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.

Thursday, October 8, 2015

Do Medicare or Medicare Advantage Plans cover eye exams? What about glasses?

Unfortunately, routine eye exams (sometimes called "eye refractions") that test for eyeglasses or contact lenses are normally not covered under Original Medicare. (Coverage is available through a number of Medicare Advantage Plans, but more about that later.)

Most major vision care procedures are covered, including cataract surgery, treatment of eye diseases and medical emergencies. Original Medicare will also pay for exams to test for other problems like macular degeneration, dry eye syndrome and eye infections.

Original Medicare provides coverage for eyeglasses following cataract surgery and contact lenses if the lens were inserted during cataract surgery. Medicare will not pick up the extra cost if you choose a specialized lens that restores full range of vision in order to reduce your need for glasses after cataract surgery. 

If you have diabetes or are at high risk for glaucoma you will be covered for an annual exam. People at high risk include diabetics, those with a family history of glaucoma and older Hispanics and African-Americans.

So are there other options? There are a number of Medicare Advantage plans that include vision coverage as part of their plan. If you know you are going to want to visit your eye doctor every year, it’s a good idea to consider one of these plans instead of Original Medicare. In addition to covering a percentage of the cost of exams and eyeglasses, many of these plans include dental, hearing and prescription drugs coverage.  

Another option is to purchase a Medicare Supplement, sometimes referred to as Medigap Insurance. A Medicare Supplement will cover your out-of-pocket costs for approved Medicare vision procedures. Remember, Original Medicare does not consider routine eye exams and prescription glasses to be approved expenses.

Military veterans who are visually impaired may be eligible for the VA’s vision health benefits. These range from primary care services to intermediate and advance clinical vision care. If you qualify for veterans benefits, check with your local VA Medical Center for more details.

If you would like to learn more about insurance plans that cover vision care, hearing or dental costs, please contact me at 440-255-5700. Open enrollment begins October 15 and is a good time to take a look at your options for 2016 to find a plan that fits your needs.

Tuesday, October 6, 2015

What are some affordable dental care options with Medicare?

If you plan to stay with Original Medicare, your dental options will be very limited. Original Medicare DOES NOT pay for routine dental care, including the cost of exams, teeth cleaning, tooth extractions, x-rays and dentures. This means that you can expect to pay 100% of the costs for all these services if you want to keep your healthy smile.

Original Medicare will only cover the cost of dental procedures related to covered medical procedures. For example, Medicare will cover extractions before cancer radiation therapy or jaw reconstruction after an injury. Procedures such as these are covered because they are necessary to treat a non-dental condition. They must be treated at the same time and by the same doctor as the covered condition.

There are other affordable options for dental coverage available to you. 

At Mutsko Insurance Services, LLC we offer a number of Medicare Advantage Plans that include coverage for routine dental care as well as vision, hearing and prescriptions. 

Coverage and costs will vary from plan to plan, and some plans may charge additional for dental coverage. There are plans that cover a percentage of your costs for cleanings, x-rays and exams while other are more comprehensive and will cover major dental services like crowns, bridges, root canals and denture, in addition to your routine care. It all depends on which plan you choose.

Before you sign up for any Medicare Advantage Plan, compare the dental coverage and costs and the find out whether your dentist is in the provider network. At Mutsko Insurance Services, we’ll do the work for you. We’ll show you your coverage options and determine whether your dentist is in the network. Our job is to help you find the plan that works best for you.

For more information on Medicare Advantage Plans, Medicare Supplements, dental, vision and other coverage options, please contact Mutsko Insurance Services, 6966 Spinach Drive in Mentor, OH or call 440-255-5700 or email me to make an appointment for a Medicare review.

Monday, October 5, 2015

Questions that help you evaluate your Medicare Plan

Medicare Open Enrollment begins October 15 and ends December 7. During this window, you have the chance to evaluate your current coverage to make sure you're getting the most out of your plan.

Start by asking . . .

Does your current Medicare plan still fit your budget?

Do you have access to the doctors, hospitals and other health care providers that are important to you?

Does your plan include routine dental, vision or hearing coverage?

Are you covered when you're traveling?

What will your prescription coverage cost you this year? And, are your prescriptions covered?

Do you have a fitness membership or other fitness benefit?

If your plan falls short on any of these points, call me. We'll take a look at other options.  440-255-5700. 

Tuesday, September 29, 2015

No Health Insurance? Penalties are going up for 2016

If you can afford health insurance but choose not to buy it and you do not have an exemption, you will likely be assessed tax penalties that will be collected with your federal tax return. 

