Here at MedicareLifeHealth.com, we focus a lot on Medicare for your health insurance options. However, some people retire earlier than age 65, the age when you are first eligible for Medicare. So, then the question becomes, what are my health insurance options in retirement?

The Traditional Retirement: Age 65+

If you are a U.S. citizen, retiring at age 65 or older, then you will have access to Medicare.

What is Medicare? It is the U.S.’s national healthcare system for citizens over the age of 65, and for some people (of any age) with disabilities. We will look at Medicare as an option for health insurance in retirement at the end of this article.

Early Retirement Health Insurance Options: Under Age 65

Retiring is very exciting for most people. Retiring early? Even more exciting!

We know we need insurance. There is too much at risk without it. Chronic illness, accidents and other big health events are always a possibility as we age. However, when you are too young for receiving Medicare, insurance options can be confusing and even expensive. This is especially true if you are losing insurance that covered your family as well as yourself.

So, what are your health insurance options if you are retiring before you are eligible for Medicare?

Your Spouse’s Insurance

Your spouse may be able to cover you under their insurance if they are still working. This is definitely worth looking into, as premiums are often subsidized by their employer. Couples will often have one person work longer just for the insurance benefits in our limited health insurance market.

Employer Insurance for Health Insurance Option in Retirement

The first option for early retirement health insurance is staying on your employers insurance. However, this is not always an option offered to everyone, and even if it is, the cost can be prohibitive.

There are some businesses that offer options for retiring with insurance coverage from their group plan. As a health insurance adviser and Medicare specialist, I have seen a few of these rare health insurance in retirement plans.

Often times, these plans are offered to employees that preformed dangerous jobs – such as being a firefighter or police officer. Sometimes, other union based jobs might have more options like this available to them.

COBRA Insurance

COBRA is sometimes an option for extending employer coverage. However, it is expensive. Moreover, the time period you can stay on the plan might be shorter than you need. Often times, COBRA is only available for 18 – 36 months.

COBRA may be an option for you if:

Your employer had more than 20 employees.

You get notice from your employer that COBRA is an option for you.

With COBRA, you will be paying for your portion of the premiums in addition to what your employer use to pay for you. As a result, some people find this option to be too expensive and a prohibitive form of coverage.

Private Health Insurance

Next, you also have the option of enrolling in private health insurance. There are a limited amount of insurance companies that offer individual plans for private health insurance on the open market in each area of the United States.

Annually, the U.S. has open enrollment into these private health plans. The enrollment period is from November 1st to December 15th. However, some years (like in 2019) they extend it a few extra days. During this time, you can find a plan and get an acceptance into that plan without going through medical underwriting. These plans are not allowed to disqualify you for illnesses you already have or had in the past.

The Catch?

The big catch here is, these plans are still often very expensive, and have high deductibles. For example, when I ran a quote for myself in my area (and at my age of 36) I was quoted around $350 a month for a plan premium. Then, if I added my whole family of 4 (total) to the quote, the premiums went up to over $1,400 a month. Additionally, that plan had a deductible over $7,000, and a max out of pocket each year of $8,500. Yikes.

If you are a part of the F.I.R.E. (Financial Independence Retire Early) movement, and you plan on retiring at age 40, you will have a lot of years of high medical premiums to consider. Especially if you have dependents.

Another Health Insurance Option in Retirement: Work Part-Time for a Job with Benefits

If you find yourself in a longer time-frame, for needing health insurance before age 65, then you may consider finding a part-time job you enjoy that has health insurance benefits for part-time employees. It is not ideal for “retirement,” but it might solve your problem. Starbucks is always the go-to example for a company that provides this benefit, but you can probably find a few more options in your area.

Option Five: Opting Out of Traditional Health Insurance

I would not recommend it, but if you decide not to have full health insurance in retirement before age 65, that is technically an option too. Up until this year, the government had a fine they would levy against you if you did not have proper insurance. Now, this fine is gone. So, although you should technically have health insurance, no one is going to fine you for not having it.

If you take this option, you can find smaller policies to cover you in catastrophic events. You can find “cash” policies too. These are policies that you pay a premium for each month, and then if you have a qualifying event (such as being diagnosted with cancer), then the policy will pay you a set amount of cash. However, these plans do not pay for routine doctor’s visits or trips to urgent care, so you will need to plan to have money saved up to cover these expenses.

What About Medicaid?

We are assuming here, that if you are entering into retirement early, it is because you have saved up enough money to do so comfortably. In this case, Medicaid is not going to be an option. Medicaid is the United State’s only other option for nationalized health insurance. However, it is only available for those that live at or below the poverty level. I hope that is not you!

