Category: Insurance

HMO vs PPO Which is Better?

HMO vs PPO Which is Better?

HMO vs PPO Which is Better?

HMO vs PPO Which is better in regards to health insurance, Medicare Advantage Plans and dental insurance

Insurance has changed a lot over the last 20 years, and there is no better example than the way we define and use provider networks. When you are looking at insurance plans, it’s important to compare HMO vs PPO. Which is better for you?

We are here to clear up the confusion, and quickly answer the most frequently asked questions in regards to what is HMO and PPO insurance, how the plans work, and where you will find HMO and PPO insurance plans.

If you are a Medicare user, you will run into HMO vs PPO in regards to choosing a Medicare Advantage Plan. You can learn more about Medicare Advantage Plans here.

What is an HMO?

To start, what is HMO health insurance? A HMO is a network of health care providers, set-up by a health insurance company, to offer services and benefits to its customers. (More at

What does HMO stand for? Health Maintenance Organization

How does an HMO work?

  • To start, when you are a beneficiary/member of an HMO, you have access to a specific set of healthcare providers in a specified geographical area. (For example, a city, counties or defined state(s).) These providers include doctors, healthcare professionals, specialists and hospitals.
  • You must use the HMO’s contracted providers to have your care paid for by your insurance plan. Moreover, if you go outside the plan for care, you will often have to pay the full cost of your care.
  • You can only go outside of your plan’s provider list in the case of an emergency.
  • With most HMO’s you need to have a Primary Care Physician (called a PCP). Your PCP takes care of your general health care and then refers you to specialists as needed.
  • So then, as a member of an HMO, if you need to see a specialist, your PCP with often have to refer you, to use one. However, in some states, and with some plans, the insurance companies have take away this requirement. As a result, it is important to check your specific plan’s requirements for seeing a specialist.
  • Finally, HMO’s are often concerned about prevention and keeping their member’s as healthy as possible to keep everyone’s costs down. For this reason, health maintenance organizations will often provide prevention based benefits and services to encourage safe and healthy behaviors among their members.

What is a PPO?

So, in regards to insurance, what is a PPO? A PPO is a type of insurance plan that uses a defined network of medical providers to meet your health care needs.

You pay a contracted rate (less than full price) to see network providers. However, unlike an HMO, with a PPO you can use doctors, clinics and hospitals outside the network at a higher cost. (More at

What does PPO stand for? Preferred Provider Organization.

How Does a PPO Work?

  • First, with a PPO, you still have a network of providers to use that offer contracted prices to members of the PPO.
  • In contrast, you have more flexibility to go outside the network if needed to use uncontracted providers. You will most likely have to pay a higher percentage of the costs to use these providers, but the insurance companies will still pay something.
  • You can use any provider when the circumstance is deemed an emergency.
  • With most PPO’s, you do not have to have a referral to see a specialist.

What is the Difference Between HMO and PPO Insurance Plans

Both HMO’s and PPO’s have contracted networks of healthcare providers, clinics and hospitals where they will pay for some or all of your care. However, there are differences to consider:

  • First, HMO’s and PPO’s treat their out of network costs differently.
    • With an HMO, if you go “out-of-network” to see a provider, they may not cover any of your costs. Unless, it is an emergency situation.
    • With a PPO, the plan will most likely cover “out-of-network” provider/hospital visits, but at a lower percentage rate than their “in-network” providers/hospitals.
  • Second, the networks treat visits to healthcare specialists differently.
    • With an HMO, you will often need a referral to see a specialist.
    • With a PPO, you can most often just choose a specialist from the network provider list and make an appointment to see them without a referral.
  • Third, the PCP is usually the person making referrals in an HMO network. As a result,
    • The HMO’s often require having a primary care physician (PCP) on file for its members.
    • While the PPO’s usually do not have a requirement to name a PCP.

So, HMO vs PPO Which is Better?

After reading about the differences between HMO’s and PPO’s, it may seem like the PPO sounds hands down better than the HMO. Regarding, its freedom to see both in-network and out-of-network providers, and its options to see specialists without a referral, it does seem more flexible.

So then, why do people like HMO’s as well as PPO’s, and which one is right for you?

  • To start, HMO’s have changed a lot over the last years. Their networks have become more robust and their requirements less strict. In certain geographical areas, the HMO might include all the major hospital systems and the majority of providers. As a result, it may not matter to a person if they have a PPO or HMO, in regards to providers available.
  • Second, in some states, it is not necessary to get a provider referral to see a specialist in an HMO’s network. State laws often dictate how HMO’s work in this capacity, so it is important to learn how your area’s plans work.
  • Third, their may be a cost difference paid by members between an insurance company’s HMO and PPO plans. These costs include monthly premiums, max out of pocket costs, deductibles, and co-pays/co-insurances. When picking a plan, it often comes down to what is the more affordable option.
  • Finally, since HMO’s are often more focused on the wellness of their members, they might have other prevention benefits and services available to their members. PPO’s can sometimes have these services too, you will just need to do your homework to see what is included when shopping for a plan.

Going Deeper: HMO vs PPO Which is Better FAQ’s.

For those of you that have further questions, here are the most asked questions in regards to HMO and PPO insurance.

What does HMO POS mean? / What is HMO POS Medicare Advantage?

An HMO POS is a type of HMO network that allows more flexibility in seeing providers outside of the specified HMO provider list. POS stands for Point of Service.

According to, with an HMO POS, you will still need to choose a PCP (primary care physician) and they will still make specialist referrals for you. However, with a POS, if they want to refer you to a specialist outside of the HMO network, they can do so with the POS designation. Keep in mind, specialists and providers outside of the HMO network may still have higher out-of-pocket costs than in-network providers.