According to,, the fees for not having coverage in 2016 are increasing and will be the higher of these two amounts:

·                  2.5% of your yearly household income
·               $695 per person ($347.50 per child under 18)
Open enrollment for Affordable Care coverage begins on November 1 and closes January 31, 2016. During this period, it is important for you to review your health care plan and make any changes or sign up for coverage for the coming year. To begin shopping for your Affordable Care plan go to and click on Online Quotes.

Don’t put off enrolling in a plan. If you have questions or need help finding the right coverage, call me at 440-255-5700 or email me today.  

Saturday, September 26, 2015

Don't get locked into a Medicare Advantage Plan that no longer works for you.

Whether this is your first Open Enrollment season or you’ve been through a few, it pays to take time now to study your Medicare and Medicare Advantage Plan options. Remember, plans can change their coverage, benefits and costs. You don't want to find out too late that you're locked into a plan for all of 2016 that doesn't cover your doctors, your hospitals or your medications. You should receive updated information by October 1 on your plan.

I also recommend that you sit down with friends or family members who may have questions and aren't sure what to do. Please set aside some time to go over their current Medicare or Medicare Advantage Plan coverage and figure out if they need to make any changes. If you need assistance, call me at 440-255-5700 or email me and I'll look into your concerns and offer some options.

The dates to remember are:

October 1 – 15   Evaluate your current Medicare plan
October 15        Open Enrollment begins and you can make changes.
December 7      Open Enrollment ends. Last day to make changes for 2016

Friday, September 25, 2015

What Medicare doesn't cover, a Medicare Advantage Plan may

Need hearing aids? Think you're covered by Medicare?

Think again.

If you have Original Medicare, you will not be covered for the cost of routine hearing exams, hearing aids or fittings for hearing aids. Medicare Part B only covers diagnostic and balance exams if your doctor or other health care provider orders these test to see if you need medical treatment for balance issues, vertigo or a recent injury.  

Even if your exam is covered by Medicare Part B, you will still be responsible for the Part B deductible and 20% of the Medicare approved amount for the doctor’s services. If your test is done in a hospital setting, you may also be responsible to pay hospital co-pay costs.  

If you have a Medicare Advantage plan or Medicare Supplement, you may have coverage for a percentage of hearing exams and hearing aids. Your first step should be to review your Insurance Plan’s Summary of Benefits and Coverage or contact your agent to find out what your plan includes. Be sure to ask if your plan requires that you go through specific approved suppliers or if the plan has other guidelines you will need to follow.

Talk to your doctor or other health care provider to find out how much your test, hearing aids and other services will cost. The amount you’ll owe will depend on several things including how much your doctor charges, whether your doctor accepts assignments and where you get your test and hearing aid. Let your doctor know you’re concerned about costs in order to avoid being surprised with an unexpected big bill.

Now, during Medicare Open Enrollment, is a good time to look into a Medicare Advantage plan that offers coverage for hearing.  I can show you a number of plans with this option.

Other Options
In some cases, the U.S. Department of Veterans Affairs may offer financial assistance or reduced cost hearing aids for Veterans. Vets are eligible for hearing aids if their hearing loss is connected to their military service or linked to a medical condition treated at a VA hospital. Veterans can also get devices if their hearing loss is severe enough to interfere with activities of daily life. For details, contact your local Veterans Medical Center or visit

Hearing loss is not just inconvenient; it’s a serious health condition. Better hearing may lead to a better life. 

If you would like to learn more about Medicare Advantage Plans that include coverage for hearing, dental and eye care, please contact me at 440-255-5700 or email me. I can show you a variety of plans that will provide the coverage you’re looking for.

Tuesday, September 22, 2015

Little known plan covers out-of-pocket costs.

If you’ve been confined to the hospital or had an accident that required medical treatment, you  know health care costs can be astronomical. And, no matter how good your insurance plan is, there's going to be unexpected out-of-pocket expenses. Everything from co-pays to hospital parking fees can  add up quickly.

There’s now a plan to fill these gaps. It’s an Indemnity Insurance Plan designed to help protect you and your savings. When major medical plans step in to cover your doctors, hospitals and other health care providers, this insurance plan pays you cash benefits to offset the cost of deductibles, co-pays, household expenses and out-of-pocket costs not covered by other insurance. The benefits are paid directly to you, unless you choose to assign them to a medical provider. Plans are available for virtually all age groups, including those over age 65.

This  is not a Medicare Supplement policy. It's not a Major Medical policy. It is affordable coverage that pays you cash to use however you want whenever you’re sick, hurt or require nursing care.

Don’t keep worrying about the ‘what ifs’ that go along with a health care emergency. Call me to learn more about Indemnity Insurance and how it can help you.