Now, let’s look at Medicare.

Health Insurance for Retirees Over Age 65

If you reach age 65, congratulations! Everything just got easier and better, at least health insurance-wise.

For United State’s citizens that paid taxes into Social Security and the Medicare system for their working years, you will get Medicare benefits. Most people have worked long enough in the U.S. to get Medicare Part A at no cost. Medicare Part B, does come at a monthly premium (of $144.60 in 2020).

What Do the Parts of Medicare Cover?

Part A = Hospital Insurance. This covers the following:

• Inpatient care
• Skill nursing facility care
• Hospice care
• Home health care

Part B = Medical Insurance. This covers the following:

• Outpatient
• Home health
• Doctors
• Health care providers
• Durable medical equipment
• Prevention

Visit here for more information on Medicare and what it covers.

Supplemental Insurance

In total, Medicare covers about 80% of the costs of your health care needs with Parts A and B. You will need to find private health insurance coverage to cover the other 20% (or just pay it out-of-pocket). However, unlike private health insurance for those not on Medicare, your options here are pretty good!

You can either find a Medicare Supplement (Medigap) Plan or a Medicare Advantage Plan (aka Medicare Part C) to help you with these extra costs.

Click here for a good article on what these options are and what option is best for your situation.

The last part of Medicare, is Part D. This is the Prescription Drug Coverage Plan set-up by the CMS (Center for Medicare and Medicaid Services). However, these plans are actually run by private insurance companies. When ready, you will choose a plan and pay for it with those companies. If you have a Medicare Advantage program, Part D might be included as part of the plan and at no additional premium.

Conclusions

In summary, retirement health care options are easy if you are over age 65. However, if you are planning on retiring early, then you may need to get creative, or save a lot of extra cash, to cover your premiums and health care costs. Either way, it is important to always be protected and to have a good plan.

The post Health Insurance Options in Retirement appeared first on Medicare Life Health.

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 Healthcare.gov.)

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 healthcare.gov.)

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 Healthcare.gov, 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?

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.

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 Healthcare.gov, “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

The post HMO vs PPO Which is Better? appeared first on Medicare Life Health.

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!

The post ‘Mutual Perks’ Announced by Mutual of Omaha appeared first on Medicare Life Health.

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?

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.

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 Medicaid.gov 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 with Medicaid or need to enroll in Medicaid only, then contact your state agency directly.

• If you need help enrolling in Medicare, then you can contact CMS and Social Security in the following ways:
  • BY PHONE: If you need to sign-up for Medicare, you can call Social Security at 1-800-772-1213.
  • ONLINE: Additionally, you can also visit CMS online at ssa.gov/benefits/medicare if you need to sign yourself up.
  • RAILROAD: Finally, if you are on Railroad Retirement Benefits, you will need to notify the local Railroad Board (RRB) office before you turn 65 that you would like to sign-up for Medicare. You can sign-up 3 months before you turn 65 even if you are not planning on retiring at 65. You can read more about Railroad requirements in our article here.

• 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.
  • You can contact your author Carly Cummings here, for assistance if you live in Nebraska or Iowa.
  • Or, if you live in all other 48 states, you can find an agent in your area here.

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The post Medicare and Medicaid Difference Guide appeared first on Medicare Life Health.

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.

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?

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.

The post What is Silver Sneakers? appeared first on Medicare Life Health.

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?

• If you have a specific procedure you want to look into, you can use the CMS’s government search tool here.

• Additionally, the Government has an app for coverage questions! You can find it on Google Play, or on the Apple App Store. “What’s Covered” is the name of the app in each store.

• Finally, you can use the Medicare and You Guidebook. CMS produces it every year. So, you can see what Part A covers and does not cover. In addition, you can see coverage for any other part of Medicare there too.

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:

• The Four Parts of Medicare Explained
• The Medicare and You User Guide
• Does Medicare Cover Hearing Aids?
• What is Medicare Advantage?
• What are Medicare Supplements (Medigap) Plans?

The post What Medicare Part A Covers appeared first on Medicare Life Health.

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:

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.

Conclusions

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!

The post Qualities of a Good Insurance Agent appeared first on Medicare Life Health.

Medicare Open Enrollment runs from October 15th to December 7th. These are the same dates every year.

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.

The post Medicare Open Enrollment appeared first on Medicare Life Health.

Here is what you need to know about Railroad Medicare Benefits to be successful in your retirement planning.

Introduction to Railroad Medicare

So, you are retiring from the Railroad? Congratulations! Mostly, your options for Medicare planning will be the same as everyone else’s. Our articles on Medicare Basics, Medicare Supplements and Medicare Advantage will all apply to you.

