Wednesday, February 3, 2016

Do you really know how Medicare Supplements work?

A Medicare Supplement plan, sometimes referred to as a Medigap plan, can be purchased at any time throughout the year. You must already have Medicare Parts A and B to purchase a Medicare Supplement. People who have a Medicare Advantage plan cannot purchase a Medicare Supplement.

Here’s how Medicare Supplements work:

Medicare Parts A and B provide basic medical coverage. But they only cover about 80% of your costs. They do not pay for everything. Medicare Supplement plans are insurance plans sold by private companies to help close this gap in coverage.

Supplements pick up many of the out of pocket costs not covered by Medicare Parts A and B such as copayments, coinsurance, and deductibles. Medicare supplements also give you the freedom to see any doctor of your choice who accepts Medicare patients rather than being locked into a specified network of doctors, hospitals and providers. Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S.  

When you have a Medicare Supplement, Medicare will pay its share of the Medicare-approved amount for covered health care costs and then your Medigap policy pays its share. Medicare Supplements do not cover long-term care, vision, dental, hearing aids, or private nursing. Plans sold today do not cover prescription drug coverage.

Supplements are identified by letters A - N and each standardized Medicare supplement plan must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medicare supplement plans with the same letter sold by different insurance companies.

If you are considering purchasing a Medicare Supplement plan, the best time to do so is during your six month Medigap open enrollment period. This period automatically starts the month you turn 65 and are enrolled in Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays even if you have health problems. If you buy a Medicare Supplement policy outside this window, there is no guarantee that you'll be able to get coverage or that your rates won’t be higher if you do get covered.

If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to consider waiting until you enroll in Medicare Part B. When your employer coverage ends, you can enroll in Part B which means your Medigap open enrollment period will start when you're ready to take advantage of it. 

Please call me for more information on Medicare Supplements. We’ll review your options and I’ll help you find a plan that suits your needs. Contact me at 440-255-5700

Tuesday, January 26, 2016

Extra Help with your Medicare Prescription Costs

If you're on Medicare and need help with your prescription costs, you may qualify for Medicare Extra Help. It's a program that provides assistance with monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug program. To qualify for Extra Help, a person must have limited resources and income, and reside in one of the 50 States or the District of Columbia. You must also be enrolled in a Medicare Prescription Drug plan.

In 2016, those who qualify for Extra Help will pay no more than $2.95 for each generic prescription and $7.40 for each brand-name covered drug. Extra Help may also cover a portion of Medicare drug plan premiums and deductibles based on the beneficiary’s income level.
The Extra Help is estimated to be worth about $4,000 per year.

In general, you qualify for Extra Help in 2016 if:
• You are single and your income is less than $17,655.
• You are married, living with your spouse, and have an income less than $23,895.
• Your assets are below $13,640 for an individual or $27,250 for a married couple.

Counted toward your assets are such things as money you have in a checking or savings account, stocks and bonds. NOT counted toward your assets are your home, furniture or other household and personal items, one car, any life insurance policies, a burial plot and up to $1500 in burial expenses in you have put that money aside.

Applying for Extra Help is easy. You can apply online at www.socialsecurity.gov/extrahelp or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application. You can also apply in person at your local Social Security office.

Even if you do not qualify, by completing the application for Extra Help you will start your application process for other Medicare Savings Programs. Medicare will send information to the State of Ohio who will contact you to help you apply for a Medicare Savings Program unless you tell Medicare not to when you complete the application. If you prefer, you can contact your Medicaid Office or your State Health Insurance Assistance Program (SHIP) directly for more information.

If none of the above options work for you, I suggest you talk to your doctor to see if there are alternatives to brand name drugs or generic drugs that will work for you. Also consider contacting your drug’s manufacturer to find out if they offer help with the cost of your prescriptions.

