B premium paid for and there are other benefits as well.
If you live anywhere but NYS, you may be eligible for a Short Term Medical plan to cover you or your spouse in the event you need a bridge to Medicare. There are plans available from 3 months up to a year. Please call and ask for more information. Remember these plans are only for those in states other than NY.
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have. Medicare. In fact, you have to have both Medicare Part A and Medicare Part B active to be eligible to enroll in a Medicare Advantage plan.
Medigap is extra health insurance that you buy from a private company to pay health care costs not covered by Original Medicare, such as co-payments, deductibles, and health care if you travel outside the U.S. Medigap policies don't cover long-term care, dental care, vision care, hearing aids, eyeglasses, and private-duty nursing. Most
Medigap is extra health insurance that you buy from a private company to pay health care costs not covered by Original Medicare, such as co-payments, deductibles, and health care if you travel outside the U.S. Medigap policies don't cover long-term care, dental care, vision care, hearing aids, eyeglasses, and private-duty nursing. Most plans do not cover prescription drugs.
You pay a monthly premium for a Medigap policy. A Medigap policy covers only one person. If you and your spouse both want a Medigap policy you will each need to buy one.
Medigap policies are only available to people who already have Medicare Part A, which helps pay for hospital services, and Medicare Part B, which covers the cost for doctor services. People who have a Medicare Advantage plan cannot get a Medigap plan.
HMOs tend to be more affordable, but you’ll usually get less coverage and more restrictions. PPOs are more flexible and provide greater coverage, but come with a higher price tag and probably a deductible. Here’s a summary of some of the key comparison points.
HMOPPOAccess to a network of doctors, hospitals
HMOs tend to be more affordable, but you’ll usually get less coverage and more restrictions. PPOs are more flexible and provide greater coverage, but come with a higher price tag and probably a deductible. Here’s a summary of some of the key comparison points.
HMOPPOAccess to a network of doctors, hospitals and other healthcare providers✓✓Ability to see the doctor you want without a PCP to authorize treatment✓Referral from a PCP not needed to see a specialist✓Low or no deductible and generally lower premiums✓Coverage for medical expenses outside the plan’s networkPossibly
It's not really a question of which is better, but which is best for you. If you have a choice between these two types of plans, consider the pros and cons of each type, along with your particular situation. Generally speaking, costs for HMO plans will be less, as premiums tend to be lower, and deductibles will also be lower, or may be absent entirely. Therefore, if your financial situation dictates that cost is most important, you might seriously consider going with an HMO plan. The trade-off will be flexibility, however. With most HMOs, you'll need to select a primary care physician, and you will need a referral from that physician if you'd like to see a specialist. If flexibility and choice are important to you, a PPO could be the way to go. Additionally, PPOs will generally have some coverage for out-of-network providers, though it will be less generous than with in-network providers. With HMOs, out-of-network coverage will usually be limited to emergencies; non-emergency services are not usually covered at all.
With any plan, check the provider network to see if your preferred providers are in the plan's network, since staying in-network will save you money. Your chances will be better with a PPO plan, since PPO networks tend to be broader, but it's best to do your research before choosing. You may find that the particular HMO plan you're considering contains your preferred providers, or at least enough of them to meet your needs. If you're considering a Medical Mutual plan, you can check our networks before you apply.