Saturday, September 19, 2015

Divorced? Don't rule out Social Security from your ex-spouse

Regardless of whether you stayed in touch with your ex . . . even if you never want to speak with him or her again . . . you may be eligible to collect Social Security spousal benefits based on your ex-spouse’s work record. 

The rules are fairly straightforward. If you were married for at least 10 years, you are age 62 or older and your former spouse is 62 or older (or otherwise entitled to Social Security retirement or disability benefits,) you have been divorced for at least two years and are now single, you could qualify.  

It does not matter if your ex has remarried. Your tapping into his or her Social Security benefits will not affect his or her benefits or what his or her current family receives from Social Security. In fact, if you’re concerned your ex will find out you are receiving these benefits, don’t worry. Social Security is not permitted to share this information so your ex-spouse won’t even know it’s happening.

If you remarried, you generally cannot collect benefits on your former spouse's record unless your subsequent marriage ended by death, divorce or annulment. The benefits you are entitled to receive based on your ex’s work record must be more than what you are entitled to receive based on your own record. 

If you think you may be eligible, contact Social Security to make a determination. They will take into account many variables including your current work status, your ex’s work record and whether your ex is living or deceased when you apply. To contact Social Security, call 800-772-1213.

Thursday, September 17, 2015

Why Life Insurance is Important for Women

I talk to a lot of women about their need to purchase individual life insurance. Many still have the outmoded idea that life insurance is important for men but not necessary for women. I also find that when they do have life insurance, they generally have policies with far less dollar coverage than men, relying primarily on life insurance provided by their employee benefit plan for coverage.

Most married women with children see the need for their husbands to have life insurance. They understand that insurance may not make their family rich, but it can provide a financial cushion to give their family time to adjust to the changes they’ll have to make if their husband died. These including possibly down-sizing their home, finding quality child care and other services to compensate for not having a marriage partner. Life insurance benefits can mean the difference between the transition being manageable or desperate.

What many women don’t realize is that the same adjustments take place when a wife dies and leaves her husband and children alone. The fact is that if something was to happen to them, both parenting roles fall to their spouse. If he’s at work, how are things going to get accomplished at home? In addition to losing her contribution to their family income, their husband might have to change careers and take an income cut to spend more time with their kids. The bottom line is that when a mother dies, it is at least as expensive as when a father dies. And, a $50,000 policy from work won’t go a long way when a single parent faces years of raising children.

Women should also consider other life insurance benefits as well, including:

-  Insurance can provide a lump sum of money to help pay expenses and generate an income. Life insurance can’t replace a spouse, but it can help pay for your kids’ college education, a daughter’s wedding or help ensure your spouse’s retirement dreams are realized.

-  Insurance can be a lasting legacy. Life insurance can create a financial legacy for your kids, your spouse or even your favorite charity or alma mater.

Life insurance is important for both men and women. It provides a measure of security for you and your family and isn’t that what you want? I can help you determine the best options for you and your family. Give me a call at 440-255-5700 or email me at to set up an appointment. I look forward to working with you.

Thursday, September 10, 2015

How do you get rid of your old medications?

If your household is like most others, you probably have a medicine cabinet filled with a variety of over the counter and prescription medications, including pet meds, cough and cold remedies and pain killers. Some have been sitting around in your cabinets for months or even years creating a potential hazard.

Sadly, I’m not aware of any programs that accept and recycle personal prescription or over-the-counter drugs. Flushing drugs down the drain or toilet is no longer a recommended method of disposal. Drugs disposed of in this manner are finding their way into our rivers, streams and ground water and are impacting our fish population. PLEASE DON'T FLUSH OLD MEDICATIONS.

Here are some safe approved disposal methods.

Medication Take-Back Programs
Many communities offer residents a place to drop off unused drugs for proper disposal. All private information should be removed or blacked out before disposing of prescriptions. Residents of Lake County can bring their unwanted and expired prescriptions, pet meds, creams, cough syrups, vitamins and pain killers to any of the following locations:

- Lake County Sheriff’s Office in Painesville
- Willoughby Hills Police Department
- Eastlake Police Department
- Madison Twp. Police Department
- Lakeland Community College Police Department
- Mentor Police Department
- Willoughby Police Department

No needles or syringes can be accepted. All drugs collected in these disposal bins will be destroyed by incineration.

For those outside of Lake County, please contact your city or county government’s household trash and recycling service to learn about medication disposal options and guidelines for your area.

Household Trash
If you don’t have access to a drug take-back program, you can safely dispose of drugs in your household trash. Mix tablets or pills with something inedible like kitty litter or used coffee grounds and wrap the mixture in a plastic bag before you throw it in the trash. This method prevents drugs from leaching into the soil or ending up in the wrong hands.