Prescription Hope . . .1500 prescriptions at $25/month


There is hope for people who are experiencing hardship affording their medication or do not currently have coverage that reimburses or pays for their prescription medications. It’s a program called Prescription Hope.
Prescription Hope is a national pharmacy program that offers more than 1,500 FDA-approved prescription medications for the set price of $25 per month per medication.
For $25 per month per medication, Prescription Hope Advocates will order, manage, track and refill your prescriptions. They maintain up-to-date records and renew your medications every year, working with over 180 U.S.-based pharmaceutical manufacturers and their pharmacy. There are no other costs, fees, or charges associated with your medication or the Prescription Hope program. 
Prescription Hope can obtain more than 1500 FDA-approved brand-name medications from top U.S.-based pharmaceutical companies. To learn whether your medication is one they are able to provide, go to their website at www.prescriptionhope.com and click on ‘medications’ where you will find an easy to search data base of available medications.  You can also call them at 1-877-296-HOPE (4673).  Applications to enroll are available online or can be downloaded and printed from their website.
Prescription Hope is not new.  It’s been around for more than a decade, helping people from all walks of life. Their operation is located in Westerville, OH and has an A+ rating with The Better Business Bureau.  

To learn more about Prescription Hope, call 1-877-296-HOPE (4673) or visit their website at www.prescriptionhope.com.

Monday, January 18, 2016

Got Diabetes? Learn more about Medicare's Therapeutic Shoe Benefit

If you have foot problems or foot deformities related to diabetes, there is a Medicare benefit that may help you cover the cost of therapeutic shoes. The Medicare Therapeutic Shoe Benefit is available to anyone who has Part B and meets certain requirements.

Your first step is to talk to your primary diabetes doctor about whether or not you need therapeutic shoes. If you doctor agrees, he or she will complete a form that certifies this. In addition, your doctor will provide medical records that show 1) you are being treated for diabetes, and 2) that you meet Medicare’s requirements for therapeutic shoes. This documentation needs to be completed each year.

Once you get a prescription for your footwear, you will be fitted by a podiatrist or other qualified individual, such as a pedorthist, orthotist or prosthetist in order to qualify for this benefit.

Your cost for therapeutic shoes will be 20% of the Medicare-approved amount (after you satisfy your deductible.) Medicare Part B  covers the furnishing and fitting of either one pair of custom-molded shoes and inserts or one pair of extra-depth shoes each calendar year. Medicare also covers 2 (two) additional pairs of inserts each calendar year for custom-molded shoes and 3 (three) pairs of inserts each calendar year for extra-depth shoes. Medicare will cover shoe modifications instead of inserts.

Please be mindful that you must meet three of the following conditions in order to qualify for the Medicare Therapeutic Shoe Benefit:
1.  You have diabetes
2.  You have at least one of the following condition in one or both feet
  -  Partial or complete foot amputation or deformed foot
  -  Past foot ulcer or calluses that could lead to foot ulcers
  -  Nerve damage because of diabetes with signs of problems with calluses
  -  Poor circulation
3. You are being treated under a comprehensive diabetes care plan and need therapeutic shoes and/or inserts because of diabetes.

Be sure to check that your doctor and shoe supplier accept Medicare assignments. This means that they will accept the Medicare-approved amount as payment in full for the shoes, inserts and fitting. Suppliers that do not accept Medicare assignment may charge you more and you could end up paying a bigger portion of the costs.


For answers to more of your insurance questions, visit my website at or call me at 440-255-5700 to set up an appointment to discuss your needs. 

Friday, January 15, 2016

Got a new Health Insurance Plan this year?

Here are five steps that can help smooth your transition to a new plan.

Every year, many Americans like you take the opportunity during Medicare’s Open Enrollment period to change insurance plans. Regardless of whether you are changing a Medicare Supplement, an Advantage Plan or a Part D Prescription Drug Plan, there are a few things you can do now to avoid problems now that your new insurance has gone into effect in 2016.  

1.  If you are going from a Medicare Supplement to a Medicare Advantage Plan, make sure you have cancelled your supplement coverage. Your Supplement is not automatically cancelled when you switch to an Advantage Plan. Although some companies will cancel and make changes over the phone, others require a written request so give your Supplement Plan insurer a call and ask what they require.

2. Cancel your automatic withdrawals for the old plan. I recommend you cancel your withdrawal with the insurance company and then follow up with a call to your financial institution to make sure the automatic withdrawal is cancelled.