In a HMO POS Medicare Advantage Plan, you also have this ability to use providers who are “out-of-network,” but they may incur an increased cost.

What is Medicare PPO? / What is Medicare HMO?

PPO’s and HMO’s come into play in Medicare when you are using Medicare Part C – aka Medicare Advantage Plans.

Medicare Advantage (MA & MAPD) Plans are alternative plans offered by private insurance companies to take the place of Original Medicare. They often include drug coverage or Part D coverage (MAPD plans). They are approved by the Federal Government and cover everything that Original Medicare covers. In addition, they often offer benefits and services beyond what Medicare offers such as dental, vision and hearing benefits.

So then, what is a Medicare Advantage PPO plan or HMO plan?

What is Medicare Advantage?

Medicare Advantage plans are often HMO, PPO, or PFFS plans. (Additionally, they have special plans set up for people with special needs.) When you are choosing a Medicare Advantage Plan, you will need to consider everything we discussed about HMO’s and PPO’s as they will apply to these private insurance plans and how they set-up their provider networks.

Ok, then what is a PFFS Plan?

PFFS is a Private Fee-for-Service Plan. These plans also have networks that include a list of providers that have agreed to accept the plan. Moreover, you can see other providers, not on the list, as long as they agree to the plan’s terms and conditions and bill the plan directly. Original Medicare is an example of a PFFS plan.

What is HMO Medicaid?

Medicaid is provided to its recipients at a state level. Each state has to decide how to manage their Medicaid programs. These “managed care” options include choosing an insurance administrator to deliver healthcare services to Medicaid beneficiaries in a way that will “manage cost, utilization, and quality.” Often times the contracted insurance company will use an HMO model to structure their network of providers.

medicare and medicaid difference guide

In addition, if you are a “Dual Eligible” beneficiary – meaning that you qualify for both Medicaid and Medicare – then you have the option of finding a private insurer to manage your health care insurance. Each state has DSNP Medicare Part C (Medicare Advantage) providers that offer plans to dual eligible beneficiaries to help them manage the care between Medicare and Medicaid. These plans can also be HMOs or PPOs.

What is an EPO?

An EPO is an Exclusive Provider Organization. According to, “EPOs generally limit coverage to care from providers in
the EPO’s network (except in an emergency).”

What is PPO Dental Insurance? / What is HMO Dental Insurance?

Dental Insurance Carriers (aka Insurance Companies) set-up their provider networks similar to how medical companies set-up their networks. They have both DHMO and DPPO plans.

Just like in medical insurance, both DPPO’s and DHMO’s have provider networks, but HMO’s will typically only pay for services rendered by providers in the network. In addition, PPO’s will pay more of the costs for services provided by network providers, but will pay some percentage of costs out-of-network. For this reason, Dental HMO’s are usually less expensive than PPOs.

What is Better HMO or PPO Dental Insurance?

There are other differences between Dental PPO’s and HMO’s including deductible costs, and co-pays/co-insurances. When you are looking at dental plans in your area, you will need to decide what type of plan most affordably meets your dental care needs.

Sometimes this will be an DHMO and other times, this will be a DPPO, so compare costs, provider networks and types of dental services covered before buying a policy. Here is a good article for more detail on dental insurance network types to help you decide what is best for you.

What is Preferred Provider Organization?

Also known as a PPO, a Preferred Provider Organization is a type of insurance plan that provides a network of healthcare providers, offices and hospitals for its members to use at contracted costs. In addition, it provides the flexibility to use providers outside of its networks if needed, but at a higher cost to the members.

Then, what does preferred provider mean?

Preferred provider means that a particular doctor, specialist, clinic, hospital or other healthcare professional or facility is a part of your insurance provider’s network. They will offer a contracted (most likely discounted) rate for you to use their services while on your PPO insurance plan.

What is the largest PPO network?

The largest PPO Network in the United States is MultiPlan.

What is MultiPlan PPO?

Multiplan is not a “type” of healthcare insurance. They are a third party company that helps insurance companies “manage the cost of care, improve their competitiveness and inspire positive change.” You do not have a Multiplan PPO, you have a PPO that uses Multiplan.

What is a Regional PPO?

We often hear the questions, “what is a Regional PPO?” and “what is a Regional PPO Medicare Advantage Plan?” Regional just refers to the service area for the PPO. Members will have access to providers in the PPO’s specified region.

What is Health Maintenance?

“Health Maintenance” refers to a system of prevention. In insurance terms, it refers to an insurance network plan with a focus on keeping medical costs down by keeping members healthy with lower cost preventative care options.

The thought is “an ounce of prevention” will lead to significant cost savings on unused healthcare dollars down the road.

So then, what are the benefits for providers who use HMO model?

Providers who are a part of the HMO model have benefits of being a part of a network that pays them based on a contracted fee. Each network will arrange the contracts differently. However, the providers will know that they have access to the insurance carrier’s pool of members to service for their healthcare needs.

HMO vs PPO Which is Better Summary

In conclusion, whether a PPO or a HMO is “better” all depends on your needs and the plans available in your area.

If we missed any questions in “HMO vs PPO Which is Better” you may have, please drop us a note in the comments and we will do the best to answer them!

All the best. Carly and the MLH Team

‘Mutual Perks’ Announced by Mutual of Omaha

‘Mutual Perks’ Announced by Mutual of Omaha

‘Mutual Perks’ Announced by Mutual of Omaha

mutual perks by mutual of omaha

What are ‘Mutual Perks'(SM) = Are they Discounts?

Yes, and we like discounts.

Moreover, anyone in retirement or on a “fixed income” certainly appreciates discounts. So when Mutual of Omaha announced an added discount benefit to their insurance customers, we were very interested.

What are Mutual Perks?

