Michael M Insurance Services Blog
The Captive Agent is an agent that is employed by the individual Insurance Company. While the captive agent is probably honest and governed by standards set by the carrier, here are a few things to take into consideration.
1) The Captive Agent only represents one plan, the one he/she are employed with. You will not get a good comparison with the other choices that are out there.
2) Sometimes you will be speaking with a Temp. A little scary because sometimes important plan items are omitted, like a deductible or coverage parameters.
3) What if you have questions after signing up? Well, one thing is certain, you will not be able to get that agent on the phone again, the 800 number will send you to the next available agent.
4) A Medicare Advisor, like yours truly, is paid when an individual plan renews therefore and has a vested interest in keeping clients and their satisfaction with his/her services is extremely important.
Identity Theft is very real and seniors are particularly vulnerable. When your turning 65 your on a list and entities are out there with one mission, sign you up for a plan and get paid. While these are probably legitimate it's easy to lose track of who's who and who is legit or not. Here are some examples of what you will be asked for in an email or phone call-
Your Full Name- Not needed to look up plan availability.
Your Email- Still not needed to look up plan availability.
Your Zip- Needed, Medicare Advantage Plans are area specific.
Your Medicare Claim Number- Not needed to look up plan availability.
Your Home Address- Not needed, Zip code is sufficient.
Social Security Number- A big No No, and definitely not necessary to determine plan availability.
Date of Birth- Nope, don't need to know that either.
Anybody that's asking for this stuff is either Phishing or generating leads that can be sold to Brokers. Oh, and by the way. If a plan looks like it is too good to be true, it probably is. Don't fall for Triple Zeros $0 premium, $0 Copays and $0 Medication costs. There is fine print that nobody can read and it's designed for one purpose. To get you to call and give your information.
Final Word of Advise- Set up a "My Social Security" account in the Social Security website, SSA.gov. If you set it up no one else can set it up in your name and collet your benefits.
Your Medicare Advisor is well aware of the solicitations that come with turning 65 and becoming Medicare Eligible being a card carrying Medicare Member himself. Be on the lookout for-
Mail Solicitations (A Flood Of Paper)
Phone calls from Company Agents (See Captive Agent)
Advice from friends and relatives
If your in it you know that this is a confusing mess at best. What can you do?
Utilize a Medicare Advisor. A Medicare Advisor is Certified with Multiple Insurance carriers, Licensed in multiple states and Certified with the Center for Medicare and Medicaid Services. He has to recertify each year as well as complete Continuing Education so there is no motive to put you into one company over an other. He is in the best position to advise you on the plusses and minuses of each plan. The advice is free as your Advisor is compensated by the carrier if he/she can help you.
What is a Preferred Pharmacy? A Preferred Pharmacy is a pharmacy that has an affiliation or arrangement with a specific Health Plan/Part D Plan. When a Pharmacy is preferred it will have a lower copay for a medication then other pharmacies in the area. If you are considering a certain health insurance plan and have a specific pharmacy you use, check to see if it is a Preferred Pharmacy, it could save you money in the long run.
Check with your Medicare Advisor, he can check if your Pharmacy is Preferred.
Some states provide assistance for expensive Medications. An example of this is E.P.I.C the New York State Medication assistance program. It stands for Elderly Pharmaceutical Insurance Coverage. On EPIC, your most expensive medication will be no ore than $25. The income limit for a married couple filing jointly is $100,000. Depending upon income, EPIC can either be paid with a small fee or for higher income individuals, a deductible that is paid for every time you go to the pharmacy to get your medications. For EPIC to help, the medication has to be covered by your Part D Rx plan.
SEP- EPIC also creates a Special Enrollment Period that gives the individual the opportunity to change his/her insurance plan outside of an enrollment period.
Check with your state health insurance department on the availability of a Pharmaceutical Assistance program or ask your Medicare Advisor, he'll be happy to check for you.
Medicare doesn't cover certain items like a tooth cavity. But, if the cavity remains and can lead to other more serious complications then it could be Medically Necessary to repair the tooth. Medicare is based on Medically needed services. Without a Medical Necessity Medicare does not cover-
This stands for the True Out Of Pocket coats of your Medications. It includes your Deductible, copays and the cost share to your Health Insurance Plan. It is used to calculate when you enter into the Coverage Gap A.K.A. the "Doughnut Hole." In 2022 the gap is reached when the $4430.00 TROOP is reached by you and your carrier. Your cost share will change to Brand Name/Generic Meds- 25% of the cost of the Med. The Gap Phase will continue until the TROOP reaches $7050.00 at which time you will be in the Catastrophic Phase and your cost share will be reduced. Once out of the gap you will pay- Generics- $3.95 or 5% which is ever greater and all other Meds $9.85 or 5% which is ever greater.
The 4 Phases of Medications Coverage-
All of us know someone that has been touched by cancer. It's my opinion that the best course of action in the event that this starts to become a reality is to have a plan in place that will give you the most options while at the same time minimizing costs. This will hopefully reduce the need to think about your Health Insurance and allow you to concentrate more on treatment. The 2 types of Medicare Health Insurance plans available are Medicare Advantage and Medicare Supplement Plans. Both help pay your Medicare cost share .Let's take a quick look.
The monthly cost to these is very low, as low as $00.00. The copays however for hospital stays, MRI's blood work can become quite expensive. Chemo and any other injectable medication done in a doctors office or facility are not covered by the plan in that you will have to pay the Medicare Part B 20%. You will more than likely reach your Maximum Out Of Pocket figure (As high as $7400) in a short period of time but your cost share will be reduced to $00.00. Also, these plans are HMO's and PPO's which means some doctor/hospitals might be out of network and unavailable or at a higher copay.
There are monthly costs to these and the individual has to weigh the benefits against the extra cost.
No doctor/hospital network. Care can be had with any doctor/hospital that accepts Medicare in any state.
Copays are reduced to very low or $00.00
Speak to your Medicare Advisor for a more detailed analysis for your individual needs.
Your 7 month window begins 3 months before your birthday month and runs to 3 months after your birthday month. If you were born in June it would start in March and run to September. The 3 months before turning 65 is critical because if you want coverage to start on the 1st on the month of your birthday there are some things to think about.
Your Medicare Advisor has an extensive check list in the mymedicaremike.com web site but here is a good outline for you.
1) Sign up for Medicare. Do it sooner than later. The fastest way is online and that will insure that it will start when you want it to. If you wait it will delay your start date.
2) Contact your Doctors, do they accept Medicare?
3) Think about what you have going on (Medically). Having a procedure? Where are you going to do it? Will it involve rehab etc. Do you take medications?
4) How are you getting coverage now? Can you keep it? How will it interact with Medicare? Some Employer coverage is enough so you don't need Medicare, others you have to sign up. Are you in a Union? Do they require you to sign up for Medicare?
5) If your collecting Social Security, You don't have to sign up, they will sign you up automatically. If not, you have to do it.
6) Most Important- Contact your Medicare Advisor, he will guide you to the best course of action for your individual needs.
This is a question that I get asked often and unfortunately the answer is always the same, No. Medicare will cover a Skilled Nursing Home stay following an admitted Hospital stay. Days 1-20 will have a $0 copay, 21-100 will be $185.50 per day and over 100 you will be responsible for all cost. For Long Term Custodial coverage, No.
What Can I Do?
Hind sight is always 20/20. If we thought about it in our 30's the premium for Long Term Care might be reasonable. getting in your 60's is cost prohibitive. Medicaid might be an option and there are services available that are designed to provide home care for fairly long periods. Ask your Medicare Advisor.