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.

Monday, November 2, 2015

What's the difference between a Medicare Advantage HMO and a PPO

Which one is right for me?

The abbreviations used to describe the different types of Medicare Advantage Plans can be confusing.  Here’s a breakdown of the main categories you’ll come across.

Let’s begin with HMO, short for Health Maintenance Organization. Generally, HMO’s tend to be among the more affordable choices because they usually have zero or low premiums (the amount you pay an insurance company each month for coverage) and low deductible (the amount you have to pay first before your plan starts to foot the bill.)

Except for emergencies, HMO’s do not cover care received outside their network. If you have a doctor that you want to keep seeing, it’s important to make sure that doctor is “in-network” for any HMO you’re considering. You may also have to choose a primary care physician (PCP) in the plan network who will provide general medical care and authorize referrals to in-network specialists. Before you choose an HMO, make sure the doctors, hospitals and other health care providers you prefer to see are in the HMO’s network.

The second group is a PPO or Preferred Provider Organization. PPO's are a second type of managed care health plan. A PPO provides a large network of physicians, hospitals and other health care providers — usually larger than an HMO. Another important difference is that unlike an HMO, you can see providers outside the network for any service at any time, as long as they accept Medicare and you’re willing to pay more out-of-pocket. With some PPO's you may need to pay the non-network doctor directly, and then file a claim for partial reimbursement.

An RPPO is a regional preferred provider organization. The "Regional" part of an RPPO simply means that the network of preferred providers is not limited to one state only but crosses state boundaries within a specified region.

All Medicare Advantage Plans (including HMO, PPO and RPPO plans) offer the same coverage as Original Medicare (Part A and Part B), and they often include prescription drug coverage as well. Many also offer dental, vision and hearing care, wellness programs and other health care benefits not included with Original Medicare so be sure to check around to find a plan that provides you with the coverage you want and need.

If you have questions or would like to see what Medicare Advantage Plan options are available to you, give me a call  or email me. We will set up a time to do a review and go over your options

Wednesday, October 28, 2015

Medicare Open Enrollment does not Apply to Medicare Supplements

Medicare Supplement Plans, sometimes referred to as Medigap Insurance, are not the same as Medicare or Medicare Advantage plans. You are permitted to purchase or make changes to your Medicare Supplement at any throughout the year. The Open Enrollment Period does not apply to this type of insurance.

The best time to contact me concerning Medicare Supplements will be after January 1 when information on new rates should be available.

Monday, October 26, 2015

Affordable Care Open Enrollment begins 11-1-15.

While there may be a lot of other things competing for your attention at this time of the year, it’s a good idea to brush up on your Affordable Care options for 2016. Open enrollment occurs this year between November 1 and January 31, 2016.

I'm often asked by some people why they need to buy health insurance.They reason that they are young and healthy so why not just go without insurance. 

Consider these facts:

Fact:  All marketplace plans cover you for the kind of health care that most young people and their families need most including immunizations and preventive services, mammograms, flu shots, childhood immunizations, cholesterol screenings and more. These services are provided with no co-pay or coinsurance even if you haven’t met your yearly deductible.They also include ten essential health care benefits including doctor visits, mental health services, emergency care, hospitalization, prescription drugs, maternity and newborn care.

Fact:  Unless you have an exemption, you are required by law to have health insurance for yourself and your family. Your coverage may be through your job, your parent’s plan, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage, but you must have coverage or an exemption.
Fact: The fees for not having health insurance are going up. If you don’t have coverage or an exemption in 2016, you’ll pay the higher of these two amounts:  2.5% of your yearly household income, or $695 per person ($347.50 per child under 18.) You’ll pay the fee with your federal income tax return you file for the year you don’t have coverage. If you don’t pay the fees, the IRS will hold back the amount of the fee from any future tax refunds.
A variety of plans will be available for individuals and families to fit your needs and budget. Financial help may be available to pay for part, or in some cases, all your health insurance premiums, but you need to apply in order to find out what this means for you. To look at your options, visit  after November 1 and click on Get a Quote. Complete the online application and we will be in touch within 24-48 hours to answer your questions and complete your enrollment.

For more information on Affordable Care Plans and other insurance matters, please contact me Laura Mutsko at Mutsko Insurance Services, LLC at 440-255-5700 or email

Monday, October 12, 2015

Get the Facts on Medicare and Avoid Costly Mistakes

Turning 65 this year?  This class is for YOU! 

To get the most from Medicare, plan now to attend Getting Started with Medicare, a 90 minute informational session that I offer through colleges, libraries and community programs. I'll cover all the basics, so you have a better understanding of your Medicare choices when it comes time to sign up. 

Preregistration is required. Please register by calling the phone number listed for the class you wish to attend. Some host sites may charge a small fee. These events are only for educational purposes and no plan specific benefits or details will be discussed.

Tuesday, October 13, 2015
Polaris Career Center – Berea High School
6:30 pm – 8:30 pm
Berea High School, 165 E. Bagley Rd, Berea OH 44017

Monday, October 19, 2015
Mandel JCC
6:00 pm – 8:00 pm
26001 South Woodland Rd., Mandel Community Room, Beachwood OH 44122

Wednesday, October 21, 2015

S.E.L.R.E.C. – Brush High School
7:00 pm – 8:30 pm
Brush High School, 4875 Glenlyn Rd., Room D105, Lyndhurst, OH 44124

Monday, October 26, 2015
Andover Library
2:00 pm – 4:00 pm
142 W. Main St., Andover, OH 44003

Wednesday, October 27, 2015

Chagrin Falls Comm Ed.
7:00 pm – 8:30 pm
342 E. Washington St., Chagrin Falls, OH 44022

For a complete list of other class dates and times, click here
 or call Mutsko Insurance Services at 440-255-5700.

Saturday, October 10, 2015

PayClose Attention to Your Medicare Part D Coverage

Don’t make a costly mistake and get locked into a Medicare Part D Prescription Drug Plan that’s not right for you. Take a look at the changes being made in your coverage and what it will cost you in 2016. You have an opportunity now, during open enrollment to change plans if you need to do so.
Some plans are making significant changes. Look at what tier your prescriptions will be in. What are the costs of each tier?  Have they changed from last year? Also look at your deductible and co-pay. All of this will determine whether your out-of-pocket costs are going up or going down next year.
Call me if you would like to look at other Medicare Part D Prescription Drug Plans. We’ll sit down and do a review and help you determine which plan is the best fit for your needs.