Mutual Perks are not directly a part of a Mutual of Omaha Policy; rather, they are additional discounts with third-party companies that are available to life insurance policy holders as well as select medical insurance policy holders.

What Kinds of Discounts are Offered?

As far as we can tell, the discounts focus on companies that can either keep you or your bank account healthy. Here is a list of the types of companies that will feature “Mutual Perks” discounts.

  • Eyeglasses
  • Hearing aids
  • Home mortgages. T
  • Massage,
  • Chiropractic
  • Acupuncture
  • Low-cost gym memberships (at over 10,000 locations)
  • Also, retail, travel and dining coupons

The official press release from Mutual of Omaha didn’t specify any particular companies, but we will update this post in the future if we hear any more details.

Why is Mutual of Omaha Offering These Discounts?

The insurance industry is an old, mostly stable industry, but it is still very competitive. It’s great to see insurance company’s still adding benefits to serve their members better. In addition, healthier members are also always better for any insurance company’s bottom line. In this case, Mutual Perks seems like a win-win.

Here is what the corporate office has to say:

“Our customers, and their financial well-being, are important to us,” said Jennifer Wulf, Mutual of Omaha’s vice president of customer insights. “That’s why we’re excited to offer these exclusive money-saving opportunities. It might be a little surprising that an insurance plan opens the doors to these offers, but we are always looking for ways to delight our customers while partnering with them in their financial security and healthy living goals.”

Mutual Press Release on Feb. 25, 2020

How Can I Get Mutual Perks?

If you want Mutual Perks, you will need to be a Mutual of Omaha policy holder. If you already are, the company will most likely be getting in touch with you to let you know if the benefits apply to you.

Otherwise, if you are considering purchasing a life insurance policy, Mutual of Omaha is probably hoping Mutual Perks might make you look again at their options. I must admit, I am interested in hearing more myself!

Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

Medicare and Medicaid Difference Guide

medicare and medicaid difference guide

The Medicare and Medicaid Difference Guide helps you understanding both services, so you can make the best decisions for yourself and your loved ones.

The United States has two separate national health care systems: Medicare and Medicaid. The government created the two programs for two different kinds of people. However, they often overlap. Let’s look at both programs, including their similarities and difference. We will also look at who needs or qualifies for each program.

Let’s Start with Medicare vs Medicaid.

What is Medicare?

Medicare is the U.S. national health care program that provides seniors age 65 and older, and some disabled people, with health insurance.

The U.S. government started the program in 1966. The Centers for Medicare and Medicaid Services runs these programs. Medicare also covers people with end stage renal disease and amyotrophic lateral sclerosis.

Medicare does not cover all of the costs associated with health care. As a result, people with Medicare will also use a Medicare Supplement Insurance Plan (Medigap Plan) or a Medicare Advantage Insurance Plan to round out their care coverage.

Please read our Ultimate Guide article on “What is Medicare.

What is Medicaid?

Medicaid is the United States National Health Care System that provides health coverage to over 64.7 Million People.

The program was created for people with low-incomes that cannot afford, or do not have access to, private healthcare insurance.

How are the programs similar?

Medicare vs Medicaid Pin

The programs are both National Health Care Systems. In fact, they are the only two nationalized heath care systems the United States has. Many other countries around the world have much more extensive national coverage for their citizens. The U.S. has a limited program for specific age, income, and health groups, and the rest of the country relies on private health insurance.

In addition, both programs cover specific hospital services, doctor services, and other health care related services.

Medicare has four parts. First, Medicare Part A, also known as “Hospital Insurance,” helps with coverage regarding: inpatient care, home health care, nursing facilities, and hospice.

Second, there is Medicare Part B, also known as “Medical Insurance.” Part B helps with coverage related to doctor and other provider services, including: doctors visits, health care providers, outpatient, prevention services, and medical equipment. Medicare Beneficiaries pay for Part B.

Finally, Medicare has a Prescription Drug Program that is administered by private insurance carriers. Click here to lean more about What Medicare Covers and Medicare Parts A, B, C and D are.

Both Medicaid and Medicare Advantage Plans can be set up as managed care plans with networks of doctors and hospitals members have access to. If you would like to learn more about how these networks work, please read, HMO vs PPO – Which is Better?

How are the programs different?

One of the biggest differences between the two programs is who runs them. Medicare is run on a national level, by the Federal government. On the other hand, Medicaid is run by each state individually.

Of course, the biggest difference is the the different populations the programs serve:

  • Medicare – For Seniors over age 65, and some disabled people
  • Medicaid – For people with low income and few resources

Medicare and Medicaid Differences in Beneficiaries – Who Gets What Program?

The U.S. government created Medicare and Medicaid to take care of different “vulnerable” populations – the poor, the disabled, and the elderly. Let’s look at each program and population.

Who should get Medicare?

Anyone who is a citizen or qualified resident of the U.S. can enroll in Medicare when they turn 65 years old. There is a seven month window of time starting three months before turning 65, the month of your birthday, and then three months after your birthday month.

How do I Sign-up for Medicare?

First, you may be automatically signed-up if you are already receiving Social Security (SS) or Railroad Retirement (RRB).

Second, if you are not already receiving SS or RRB benefits, you must sign up for it when you turn 65 years old.

Conversely, if you are not ready for Medicare when you turn 65, you must notify the government that you want to delay your benefits. If you do delay, it must be because you have credible coverage in place. An example of this would be an employer plan.

Click here to read more about Medicare, including where to go to enroll.

From Our Article What is Medicare? A Guide to All Medicare Basics

Supplemental Medicare Insurance Options

Medicare picks up about 80% of the health care costs for its beneficiaries. For the other 20%, seniors turn to either Medicare Supplements (aka Medigap Plans) or Medicare Advantage Plans. Click here to read our article on Medicare Advantage vs. Medigap, or see the informational articles below.

