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Baby Boomers

October 3, 2017 by helpinsureus

Are you a Baby Boomer?  It’s a fact that from now until the year 2030 10,000 people per day will turn 65. Lucky you! When that happens you will be eligible for MEDICARE.

The government’s book on Medicare is in excess of 100 pagesAnd it’s boring.  Below is my condensed version, more like a Reader’s Digest article.

By the way, if you have not already registered for Medicare now is the time to do so ONLINE at this link:

The Devil’s in the Details of Medicare

Let’s take a quick look to make sure you understand exactly what Medicare covers and what you will be responsible to pay.

Medicare PART A is primarily a HOSPITAL plan that – after the small deductible – covers 100% of expenses for in-patient care for your first 60 days. After 60 days you begin to help out with expenses. (see below). If you qualify, you are not charged a premium for PART A.

Medicare PART B covers outpatient benefits such as preventive care visits, certain doctor visits, and lab services. PART B is purchased from an insurance agent who represents private insurance companies. Premiums run from $28/month to over $200/month.

Expenses you will pay under Part A:

  • There is an annual deductible that you must pay before hospital admission – $1,316 for 2017.
  • If your hospital stay is longer than 60 days
    • For days 61-90 you pay $329/day
    • For days 91-150 you pay $659/day
  • Medicare pays nothing beyond that
  • Skilled Nursing Facility
    • Medicare will pay for the first 20 days that you are in a Skilled Nursing Facility
    • For days 21-100 you pay $164.50 per day
    • Medicare will not pay after day 100 in a skilled nursing facility
  • You pay for the first 3 pints of blood – Medicare pays after that
  • If you want a private hospital room YOU PAY

Expenses you will pay under Part B, also called MediGap or Medicare Supplement: (outpatient services)

  • There are 10 different plans available under PART B
  • Some plans have office copays and some do not
  • There is an annual deductible for PART B – $183 for 2017
  • Medically necessary doctor visits are covered. You either pay 20% or you have a copay in your plan
  • You pay for the first 3 pints of blood and Medicare pays 80% after the deductible
  • Durable Medical Equipment – Part B pays 80% after the deductible
  • Part B pays 100% for Lab Services and Home Health Care
  • Other medical expenses – Part B pays 80% and you pay 20% after deductible
  • You pay all expenses above Medicare approved rates – however, some plans pay the expenses above Medicare-approved rates
  • Alternative medicine – you pay all
  • Most dental care and hearing aids – you will pay
  • Custodial care – you pay (help with bathing, toileting, dressing, etc.)
  • You will pay for cancelled or missed appointments; copies of x-rays, etc.

MediGap Plans Pay What Medicare Doesn’t

Most beneficiary’s (that’s what those on Medicare are called) find it prudent to get a Medicare Supplement plan – also called MediGap – to reduce the risk of possible major expenses not covered by Medicare. REMEMBER, Medicare does not pay 100% of your medical bills. It only pays up to 80%. That’s why you need a MediGap plan. Imagine a $100,000 hospital bill where you end up owing $20,000 because you do not have a MediGap plan. MediGap plans can be as little as $28/mo. or as high as $200.

If you would like to get a MediGap QUOTE just let me know. The quote I send you will show all that Medicare pays and all that the MediGap plan pays as well as the premium.

Warning – Some Things Your Health Policy Will Not Pay For

September 23, 2016 by helpinsureus

There are Certain Types of Medical Treatment Not Covered by Your Health Policy

When a serious medical need arises there are often multiple stages that one goes through on the path to recovery. For instance, a stroke victim may stay in a hospital for several days but then will be released to either the care of a family member or to a skilled care facility. Why? There is an indefinite period of time after a stroke that a stroke victim needs assistance with many daily activities. The hospital stay is part of health insurance. The assistance with daily activities is not part of a health insurance policy.

Example of possible needs beyond health insurance

  1. Acute Care – medical care aimed at treating physical problems directly in an attempt to permanently cure or control them. This is typically covered under a health policy.
  2. Skilled Nursing Care – services for those who require ongoing medical or nursing care; or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Some health insurance policies offer limited care in a skilled nursing facility, typically 20-60 days. Some do not include coverage for it at all.
  3. Long term care (LTC) – This type of care is not part of a health insurance policy. Insurance coverage for this is called LONG-TERM-CARE insurance. The goal of LTC is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning. This type of care is designed to meet the medical, personal, and social needs of those who cannot fully perform many daily activities. When something happens that limits a person’s ability to carry out basic self-care tasks, LTC is needed. (The average annual cost to care for someone with a LTC need is between $30,000 and $70,000 annually. That’s why we all should have some type of LTC insurance coverage.)


Yikes! What he found in his medical records was devastating

August 8, 2016 by helpinsureus

First off, understand this.

They’re YOUR medical records.

Recently, someone applying for one of our health plans learned something that truly shocked him. Written in his records was a diagnosis that he has a debilitating muscle disease – and the doctor never told him!

You may have a medical condition listed in your medical records that you do not have or do not know about!

In this man’s case it was eventually learned that the condition was not his but was for ANOTHER PATIENT and was mistakenly included in his records.  It took time and effort for him to get this mistake corrected.

Everyone should ask to see and get a copy of their health records from the Medical Information Bureau (MIB), if for no other reason than the see if you agree with the information that is being written about you.

It’s the law – you have the right to obtain your medical records and other health information.

Like a credit bureau, there’s a Medical Information Bureau. Your MIB report shows key risk factors about you like health-related conditions. Other insurance companies can access, review, and confirm this information to prevent fraud if you apply again for certain types of insurance.