 3. Tell your doctor that you have different insurance. If your doctor unknowingly files for reimbursement with the wrong insurance company, it will cause confusion and delays in payment. Let your doctors know about your new plan the first time you see them in the New Year.

4. Check your Prescription Drug coverage to find out what pharmacies are the preferred pharmacies of your new plan. If it’s a different pharmacy than the one you’ve been using, arrange to transfer your prescriptions now so they have your information on hand. You should also present your new insurance cards to your pharmacy before you need your next prescription. Don’t wait until you need a refill or have an emergency before you make this change.

5. Determine whether your new plan has different requirements for prescriptions. Some plans may require a pre-authorization before your prescription will be filled. Take steps ahead of time to let your physician know what’s required by your new plan.


For your other questions on Life, Health, Dental, Vision, Annuities or Medicare Advantage Plans, please contact me at 440-255-5700 or email me. I look forward to serving you.

Wednesday, November 18, 2015

How do I get fast answers from my insurance company?


I always tell my customers to CALL ME with any questions about their health insurance coverage. As an insurance professional, I work with insurance companies every day so I know who to contact regardless of how complicated an issue may be. It is my job as their agent to take care of these matters for them.

If you don’t have an agent you can rely on for answers, here are a few tips to make the process of calling your insurance company a little bit easier:

1.    Have all pertinent information handy, including your insurance card, your Medicare card (if you have original Medicare), billing statements from your hospital and/or doctor and your Summary of Benefits. If you are discussing a specific procedure, ask your physician for the diagnostic code he or she uses.

2.    Familiarize yourself with the basics of your plan including your co-pays, cost of visits to specialists, out-of-pocket maximum and annual deductible.

3.    Be prepared to take notes. Write down the date of your call, the name of the person you spoke with and what they told you. Ask if they can send their response via e-mail so that you can save a copy for your records. Many issues will require more than one phone call, so keeping records will prove helpful should you need to check back.

4.    If the insurance company representative promises to get back to you by a certain date, note this on your calendar and be prepared to follow up then.

5.    If the insurance company agrees to make an exception to their coverage rules, get that agreement in writing. The alternative is to record your conversation.

6.    If you are calling on a parent’s behalf, be ready to put Mom on the line to let the insurance company know it’s okay to talk with you. If possible, set up a conference call including your parent on the call. If you will be handling your parent’s insurance matters often, find out what forms are required in order for you to represent them.

7.    If you’re discussing complicated medical issues, ask to speak to a nurse. Many case managers at insurance companies are RNs who can be more familiar with medical issues.
If you take these steps, I think you’ll find the process of getting answers from your insurance company a lot less frustrating. And, if you prefer to have someone do the leg work for you as I do every day for my customers, give me a call to learn how you can become one of my customers.

Wednesday, November 4, 2015

Beware of Sales Pitches during Open Enrollment

Before you make any changes, please read this:

If you’re over age 65, your mailbox is probably being swamped right now with a variety of Medicare Advantage Plan offers. Here are a few tips to keep in mind if you decide to do some shopping around:

Tip 1:  Double check any mail that promises to give you details on Medicare changes for 2015 to make sure it is sent from Medicare and not a sales pitch from an insurance company. Mailings have been spotted that look like the real deal, but are only meant to generate leads for insurance companies.

Tip 2:  Ask for details. Know what coverage your current plan provides and do a side-by-side comparison on co-insurance, co-pays, premiums, prescription costs, deductibles, doctors and hospitals in the provider network, etc.

Tip 3:  Be careful sharing your personal information with anyone you do not know or with whom you do not have an established relationship. Scammers are always looking for an opportunity to tap into your personal information.

Tip 4: If I'm your agent, call me before you make any changes.

I want to continue to provide you with all the personalized services you have come to expect from me. But, if you make changes in your Medicare Advantage Plan or other insurance through an 800 phone number or someone sitting at a table at your local pharmacy, you will lose me as your agent of record. That’s just the way the insurance companies 

I want to continue to be here for you when you need me. Please contact me and only me when you have a question or concern about your insurance.