What is Medicare Advantage?
What are Medicare Supplements_

Who should get Medicaid?

Medicaid is for people with limited income and resources. Medicaid is run on a state level, not on a federal level. As a result, in order to qualify for Medicaid, you will need to determine what your state defines as a qualifying income level.

How Do You Enroll in Medicaid?

Again, since Medicaid is run by State Governments, you will need to contact your state’s agency to start see if you qualify to enroll.

You can find a list of State Agencies here on the website.

Who Can Get Both Medicare and Medicaid?

People of any age who have certain qualified disabilities and people over 65, who are also below their states Medicaid income levels, can qualify for both Medicare and Medicaid.

For example, Henry is a 55 year-old disabled man who is also unemployed and living below the poverty level set by his state. Consequently, he would most likely qualify for both Medicaid (because of his income level) and Medicare (because of his qualified disability).

People that qualify for both programs are called “Dual Eligible.”

Who Can Help?

Navigating one (let alone both) of these systems can be confusing. But there is help available.

  • If you need help enrolling in Medicare, then you can contact CMS and Social Security in the following ways:
  • Finally, if you need help finding a Medicare Supplement or Medicare Insurance Plan, or if you are dual eligible for both Medicare and Medicaid, then please contact an Insurance Agent. An Independent Medicare Insurance Agent will help you explore your options, and help you make the right choice for your unique situation.

Further Helpful Reading

How to Choose A Medicare Plan
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What is Long Term Care Insurance?

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What is Long Term Care Insurance?

What Is Long Term Care Insurance

Long Term Care Insurance Polices provide cash to cover the cost of your care when you cannot take care of yourself.

At some point, you may need help to get through each day. Hopefully, you have family and friends to help you, but even they can only help you to a point.

Many people find maintaining their independence and dignity an important value. Consequently, these people find Long Term Care (LTC) Insurance is an important part of their financial planning.

Defining Your Needs

You need to start thinking now about how you will plan for your own care down the road. “Long-Term Care” as a plan has many parts including:

  • Where you will live
  • What services you will need
  • What people you can depend on
  • How you will pay for everything
  • What legal considerations you need to address

Additionally, part of your plan might also include insurance.

What Can Long Term Care Insurance Help You Pay for?

Long Term Care Insurance can help you pay for:

  • Nursing homes & LTC facilities
  • In home daily living services
  • In home personal services

Who Needs Long Term Care Insurance?

According to New York Life Insurance Company, 70% of people age 65 and older will need help with daily living at some point. Moreover, almost 50% of these people will end up spending more than $107,000 on Long Term Care costs.

Reasons People Get LTC Insurance

Here are a few types of people that need Long-Term Care Insurance:

Do I need Long-Term Care Insurance?
  • Independent people who do not want to rely on their family to take care of them or pay for their care.
  • Prepared people that do not have reliable support they can trust to help with their care.
  • Determined people that want enough money to cover in home services so they don’t have to go to a nursing home.
  • Planning people that do not want to drain their retirement accounts with LTC expenses.
  • Finally, people that do not want to end up on Medicaid at any point in their lives.

Does Medicare Cover Long-Term Care?

Many of my clients have asked me if Medicare covers Long-Term Care costs and services. It is a good question, but perhaps not a good answer. The answer is no. Medicare does not cover LTC costs.

Why Doesn’t Medicare Cover LTC?

What is Medicare - Medicare Life Health Co.

To start, long-term care has mostly to do with the support and services you will need for daily living and personal care activities. These are not medical services. Consequently, they are not covered by Medicare.

  • For example, if you need to see a doctor or medical provider, that is a medical expense.
  • In contrast, if you need help using the toilet, that is a long-term care expense.

What About Medicaid?

Medicaid will eventually help you pay for LTC expenses. However, you must be considered below the poverty level before the Medicaid program kicks in.

As an example, my grandparents both lived to be about 87 years old. (Married 67 years!) They had enough money to cover their assisted living expenses for a while, but the last 6 months or so of their lives were spent on Medicaid. They had to do a “spend down” of all of their assets to cover LTC expenses. Once their funds were exhausted, Medicaid kicked in.

In their case, while they had money to spend, they had choices on where they lived and what services they used. However, as soon as the money was gone, they had to move to a place that had “beds” available for Medicaid recipients. As a result, they were moved around a lot in their last year.

On the much brighter side, they were together until the end and passed months apart. They were also happy and loved. So, even though the journey was difficult, we were all in it together. You can read a little more about my care-giving story here.

If you do not want to “spend down” your assets on LTC costs, you will need to have insurance to cover your care costs.

How Does LTC Insurance Work?

LTC is an insurance policy. Consequently, you take it out now to pay for a future event that may or may-not occur.

  • First, you pick a plan with an insurance carrier and structure it to fit your needs. This includes deciding how large of a benefit you want.
  • In addition, your decision will also depend on how much premium you can afford to pay a month for your policy.
  • Premium cost is based on age, and availability of policies are dependent on health underwriting. As a result, not everyone will be able to afford a plan, and not everyone will be able to get a plan. As with most insurance, the younger and the healthier, the better. So, start soon.
  • Then, you keep paying premiums until you need the policy. (Or you cancel the policy because you ended up not needing it. For example, you die before you needed it.)

When Do Long-Term Care Insurance Benefits Begin?

First, in order to start using your LTC policy’s benefits, a licensed medical practitioner will need to certify you chronically ill.

According to Mutual of Omaha, being chronically ill means, “You need help with at least two of the six activities of daily living for at least 90 consecutive days or you need continual supervision due to a severe cognitive impairment.”

The government defines Activities of Daily Living (ADLs), as “basic actions that independently functioning individuals perform on a daily basis.”