You are entitled to one free report from the MIB annually. Simply call the MIB at 1-866-692-6901 and help them identify your file – if one exists.

Are there ERRORS in your medical records?

Once you have your MIB report you can use it by asking your provider to change any wrong information in your file or, at least, to add information to your file if it is incomplete.

In most cases the file should be changed within 60 days, but the hospital can take an extra 30 days if you are given a reason.

Be wise & stay informed.

How to Survive When You Cannot Physically Work

March 25, 2013 by helpinsureus

A lot of people are out of work.  I’m sure you’ve thought about the possibility of not having any paycheck coming in. But it’s one thing to be unemployed and another to be physically unable to work.   If you are self-employed or if you are not covered by a disability income plan through your employer, it clearly makes sense to consider purchasing an individual disability income protection plan.

Why do I need this? Won’t social security cover me if I’m disabled?

Disability insurance replaces a portion of your income if you become disabled and are no longer able to work. No plan will cover ALL of your salary for fear that you would have little or no incentive to return to work.

Social Security pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. Federal law requires this very strict definition of disability. While some programs give money to people with partial disability or short-term disability, Social Security does not.

Disability is something most people do not like to think about. But the chances that you will become disabled are probably greater than you realize. Studies show that a 20-year-old worker has a 3 in 10 chance of becoming disabled before reaching full retirement age.

What questions should you be asking yourself before applying for a disability income plan?

  • How much income will I need each month?
  • How many years would I want it to continue?
  • From the time I become disabled, how long would I want to wait before the disability income starts paying me?

Click here for a personal quote

Call me if you would like more information or a proposal. I have clients paying as little as $40/month for a $2,000 income protection plan.

Fred Fortson

Top 4 Ways to Prevent Health Insurance Claims Problems

November 29, 2012 by helpinsureus

Of the many health insurance companies I represent, the following guidelines are valid for each. Here are four steps you can take to help minimize any “claims surprises.” Follow these steps and you may be stress-free.

  • Never rely on the assumption that a certain benefit is covered or that a particular health provider belongs to your HMO or PPO. Always double-check on whether the benefits, services or providers you need are covered before you go to get treatment. You can do this by calling your health plan’s customer-service department. Remember to take notes. Get the representative’s name and write it down, along with the date, time and general details of your conversation.  Keep these notes with your policy. If a claim problem arises and you need to file a grievance, these notes will come in handy. Most insurers customer-service phone calls are tape recorded. Having the date and time of your call will make locating your call history with the representative much easier.

  • Should you have a problem with a claim, call the insurance company CLAIMS DEPARTMENT and ask for an explanation. Again, remember to take detailed notes.

  • If the explanation is not consistent with your understanding of your health benefits, call your agent. Because of their position and their greater knowledge of the health plan details, they might be able to quickly resolve your problem.

  • If you have a claim problem that’s unresolved, file a grievance with your health plan. If you get a denial, don’t give up. In many states, the complaint eventually goes before a state sponsored grievance committee that’s outside the plan (an “external review”) or a “peer review committee” of other health care professionals. There’s always a chance the denial might be reversed.

Otherwise, your health plan is regulated by your state’s insurance department. Your state has a complaint procedure that will trigger an investigation into your problem.

You are Not Paranoid! Your Confusing Health Policy is on Purpose

March 4, 2012 by helpinsureus

Please Say What You Mean

About a generation ago it became fashionable to put fancy titles to common jobs. Janitor became maintenance engineer; stewardess became flight attendant; receptionist became front office administrator; used car salesman became transportation specialist. These days the health insurance companies have decided they want into the act. Most of them have begun misusing the term out-of-pocket maximum (OOPM).  The result is that people are being confused and the insurance company continues a tradition of selling a confusing health policy.

Please tell me – when you hear an insurance company says the words out-of-pocket maximum what do you think? Silly question, you say? Of course, it’s the maximum of out-of-pocket that you will have to pay on your medical expenses.  “Not so!” replies the insurance company. Are they purposefully trying to deceive people with that wording?

Using a real life example, let’s listen in to a conversation between an agent and his new customer.

Agent: “Ok, John, your new policy will have a $3,000 deductible and a $5,000 out-of-pocket maximum.”

John:  “Great! So if I land in the hospital it will only cost me $5,000, right?”

Agent:  “No, the $5,000 is your out-of-pocket maximum.”

John:  “Isn’t that what I said?”

Agent: “If you land in the hospital it will cost you $8,000.”

John:  “I thought you said my OOPM is $5,000.”

Agent: “It is!”

John: “What?”

Get the idea?  It’s like listening to Abbott and Costello doing their “Who’s on First?” comedy routine. See their hilarious skit here:

No More Confusing Health Policy Terms

Let’s set this straight. Other than copays and preventive care:

  • The deductible is the amount you pay before the policy begins paying.
  • Co-insurance is the amount you and the insurance company share in paying after the deductible. Generally, after the deductible the policy pays 80% and you pay 20%. Like the deductible, there is a limit set on coinsurance. This is now what they are calling OOPM.
  • OOPM is – well, should be – the combination of your deductible AND the shared amount.

To avoid confusing a client and getting wrapped up in a Who’s on First dialog, I do not use the term OOPM as defined by insurance companies today. To do so would be like continuing a ruse.

I use the term Total Out-of-Pocket and I explain that it’s a combination of the deductible and coinsurance or shared amount. In a nutshell, all the client really wants to is how much it will cost them if they land in the hospital. Keep it simple.


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