With the high price of medications, it may be difficult for you to throw away pills and prescriptions that cost you so much money. The hard fact is that it’s not safe to pass them on to others, their potency will change with age and their presence in your home is hazardous. So, please takes steps and clean out your medicine cabinet this week.

Questions? Contact me at 440-255-5700

Monday, September 7, 2015

Watch for Important Medicare Info in the Mail

Your Annual Notice of Change Booklet is Coming Soon.

By the end of September, everyone who has a Medicare Advantage plan or a Part D Prescription Drug plan will receive information in the mail called the “Annual Notice of Change” (ANOC). This booklet provides important information on changes you will see in your insurance coverage, cost and services for 2016.  
Please go over this information in detail. Don’t make a costly mistake and find out too late that your plan has made major changes that you will be locked into for the next year.

Some key areas to review are:

Changes in benefits and cost
Do the changes affect the services you use? 
Has the amount of your co-pay changed? 
Have the premiums or out-of-pocket costs changed? 

Part D Prescription Drug Plan  
Are your prescription medications covered? 
Are they in a different tier? 
Can you continue to use the same pharmacies?
Has the premium, deductible or tier costs changed?

Provider Network 
Are your doctors still in the network? (You can confirm this with the insurance provider’s online directory.)
Is your plan still available in your county? Some plans may be discontinued for certain counties.

What to do if you find gaps in your coverage
If you find gaps in your coverage, you have an opportunity during the Medicare Open Enrollment Period to switch to more suitable coverage. This year, open enrollment begins October 15 and continues through December 7 so there is plenty of time to shop and compare plans. 

Please review your Annual Notice of Change carefully. If you have elderly family members or friends, please help them review their plans, too. Don’t wait until it’s too late. If you have questions, call me at 440-255-5700 or email me and we’ll set up an appointment to do a Medicare review together.

Friday, September 4, 2015

When to use prescription discount programs and when not to use them

Many pharmacies, including many grocery store pharmacies, offer deeply discounted prescription drug prices to help you save money on your prescriptions. In some instances, the loyalty program drug prices are close to or less than the amount of your Medicare Part D copay. Purchasing through the loyalty program may be a good option for some people, but it isn’t always the best choice for everyone.

Here’s why. It all depends on whether you are likely to end up in the Medicare drug coverage gap, often called the donut hole. If you take a minimum number of prescriptions and getting your prescriptions filled through a discount loyalty program means that you will never reach the donut hole, it may be beneficial to use your pharmacy’s loyalty program.

However, if you are heading toward the donut hole, you may want to take a different approach.

Most Medicare drug plans include payment tiers or limits. The first tier is called Initial Coverage. In this tier, you and your plan pay up to $2960. This dollar amount is based on the total cost of your medications, including plan contributions and copays. Once the total of your plan contributions and your copays have reached the $2960 amount, you enter the Coverage Gap or Donut Hole. While in the coverage gap, you will pay a larger share of your prescription drug costs up to $4700. This $4700 is made up of your out-of-pocket expenses only. Once you get out of the donut hole and into the Catastrophic Coverage tier, you will only pay a small coinsurance amount or copayment for covered drugs for the rest of the year. In this case, as tempting as that $4 copay is, you should still use your Part D plan to pay for your prescriptions.

The coverage gap is set to close in 2020. Until then, filling prescriptions outside of your plan may count against you if you have large prescription drug bills and need to get out of the coverage gap and into catastrophic coverage.

Have questions about this? Contact me at Mutsko Insurance Services, LLC.
Email me or call 440-255-5700 today for an appointment.

Friday, August 7, 2015

Tips for keeping hospital costs down

Outstanding medical bills make up the largest single category of consumer debt in collection today. You’re smart to take steps now to manage your costs. One place to start is by keeping a close eye on what you’re being charged. Billing errors are more common than most people realize.

I recommend that you do your best to keep an accurate record of your hospital stay, noting the dates, times and places of your admission, release, procedures performed, doctors who saw you and medications provided. Ask your spouse, a companion or friend to help you with this task.

Once you’re discharged, request an itemized statement from the hospital with every individual charge listed. Although you are entitled to receive an itemized bill, many hospitals send a summary bill unless requested otherwise. Check through the itemized list to make sure everything you’re being charged for is correct.