However, there are just a few differences between Social Security and the Railroad when it comes to Medicare. Let’s look at what these similarities and differences are.

What is the Same

Signing-up

• Already Retired: Signing-up for Medicare is the same on SS or RRB. If you are already receiving benefits from Social Security or the Railroad you will be automatically enrolled in Medicare Part A and Part B. You can then decline Part B if you want to. (Read about declining Part B here.)
• Not Yet Retired or Not Receiving Benefits: For those of you that are not already retired and/or not yet receiving benefits, you will need to notify the local Railroad Board (RRB) office before you turn 65 that you would like to sign-up for Medicare. You can sign-up up to 3 months before you turn 65, and even if you are not planning on retiring at 65.

Your Medicare Path Choices

Just like Social Security Medicare, you will have two options for setting up your Medicare:

• Original Medicare: You have the option of choosing to keep Original Medicare and then enrolling in a stand-alone Part D Drug Plan. In addition, you can then add a Medicare Supplement (Medigap) plan to pick up the costs Original Medicare does not cover. You can read more about Original Medicare here.
• Medicare Advantage: You also have the option of moving to a “bundled” Medicare Advantage plan. These plans are run by private insurance companies and bundle together Parts A, B & D all into one plan with one point of contact. They are also called Medicare Part C. You can read more about Medicare Advantage here.

You can read about the difference between Original Medicare and Medicare Advantage here.

What is Different

Part B Claims Processing

The major difference in Medicare for Railroad Board vs Social Security, is how the Part B claims are handled. Unless you are enrolled in a Medicare Advantage Plan (where the private insurance company you use handles all of your Medicare claims), you will deal with a different claims handling entity than those enrolled in SS Medicare.

The Railroad Medicare program uses an outside company for medical insurance claims that fall under Part B services. (Read more about the different parts of Medicare and what they cover here.) This company Palmetto GBA. They are a subsidiary of Blue Cross and Blue Shield. You will need to submit claims directly to them if you are under Original Medicare through the RRB.

How to Contact Palmetto GBA for RRB Original Medicare Beneficaries

If you need to submit a claim for a Part B service or ask a question, you can contact Palmetto GBA here:

Palmetto GBA
Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001

Toll Free: 1-800-833-4455
TTY/TDD: 1-877-566-3572
Website: www.palmettogba.com/medicare
According to the RRB website, you will click on “RRB Specialty MAC Beneficiaries” on the website above

More Information

For more information about Railroad Medicare Benefits, you can visit their website here.

The post Railroad Medicare appeared first on Medicare Life Health.

One questions we hear a lot at Medicare Life Health is “Does Medicare Cover Hearing Aids?

• The simple answer is NO.

• However, some Medicare Advantage Plans will. Let’s look at both.

Original Medicare Will Not Cover Hearing Aids.

“Hearing and balance exams – Medicare covers these exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay the hospital a copayment.”

Medicare and You 2020 Guidebook

What about Medigap (Supplement) Plans?

No, Medicare Supplement Plans (also called Medigap) do not cover hearing exams or hearing aids. These supplements cover the costs of covered services that Medicare leaves for beneficiaries to pay. (For example, coinsurances, co-pays and deductibles.)

They are not structured to pay for extra services like hearing, dental, vision, wellness or long-term care.

Do Medicare Advantage Plans Cover Hearing Aids?

All Medicare Advantage Plans are designed differently, but most of them offer benefits for exams and hearing aids. Depending on the plan, you may find covered, or partially covered, hearing exams. In addition, many plans will have co-pays or coinsurance on hearing aids.

As an example, one MA plan might offer 0% co-pay on a hearing exam and a co-payment on a hearing aid. They might have two kinds of hearing aids with different amounts you pay as your portion for either a standard hearing aid or a more advanced one.

Also, some Medicare Advantage Plans will contract with specific hearing aid companies to offer discounted or even fully covered hearing aids if you use these providers.

Summary & Action Steps

In summary, if you are in need of hearing aids, Original Medicare and Medigap Plans will not cover them. However, a Medicare Advantage plan often will.

With hearing aids often costing thousands of dollars, it can make sense to consider a Medicare Advantage plan where you can get discounted hearing benefits and hearing aids.

How to Get Started

• Interested? Talk to an agent to learn more about plans with hearing aid options.

• Or, to learn more about Medicare Advantage Plans – how they work and what they cover – please click here.

• If you need more information on how to choose a Medicare Plan, please start with this article.

• Finally, of you need help applying for Medicare, click here.

The post Does Medicare Cover Hearing Aids? appeared first on Medicare Life Health.