ADLs Include:

Caring for Elderly Parents - a how to guide from medicare life health co.
  • Bathing
  • Dressing
  • Using the toilet
  • Transferring (to or from bed or chair)
  • Caring for incontinence
  • Eating

So, you typically need to not be able to do at least two of these to start your benefits.

Do Benefits Start Right Away?

To start, it takes a bit of time to get the right paperwork completed by your doctor, sent in and then certified by the insurance company. Even then, your policy might not kick-in right away.

To keep the cost of LTC insurance lower, many insurance companies will build-in an elimination period. Often, you can decide how long this waiting period will be before benefits begin. Naturally, the longer the waiting period, the less expensive the policy.

Will My Policy Last Until I Die?

Typically, your policy has a set payout rate. This means that it will pay out up to a specific dollar amount. If you outlive this amount, then you will have to use other resources to pay for your care.

How Much will my LTC Policy Cost?

The cost of your policy will depend on your needs, cost of living in your area, your age, your health, and many other factors. To find out an exact cost, you will need to work with an agent to discuss your unique situation.

How Much Long-Term Care Benefit Do I Need?

This is also a question we can’t answer without knowing your needs and situation. If you are wanting a rough idea of what you may need, try out this Long-Term Care Insurance Calculator from Mutual of Omaha.

What are the Alternatives to Purchasing a Long-Term Care Plan?

Long-Term Care Policies are expensive. Additionally, if you wait too long they might not be available to you. One alternative is to spend down your assets until you qualify for Medicaid. If you do not have a lot of assets left by the time you need Long-Term Care, then this may be an option for you.

However, if you have saved money and do not want to drain it all away in medical costs, then you may have another option: Life Insurance.

Do I need life insurance in retirement?

“As an alternative to Long Term Care Insurance, some retirees consider Life Insurance Policies that have LTC riders or a Chronic Illness Rider. For example, an insurance carrier might offer a product (like an IUL policy) with an option to purchase up-front a rider that will cover long term care events. You can pay qualified long-term care expenses with the death benefit, naturally, before death. Then, when you pass, the insurance company pays what is left to your beneficiaries.”

From Our Article: Do I Need Life Insurance In Retirement.


In summary, long-term care insurance can protect you and your family against the rising costs of assisted living and nursing home care. However, it is expensive. You need to plan ahead to either secure LTC insurance early on, or find another option like life insurance with LTC riders.

medicare and medicaid difference guide
What is Final Expense Insurance?

What is Final Expense Insurance?

What is Final Expense Insurance?

what is Final Expense Insurance

Final expense insurance is an insurance policy that provides cash to cover end of life expenses such as funeral and burial costs. They are typically smaller face values (the amount of payout money). In addition, insurance companies often structure them as whole life policies.


My father-in-law passed away one year ago. (One year and one day from the day that I am writing this article.) His passing was my first experience in how important Final Expense Insurance is. It made everyone’s lives easier that he had a policy in place to cover end of life expenses.

Up until about 2 years ago, my father-in-law had a larger term policy on himself and his wife. However, they decided to cancel that policy since they were set financially for retirement. Fortunately, he had a good agent that set him up with a smaller Final Expense policy.

Now, my in-laws did have enough in savings to cover a funeral. However, it was just so much easier not to have to worry about how to get access to that cash. Their savings sat invested in mutual funds and stocks, which take a few extra steps to get to. Consequently, no one wanted to go through any more extra steps to get to it.

The insurance money was easy enough. We did have to wait for the hospital to file a coroner’s report before we could get the money. However, in the meantime, we “assigned” the insurance money to the funeral home and burial services before we had it. The whole experience was positive and the final expense money was helpful.

What is Final Expense Life Insurance?

Final expense policies are life insurance policies. Just like other types of life insurance, a final expense policy issued by an insurance company pays money to a designated beneficiary when the insured person dies.

Final Expense policies are whole life policies. Since whole life premiums are usually more expensive than term premiums, the face value is usually a smaller amount. The purpose of these policies is to pay for end-of-life expenses such as funeral costs, burial fees, and even medical bills. Of course, you can use the money for anything. It is just a cash payout.

The Benefits of a Whole Life Policy

As noted, a final expense policy is usually a whole life policy. This means a few things:

  1. Your policy will have a cash value in addition to a face value. A cash value in an insurance policy is an amount of money you have access to for loans while the policy is active (in force). (The face value is the amount of money your beneficiary receives when you die.)
  2. The cash value grows on a tax-deferred basis.
  3. Your final expense policy will have level premiums. (The premiums will be guaranteed not to go up as you age.)

How Much Final Expense Insurance Do I Need?

When you are deciding how much cash you need consider funeral costs, burial costs, end-of-life medical bills, and any other loose ends. According to Mutual of Omaha, an average funeral costs about $7,000 to $10,000. Most people don’t have access to that sum in cash. Even those that do, might have other things they want to do with that cash.

Every insurance company prices premiums differently. Additionally, they all offer different face value amounts (i.e. the amount of money your beneficiary receives when you die). However, the usual amounts are anywhere from $2,000 to $40,000.

Can I Use My Policy for Long-Term Care (LTC) Costs?

Do I need Long-Term Care Insurance?

Additionally, some Final Expense policies have accelerated death benefits for terminal illness or nursing home confinement. This means you can use the face value of the policy as cash to pay for these expenses. However, if your policy is only for $10,000, this will not get you far!

If you are looking to use insurance to cover long-term care (LTC) costs, a final expense policy is not the tool to use. Final Expense policies usually do not have a big enough face value, or accrue cash fast enough, to fund LTC. Look at funding an Indexed Universal Life (IUL) with a LTC/Critical Care Rider to help with this.

Additionally, you can get a Long Term Care Insurance Policy.

Is Final Expense Life Insurance for Me?