Check the following information for errors: 
Verify your insurance policy number and all personal information. Errors may result in delayed or denied payments from your insurance provider.
Correct date and time for your admission and release
Correct list of the procedures and tests performed
Duplicate charges for any services or procedures
Charges for tests or procedures that were canceled

If you find a questionable charge, contact your health care provider right away. Track all calls, noting the names, phone numbers and call reference numbers every time you talk to someone about your medical bills. This goes for your insurance providers, your physicians and their staff as well as the hospital customer service department.

If you believe you have been overcharged and you’re unable to get any satisfaction, seek assistance from a medical or patient advocate. My clients can always call me if they have questions on medical bills or other issues concerning their insurance coverage. It’s one of the benefits of having a personal insurance agent.

 There are other ways you can reduce your out-of-pocket costs for co-pays, deductibles and other medical expenses, including indemnity insurance plans and Medicare supplement plans. Contact me to go over your options and come up with a plan that works for you. Email me or call 440-255-5700 today.

Wednesday, August 5, 2015

Medicare terms: How many do you know?

Ever get confused by different terms used by Medicare or your Medicare Advantage Plan. Here are a few of the more common ones that you need to be familiar with.  Test yourself and see how many you get right.

Accepts Assignment: An agreement that your health care provider will accept the Medicare-approved amount for services as full payment limiting your share of the cost to your coinsurance and deductible.

Benefit Period: A benefit period begins the day you are admitted as an inpatient to a hospital or skilled nursing facility and ends when you haven’t received any inpatient hospital care (or skilled care) for 60 days in a row. You may be in the hospital more than once during a benefit period. There’s no limit on the number of benefit periods Medicare will cover. Part A charges a deductible for each benefit period.

Coinsurance: The percent of the cost of a service which you pay. For example, Medicare pays 80% and you would pay 20% as coinsurance.

Deductible: A fixed amount that you pay for your medical care first, before insurance or Medicare starts to pay.

Lifetime Reserve Days: For Medicare Part A, there are a set number of hospital days you can draw on if your stay lasts longer than 90 days in a benefit period. You have 60 lifetime reserve days. A lifetime reserve day cannot be replaced.

Medicare-approved amount: In Original Medicare, this is the amount health care providers who accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. Providers who accept Medicare but not assignment can charge up to 15% above this amount.

Out of pocket limit: A limit that Medicare Advantage plans set on what you will have to personally spend in a plan year. For Medicare Part D plans, this is the maximum amount of money you will have to spend out of your own pocket before catastrophic coverage kicks in for the year.  

If you have more questions, please join me for my class, Getting Started with Medicare. It will help you gain a basic understanding of Medicare, Medicare Advantage Plans and many other terms you’ll need to know. For a list of all my upcoming classes, visit my website at (Pre-registration is required. These events are only for educational purposes and no plan specific benefits or details will be discussed.)

Monday, August 3, 2015

Are changes in store for health care insurance for same-sex spouses?

The Supreme Court ruling legalizing marriage in all 50 states for same-sex couples is bound to have far-reaching repercussions. In the coming months, you are sure to hear more about how the ruling is affecting income taxes, social security, retirement accounts, inheritances and, of course, health insurance.
Many issues surrounding same-sex spouses and health care have already been addressed., the official website for the Affordable Care Act, already states, “For coverage starting in 2015, an insurance company that offers health coverage to opposite-sex spouses must do the same for same-sex spouses.”
This means that as long as a couple is legally married an insurance company is not permitted to discriminate against them when offering coverage. The company must offer to same-sex spouses the same coverage it offers to opposite-sex spouses.
The Affordable Care Marketplace treats married same-sex couples the same as married opposite-sex couples when they apply for premium tax credits and lower out-of-pocket costs on private insurance plans. This is true in all states.
Legal questions remain about whether employers who provide health insurance benefits for spouses will be required to provide the same benefit to same sex couples. While the issue is not yet settled it is likely that many employers who offer health coverage to an employee’s spouse will simply offer that coverage to all spouses in the future. It simplifies administration of the plans and also avoids any discrimination issues that could result if the employer limited coverage to opposite-sex spouses.
The Supreme Court’s ruling also means that same-sex married couples have the same rights under Medicare as other married couple. If a spouse has not earned 40 credits to qualify for premium-free Medicare Part A they now can qualify for it based on the work record of their spouse, if he or she has achieved the required credits and is age 62 or older. 
Same-sex spouses will now be treated as family, so that if one spouse requires hospitalization, the other will have access to medical information regarding the hospitalized spouse’s condition, as well as to visitation rights — without having to worry about whether the specific state recognizes their marriage.
If you have any questions concerning your health or life insurance coverage, please let me know. As an independent agent, I represent many of the nation’s most respected insurance companies and will help you find the right insurance plan for you Contact me at 440-255-5700 or email me and we’ll set up a time to talk.