Tag Archives: Insurance Plan

Confused about Medicare-Based Health Insurance Options?

Confused about Medicare-Based Health Insurance Options?

Congratulations, you are turning 65. Now you are eligible for Medicare…and suddenly you are knee-deep in insurance decisions you have to make with little or no information to guide you. What is Medicare Advantage? Do you need Medigap? Do you need a Part D plan and if so how do you choose? Why are you paying premiums to Medicare and an outside insurance company?

Let’s start with a short history of Medicare. In the beginning, upon retirement or disability, there was no affordable insurance option available to most people.

Medicare started out as a government based insurance plan to cover the largest single cost in healthcare for the 65+ population – hospitalization. An inpatient hospital stay can easily run $15,000.00 a day. This part of Medicare, called Medicare part A usually has no premium requirement.

However, since many retirees have ongoing health issues and little income, Medicare added coverage for visits to doctors and diagnostic testing. This coverage, called Medicare part B, has a premium that you pay to Medicare. And more recently Medicare part D, which provides coverage for prescription drugs, has been introduced. 

Still, even between Medicare’s part A for hospital costs and part B for other healthcare costs, there are large gaps in Medicare’s coverage. So, in comes gap coverage insurance, otherwise known as Medigap.

Medicare was becoming a huge bureaucracy by this time. They needed to find a way to outsource this new option. At the same time, private insurance companies did not follow the same rules set down for Medicare. What could they do?

In the end, it was decided that private insurance companies could offer gap insurance, called Medigap, and collect separate premiums for it, but they had to use Medicare?s rules. This is why Medigap plan E through one carrier will give you exactly the same coverage as Medigap plan E through another carrier. This option is completely voluntary.

Medigap plans are secondary insurance. That means the bills go to Medicare first. After Medicare pays its share of the bills, they send the bills on to the Medigap insurance companies.

Unfortunately, these options, with all their premiums left a good portion of the 65+ population with insurance costs beyond their means.

Medicare’s solution to this problem was Medicare Advantage, sometimes known as Medicare part C. Medicare Advantage plans offer low premium plans sold by private insurance companies.

Medicare has given broad boundaries that insurance companies must comply with for these plans. In exchange, Medicare pays part of the costs incurred by the insurance companies to offset the lowered premiums.

Medicare Advantage plans are primary insurance. With a few exceptions, bills go to the Medicare Advantage insurance carrier, and the retiree is responsible for whatever portion of the bill that insurance company does not pay.

Still wondering which plan is best for you? Ask yourself a few questions:

* How much can you afford to pay in premiums on top of the Medicare part B premium?

The Medigap premium you pay will depend on the level of coverage offered by the plan you select.  The more comprehensive the coverage, the higher the premium.

* How often do you need to see a health care provider?

With Medigap plans, unless otherwise noted, coverage mimics that provided by Medicare itself.  So if Medicare imposes no limits on doctor visits, the Medigap plan will also not have any limits. But Medicare Advantage plans might have their own limits, but they also come at a lesser cost too. So, if you normally don’t see a healthcare provider very often – say twice a month – even with a couple of months that are more expensive, it averages out over the year to be less expensive.

* How much do you travel?

Medigap offers you the same coverage anywhere you see a Medicare eligible provider, whether you are visiting your sister in another state or at home. Most Medicare advantage plans, on the other hand, have very reasonable rates for seeing providers that are part of their local network, but have much higher costs for "out of network" providers, if they offer any coverage other than emergency room services outside of their local network at all.

Medicare and its many options, plans, and rules can confuse anyone. The best thing you can do is to get in touch with an experienced agent in your area who can help explain all of your options. Getting the Medicare plan that is right for you really is possible. Just remember, it is your right and responsibility to make an informed choice.

How Healthcare Reform Will Affect You

How Healthcare Reform Will Affect You

Just about everyone in the country is wondering how the passage of the health reform bill by Congress will affect him or her. According to Kaiser Health News, this historic legislation could “have an effect on almost every citizen.” People, even those who are unemployed, will be able to get medical care. But professionals who have been enjoying the best health coverage available may possibly see their benefits dwindle.

What Are the Immediate Changes?