What is Final Expense Insurance Pin

To start, insurance companies created final expense policies for older adults (typically 45 years old +). If you are younger and reading this article, there are better options for you at this time in your life. Head over to our IUL page to learn about Indexed Universal Life, or think about term insurance.

As you get older, term insurance and other higher face value whole life policies get more expensive. In addition, insurance takes on a different importance as your debts dwindle and your savings rise. You can read more about insurance needs as you age in our article “Life Insurance in Retirement?”

Final Expense Life Insurance is a great solution for older adults that need to take care of their loved ones by leaving cash to cover their end of life expenses.

How Do I Get a Policy?

If you are ready to get a final expense policy, it is time to talk to an agent. She or he can help you in creating a solution that meets all your needs. Different companies have different options and riders, so it is a good idea to work with an expert to set your’s up right. It does not cost you anything extra.

What is Silver Sneakers?

What is Silver Sneakers?

What is Silver Sneakers?

what is Silver Sneakers Senior Fitness

Maybe you just overhead your neighbor talking about his free gym membership, or maybe your doctor asked you if you are a SilverSneakers user. You might then be wondering, just what it Silver Sneakers?

SilverSneakers(r) is a fitness and wellness program for seniors age 65 and up. It includes free gym memberships across the country, and it is included with many Medicare Advantage Plans.

NOTE: If you are a part of AARP’s Unitedhealthcare’s Medicare Advantage Plans, then you will be a part of Renew Active. This is a similar program, but has several differences you can read about here.

Renew Active vs Silver Sneakers

What is Included in a Silver Sneakers Membership?

  • LOCAL GYM MEMBERSHIPS: Silver Sneakers has an extensive list of gyms that participate in their program that offers free gym memberships to seniors. Their website boasts having more gym facilities than there are Starbucks locations in the U.S. (at over 16,000).
    • If you are a part of a Medicare Advantage (MA) program that uses Silver Sneakers, then you can access the gyms in their network at no cost. You can use as many of these facilities as you like while you are a part of your MA plan.
  • ONLINE FITNESS CLASSES: If you prefer to workout at home, or do not have a physical location close to you, SilverSneakers offers online fitness classes.
  • APP: They also have an app to help you track your fitness goals and schedule your fitness plans. The app can also help you locate participating locations.

What you Need to Know About Silver Sneakers

First, there are a few things you need to know to get started. Here is an overview and some frequently asked questions about the program.

How do I know if I am a member of SilverSneakers?

Well, if you are part of a Medicare Advantage Plan, then there is a very good chance you are already a part of the program.

To check on your eligibility, click here.

Where can I find participating gyms and wellness facilities?

As an overview, SilverSneakers tries to be in as many convenient fitness facilities as possible. Moreover, they are doing an excellent job of reaching this goal! Right now, they are in over 16,000 fitness facilities.

Here is the official link to search for a participating fitness facility near you.

What if there are no facilities close to me?

If you are in a smaller town or rural area, there might not be a class or gym close to you. However, even if there is not a Silver Sneakers contracted location close to you, you can still participate. The program features online classes and workout kits.

Do I have to take the Silver Sneakers Classes?

what is silver sneakers?

Often, people will ask me if they have to attend the SilverSneakers branded classes at the gym. The answer is no. The program gives you access to the whole facility. This includes Silver Sneakers classes, but also all the other classes at the gym. You can also just go walk on the treadmill or lift weights.

What Medicare Part A Covers

What Medicare Part A Covers

What Medicare Part A Covers

What Does Medicare Part A Cover

Here is what Medicare Part A Hospital Insurance covers:

  • Inpatient Hospital Care
  • Skilled Nursing Care
  • Stays at Skilled Nursing Facilities (short-term)
  • Home Health Care
  • Hospice Care

In addition:

  • Part A also includes inpatient care in a religious non-medical health care institution.
  • Blood is also a Part A covered service. You will have to pay for the first three units of blood that you use. However, if the blood is donated free to the hospital or donated to you, then you do not have to pay for it.

What Medicare Part A Will Not Cover

Medicare Part A or Part B will not cover custodial, long-term care, nursing home or assisted living facilities. Click here to read more about ways to cover these costs.

Will Medicare Cover My Costs?

How Do I Know if I am Signed-up for Medicare Part A?

Part A and B are separate in Original Medicare, and you can be signed-up for one and not the other. First, to see if you are signed-up for Part A, you can check your Medicare Card. If you are signed-up, it will say “Hospital” and then have an effective date listed right on the card.

In addition, if you are a part of a Medicare Advantage Program, they you are also already signed-up for Part A. This is a prerequisite for join a Medicare Advantage (aka Part C) plan.

For More on What Medicare Part A Covers & the Other Parts of Medicare

Please Read:

What is Disability Insurance

What is Disability Insurance

What is Disability Insurance?

What is Disability Insurance by Carly Cummings, licensed agent and creator of Medicare Life Health Co.

If you depend on your income or a family member’s income to pay for daily living expenses, then you need to answer, “what is disability insurance?”

Disability insurance protects your family from a loss of significant income when you get sick or injured and cannot work.

There are two types of disability insurance.

  • Long-Term Disability – LTD can cover you from 2 years up to life (depending on the plan). It provides monthly payments to help you in covering life expenses. LTD benefits start when you have a qualified sickness or injury and are unable to work.
  • Short-Term Disability – STD can cover just a few days up to six months. It is often a part of an employer’s group insurance plan options. It can be used for short-term sicknesses, injuries or even as a pregnancy/family leave option.

Uses for Disability Insurance

When you have people to provide for and bills to pay, disability insurance is a safety net for your family. In addition to paying for daily living expenses, disability insurance can help you meet your saving goals. Let’s look at both uses in a little more detail.

Use #1: Meeting Daily Living Expenses

If you are suddenly unable to work, due to illness or injury, the last thing you need is extra stress. Stress can slow down healing and keep you out of work longer. Disability insurance will give you a cash flow while you can’t work. You cans use this cash to pay for groceries, rent/mortgage payments, utilities, and other living expenses.

In your working years, paychecks are important. Many people have life insurance to provide cash if they die, which is also important. However, less people have disability insurance, even though injury or sickness is much more common than death.

Use #2: Keeping on Track with Retirement Savings

Next, disability insurance is helpful to anyone who depends on a paycheck, no matter what your age is. However, it is especially important in the years when you are significantly saving up for retirement.

The younger you are, the more time your retirement funds have to grow. As a result, the years in your 20’s, 30’s and 40’s are critical for stashing cash in your accounts. If you get injured and can’t work, you need to consider having enough disability insurance to cover not just your living expenses, but your saving goals too.

How to Get Disability Insurance

There are a few options for receiving disability benefits in the event of injury/sickness.

The US Government Disability Program

The US Government has disability insurance program through the Social Security Department (SSDI).

Social Security has a disability program that pays benefits to people who cannot work because of a medical condition. However, you must prove that the medical condition you have will last longer than one year or result in death. In addition, there is a five month waiting period to receive benefits after disability consideration.

SS disability benefit payments are based on the average earning you made in your lifetime before you were disabled. The average payment in 2019 was $1,234 a month.

You can visit the governments disability website here to learn more and apply if needed.

TDI Short-Term Disability in Five Lucky States

In addition, Puerto Rico and US five states (California, Hawaii, New Jersey, New York, and Rhode Island) have Temporary Disability Insurance (TDI) programs that offer limited disability benefits to workers that are sick or injured in events unrelated to work activities. In more good news, four of these states (CA, RI, NY and NJ) also have required family leave benefits. You can read more about these programs on this web-page.

Disability Insurance from an Employer

If you have an employer that offers disability insurance, start there. Often times employers have a plan to cover around 60% of your salary. You may or may not have to choose this benefit. In addition, you may or may not have to contribute premium payments to the employer’s group plan.

The group insurance premium cost is often very affordable, so we recommend always participating in your employer’s plan. This is true even if they do not pay for premiums.

Note that when your employer pays your disability benefit premiums, you will need to pay taxes on these benefits. In some rare cases, your employer might pay these taxes for you. However, usually they are taken out of your benefits. As a consequence, you will need to account for taxes in your cash flow budget.

Some at Work Action Steps

  • First, check with your employer to see what your disability benefits include (short-term and long-term). Then, confirm you are signed-up.
  • In addition, when you are discovering how much your employer’s plan pays, see if the payments take into account Social Security Disability Payments or if those are considered separate.
  • Then, calculate what your benefit payments would be. (Remember to take out taxes if your employer is paying your premiums.) Is that enough monthly cash to cover your expenses?
  • Finally, ask what the time limits are on payments and if there is a waiting period before the payments begin.

What About Worker’s Compensation Insurance?

Additionally , if you are injured on the job, your employer’s worker’s compensation insurance may be available. Workers Comp is insurance specifically designed to protect workers from the hazards that are present at work. Accordingly, it only treats injuries and sicknesses that arise as a direct result of working activities.

To clarify, worker’s comp will not cover you for injuries or sicknesses that happen outside of work activities. That is what disability insurance is for.

Disability Insurance from a Private Insurance Company

Unfortunately, the 60% of your paycheck that employer plans cover is often not enough money to cover your living expenses. This is especially true in one-earner households.

In these instances, you will want to find second disability insurance policy from an insurance company. Moreover, finding a stand-alone disability policy is even more important when your employer offers no disability benefits.

We recommend purchasing a stand-alone disability insurance policy for anyone of working age that has not saved up enough yet to retire comfortably if forced to.

According to the Social Security Administration, there is a one-in-four chance a 20-year-old worker will end up needing it before retirement age.

So, Where to Start?

Depending on your comfort level:

How to Tailor Your DI Policy

You can tailor your DI policy to fit your needs. While researching policies, look at what you know you already have and where your short-falls are.

Here is a familiar situation:

You have 60% coverage from your employer (which may include in it the SS benefit payments). Thus, you will need to provide for the other 40% or less of your monthly paycheck. Just think about what is necessary to cover all your expenses and retirement saving plans.

Options and Add-Ons to DI Plans

Private DI plans can give you options and features to add on.

  • You can choose total disability benefits or proportionate disability benefits.
  • Next, you can adjust the amount of monthly payout, as well as the premium amount, to reflect your needs.
  • In addition, benefit periods can last different amounts of time. For example, you can pay for a 2 year benefit, which would be a smaller premium than a 10 year or to age 67 premium.
  • Also, you can choose the amount of time that lapses before the benefits kick in after being considered disabled. This is also known as the Elimination Period. The more days out the benefits start (60, 90, 180, etc.), the lower your premium costs can be.
  • Competitive polices include features like guaranteed renew-ability. (This means insurance companies cannot cancel them as long as you pay your premiums). Also, they can include waiver of premium options, accelerated benefits for terminal illnesses, or survivor benefits.
  • There are also riders you can add on with some companies. These riders can include inflation cost-of-living benefit adjustments, hospital/medical/critical illness riders, and return of premium riders.


In summary, if you are of working age and still saving for retirement, you need to have a disability plan. Who will provide for you and your family if you are unable to work? When you can answer this question, you are one step closer to having a complete financial plan.

Further Reading

Qualities of a Good Insurance Agent

Qualities of a Good Insurance Agent

The Top 6 Qualities of a Good Insurance Agent

What are the qualities of a good insurance agent you should be looking for when you are searching for an agent? Your insurance agent helps you make important decisions to protect you and your family – let’s make sure you have a good one.