There are certain things that will happen in the first 6 months after the bill is actually signed into law:

  • Insurance companies will not be allowed to put lifetime limits on coverage. This means that people with chronic health conditions will never “use up” all of their insurance coverage.
  • People with children on their company insurance plan can keep unmarried dependents enrolled until they turn 26. This is very important because of the number of college graduates who are unemployed.
  • Insurance plans will be required to cover preventative health services like colonoscopies, osteoporosis screening, screening for things like high blood pressure, diabetes, and sexually transmitted diseases and quit-smoking counseling.
  • Pre-existing serious health conditions can no longer prevent people from getting health insurance. They will be able to purchase coverage from a government-subsidized exchange. However, this coverage will not be available until 2014.

Health Insurance Will Be Required

Uninsured people will be required to purchase health insurance by 2014. Subsidies will be available that reduce the premiums subject to income limits.

Penalties will be imposed on people who do not purchase insurance that could be as much as 1% of their income.

Changes to Medicare

Tighter controls may be put on decisions for care that are considered too costly. The care provided to older people may even be restricted. Cancer screening could be denied for older citizens.

The Medicare system will see a huge hit because approximately one-half of the health reform costs for the next 10 years will come from the Medicare budget.

Pre-Existing Illnesses and Loss of Coverage

Starting this year, the health reform bill will ensure that insurers can’t deny coverage to any child based on existing health problems. In 2014, this will be expanded to include all applicants.

Within the first six months of the bill being signed into law, an insurer cannot drop policyholders except in cases of fraud.

Longer Wait Time to See Your Doctor

Millions more people will have access to health care but the number of healthcare workers will not grow quickly enough to keep up. You can expect to wait about twice as long to get in to see a doctor as it did in the past.

Changes to the Coverage You Get from Your Employer

Employers who offer high-value, ‘cadillac’ health plans will probably begin to cut back on those benefits. If they don’t do so by 2019, they could face fines from the government. This could possibly mean no more vision or dental coverage or going to a specialist without a referral from your family doctor.

Benefits for Women

With this new health bill, insurers will have to cover maternity care the same way they cover any other medical procedure, but not until 2014. Employers will also be required to allow break time for mothers who are nursing and a private place where they can use their breast pump.

Losing or Leaving Your Job

If someone quits or loses their job, the same exchanges that help lower income people purchase insurance will be available. This means when you leave your job, you don’t necessarily have to pay the high COBRA costs. This is very important for people with a pre-existing condition. You may even be able to get free health coverage under some circumstances.

Higher Taxes

In 2013, Medicare payroll tax will go up for incomes over $200,000 a year.

Invest in Your Business and Your Key Employees

Invest in your business and your key employees

Dear Fellow Business Owner

Employees are your company’s most important asset and in today’s competitive job market it is important to reward, retain and invest in top talent. That’s why, more than ever, employers are adding long-term care insurance to their benefits plans.

Your employees have worked hard to build their assets over the years. Should a long- term care event happen, how would they protect that savings?  Long-term care insurance is a critical component of any financial plan.  A good financial plan will help protect assets, cover the cost of long-term care services and help provide support for employees and their families. Perhaps it’s time your organization considered this very important benefit.

Incorporating long-term care insurance into your benefits package is easy. Depending on your objectives, you can choose to offer this plan as an employer-paid or a voluntary benefit, with minimal administration. By offering this coverage, you show employees and their families that you care about their well-being, and you support the future success of your company.

To learn more about how to include long-term care insurance in your employee benefits plan, please contact me at 509-720-8178  or brian@briangruss.com

Traveling Abroad

When you travel internationally, do you have the medical coverage you need away from home?  Many travelers believe their domestic insurance plan will be enough when they travel abroad, but that may not be the case.  Without the right plan, you may not be covered for an illness or injury.  I offer long-term and short-term coverage for U.S. and non-U.S. citizens, individuals and groups.

Short Term Travel
Individuals Patriot Travel Medical Insurance(R)
Groups Patriot Group Travel Medical InsuranceSM
Extreme Patriot Extreme Travel Medical Insurance(R)

Trip Cancellation
Patriot T.R.I.P.(R) Elite brochure and application

To apply complete the paper application and fax or mail, or you can apply online.