The Top 6 Qualities of a Good Insurance Agent

Here are the top six qualities of a good insurance agent:

qualities of a good insurance agent
  1. Educator Over a Seller.
  2. Learner.
  3. Good Listener.
  4. Problem Solver.
  5. Trustworthy.
  6. Authentic & Likable.

Let’s take a look at each one of these qualities and why they are important.

1. Educator Over a Seller

No one wants to be just sold to. You want to be helped, informed and guided. That is why it is so important to pick an insurance agent that is an educator rather than a seller.

One of the reasons I encourage everyone to find an independent insurance agent is that independent agents do not have to push just one insurance company. This goes for Medicare, life insurance, health and even home and auto.

As an example, for those of you that don’t know me, I am an independent agent that specializes in Medicare insurance. When I meet with clients, I spend time helping them understand the two basic ways to set-up their Medicare. Then, I let them make an informed decision that is best for their unique situation. As a licensed representative for many companies I can feel like an educator and not a “salesperson.” This is an important distinction.

2. Learner

The Insurance Industry is constantly changing. Insurance companies roll out new products regularly. In addition, companies create new ways to use these products to best protect yourself and your family. You need an agent that truly enjoys learning about these changes and products so they can keep your financial plan up-to-date.

LTC “Learner” Example

For example, in the Long Term Care (LTC) insurance world, it is good to have an agent that can help you be creative with how to fund long-term care expenses. As the LTC products have changed and premiums have priced people out of the market, you need an agent that likes to learn about using different types of products that can meet LTC needs (like IUL riders).

The more information and insurance education your agent has, the more they can effectively meet your needs.

Medicare “Learner” Example

Again, to use my situation as another example, I sell Medicare and the Medicare plan landscape becoming crowded with options. In this niche, education is more important than ever. However, less agents are dedicating themselves to certify with all the Medicare options.

Medicare Advantage sales takes a lot of education. I had to take roughly 17 different tests on various Medicare Advantage (MA) plans offered in my service area just for 2020. In addition, all Medicare agents that sell MA must retake these tests every year as they are necessary to understand plan changes.

This is a big reason why independent agents that are fully certified in both Medicare Advantage and Medigap are difficult to find, but necessary for making informed decisions. My advice is it is worth it to have an agent that understands both well.

3. Good Listener

Insurance solutions should meet your needs and not the needs of the insurance agent. That is why being a good listener is one of the qualities of a good insurance agent.

You need to feel like your insurance agent has fully understood you, your family and your financial situation. Make sure you have an agent that asks lots of good questions. Moreover, make sure your agent actually listens to your answers.

4. Problem Solver

Creating the best insurance solution for your needs requires active problem solving. No two situations are exactly alike. We have already established that you should have an agent that is up-to-date on the latest products and trends in insurance. Then, you need an agent that can synthesize this information into a solution that meets your unique needs.

You may not realize it, but creativity is a big part of being a good insurance agent. Insurance is certainly used for asset protection, but it can also be a creative tool for retirement funds and estate building.

5. Trustworthy

Honesty and integrity come as a package deal. Insurance agents should have both and demonstrate it actively to earn your trust. Enough said.

6. Authentic & Likable

You must like your insurance agent, and they must also like you back! Otherwise, you will dread working with them, and they will probably feel the same about you.

I know when I leave 95% of my clients, I feel energized and happy from our meeting. Consequently, I know they do too. I am always working to get this number to 100%. I purposefully search out clients I can be myself with. When I am my authentic self, I know I can do my best work for my clients.


In summary, there is a good agent out there for everyone. However, it might take a few attempts to find the one that is right for you. Just be on the look out for agents that are: educators, learners, listeners, and problem solvers. In addition, they should be trustworthy and authentic, but above all, you should like them!

Medicare Open Enrollment 2019

Medicare Open Enrollment 2019

Medicare Open Enrollment 2019

medicare open enrollment 2019

Medicare Open Enrollment 2019 runs from October 15th to December 7th. These are the same dates every year. In 2020, Annual Open Enrollment will also be 10/15/2020 – 12/07/2020.

What is Medicare Open Enrollment?

Also called AEP – Annual Enrollment Period is the time of year Medicare Beneficiaries can make changes to their Medicare Advantage Plans and Prescription Drug Plans.

Information for new plans starts to become available each year on or around October 1st, but changes can not be made until AEP actually starts on October 15th.

What Changes Can you Make During the Annual Enrollment Period?

  • If you are in Original Medicare, you can join a Medicare Advantage Plan during this time.
  • You can also join or switch Part D Prescription Drug Plans.
  • In addition, if you have a Medicare Advantage Plan, you can switch to another plan.
  • Finally, you can drop a Medicare Advantage plan to return to Original Medicare during this time.

Are Medicare Supplements Affected by Medicare Open Enrollment?

This enrollment period does not apply to Medicare Supplements (Medigap) Plans. You are free to change these plans when you please. However, if you are outside of a Special Enrollment Period (SEP) then you will need to go through medical underwriting to get into a new Medigap Plan. Medical Underwriting usually entails answering basic health questions by phone or in person with an agent.

What is the January – March Open Enrollment Period?

Sometimes also called Open Enrollment, the government created a new time period that runs from January 1st to March 31st each year where you can make limited changes. According to the Medicare and You Book,

If you’re in a Medicare Advantage Plan, you can make a change to a different Medicare Advantage Plan or switch back to Original Medicare (and join a stand-alone Medicare Prescription Drug Plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request.

Medicare and You 2020

The important thing to note here, is that you can only make ONE change during this time. Lawmakers created this time period to give you the opportunity to fix any problems you may have found in your current plan or any new plan you may have adopted.

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