Wednesday, January 28, 2015

Do you know the difference between Medicare Supplements and Medicare Advantage Plans?

There are some very important differences.

When it comes to Medicare, you have a number of options including Original Medicare, Medicare Supplements and Medicare Advantage Plans. Here’s a short explanation of each of these:

Original Medicare is the federal insurance program for people age 65 or older, certain younger people with disabilities and people with End-Stage Renal Disease. While Original Medicare will cover a big part of your medical bills, it does not cover 100% of them. Your out-of-pocket costs will include deductibles, coinsurance and copays in addition to your premiums. These costs can add up quickly if you have a serious illness or medical condition.

Medicare Supplement Insurance (sometimes referred to as Medigap Insurance) is insurance coverage sold by private companies that you add to Original Medicare Part A & B. The purpose of a Medicare Supplement is to help pay the out-of-pocket costs not covered by Original Medicare.

A Medicare Advantage Plan is a government-approved alternative to Original Medicare. Advantage Plans are offered by private companies that contract with Medicare to provide all Part A & B benefits, plus additional benefits and services. With an Advantage Plan you will pay Part B premium plus the Advantage Plan premiums, often as low as $0. Prescription drug coverage may be included. With an Advantage Plan, your out-of-pocket costs will include copays, deductible and coinsurance. 

One of the most important benefits of Advantage Plans is that annual out-of-pocket costs are capped. Once you reach a pre-set limit, your plan will cover 100% of your hospital costs for the remainder of the year. There is no annual cap with Original Medicare.

There are a number of other issues to take into account before you decide which is right for you, including whether you travel out of the state or country, your prescription drug regimen and whether you need additional coverage for vision or dental care. Please contact me at 440-255-5700 or to go over your specific situation.

Tuesday, January 20, 2015

Affordable Care adult and child dental insurance are different

Under the health care law, dental insurance is treated differently for adults and children 18 and under. Here's the official guidelines for Marketplace plans . . .

  • Dental coverage for children is an essential health benefit. This means if you’re getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. While it must be available to you, you don’t have to buy it.
  • This is not the case for adults. Insurers don’t have to offer adult dental coverage.
Under the health care law, most people must have health coverage or pay a penalty of $325 per person and $162.50 per child or 2% of their income. But this is NOT true for dental coverage. You don’t need to have dental coverage, even for children, to avoid the penalty.
Time is quickly running out to get signed up for 2015 Affordable Care insurance. Contact me today and we will go over your options in detail. Call me at 440-255-5700. 

Friday, January 16, 2015

My policy covers my daughter who will turn 26 in July.

When should he get his own health insurance?

The rules concerning health care coverage for adult children are complicated. This is why it is always best to discuss your specific situation with a qualified insurance professional who will give you all the different options.  

Your daughter’s under-26 insurance coverage will end on her 26th birthday. Because she is losing coverage on her birthday, she is qualified for a Special Enrollment Period that will allow her to enroll in a health plan outside the Open Enrollment Period.

The Special Enrollment Period ends 60 days after her 26th birthday.

If she enrolls in a new plan before her 26th birthday, coverage can begin as soon as the first day of her birthday month. If she postpones enrolling and enrolls during the 60 days after her birthday, coverage can start the first day of the month after she selects a plan. 

If your daughter does not enroll in health coverage within 60 days of her birthday, she may not be able to get coverage until the next Open Enrollment period and may be subject to penalties for being uninsured of up to $325 (per individual) or 2% of her income, whichever is more.

Many young people who are ‘aging’ off their parent’s plans qualify for premium tax credits and other savings based on their income. Whether she qualifies for these savings will be determined when she applies for an Affordable Care Plan or I can help her determine what she is qualified to receive.

Because your daughter is under age 30 she may choose to get coverage through a catastrophic health plan. These plans usually have lower monthly premiums but high deductibles. A catastrophic plan is an affordable way to be protected from worst-case scenarios, like serious accidents or illnesses.

For information, please visit our website at Or call us to make an appointment to discuss your situation. We will review all your options and help you select the plan that best suits your needs. Call me at 440-255-5700 or email 

Thursday, January 15, 2015

Pregnancy and delivery are covered by Affordable Care Plans


All Health Insurance Marketplace plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage takes effect. 

Please pass this important information on to someone who is without insurance.

To learn more, contact me before open enrollment ends on February 15.  440-255-5700 or

Wednesday, January 14, 2015

Take this step to guard your medical identity

What do you do with the form you receive in the mail a few days after you see your physician or refill a prescription?  If you're like so many others, you toss it aside after a glance, relieved to know that it's an Explanation of Benefits and not a bill..

But, it’s important for you to check it out in detail to make sure the information it contains is correct.

Each insurance company and Medicare EOB usually contain the same information including your personal information, the doctor or facility visited, dates and description of your service, the fee billed to your insurance company and what you will be expected to pay once you receive your bill. It will also include any reason a service has been denied.

If any of the information on your EOB is incorrect, it could be a clerical error – or worse. Someone may have illegally used your medical identity. If you have any questions at all about your Explanation of Benefits call the phone number listed on the form and let them know your concerns.

Tuesday, January 13, 2015

Tax time will hold surprises for many

For many people, tax time will hold some big surprises. These won't be pleasant surprises, either. 

Those who were uninsured and didn't have an exemption in 2014 may be facing tax penalties. If they continue to go without insurance or have a qualified exemption in 2015, the tax penalties for this year will be even stiffer than last year's.

      (The penalty for not having qualified insurance in 2015 
       will be $325 per individual, $162.50 per child or 2% 
       of your income, whichever is more.)

Many people will not be aware of these penalties until they file their tax returns in April. By then, they will have missed the deadline to enroll in Affordable Care for 2015 and will have a very hard time avoiding the penalties - and may face fines for being uninsured in both 2014 and 2015.  

If you or someone you know still doesn't have health insurance, let me help you get started. Call me at 440-255-5700 or email me at today. Subsidies may be available but you have to apply in order to find out what this means for you.

Saturday, January 10, 2015

Turning 65 this year? It's time to learn about Medicare

Attend Getting Started with Medicare, a 90 minute informational session to help you gain a basic understanding of how Medicare works and how to make the most of it.  

Classes are scheduled at the following locations:

Tuesday, February 3, 2015
Chagrin Falls Community Education
7:00 pm – 8:30 pm
342 E. Washington St., Chagrin Falls OH 44022

Wednesday, February 4, 2015       
Kenston Community Education-Middle School
6:30 pm – 8:00 pm
17425 Snyder Rd., Chagrin Falls, OH 44023
440-543-2552 x 2566

Monday, February 10, 2015
SELREC-YMCA – Brush High School
7:00 pm – 8:30 pm
Brush High School, 4875 Glenlyn Road, Lyndhurst OH 44124

Monday, March 2, 2015 
Lakeland Community College
6:30 pm – 8:30 pm
7700 Clock Tower Drive, Kirtland, OH 44094

Monday, March 16, 2015       
Concord Community Center
6:30 pm – 8:00 pm
7671 Auburn Rd., Concord, OH 44077

Wednesday, March 18, 2015
Chagrin Falls Community Education
7:00 pm – 8:30 pm
342 E. Washington St., Chagrin Falls OH 44022

Sessions are educational only: no specific benefits, products or prices will be discussed. Pre-registration is required. Please call the individual location to register. Some venues may charge a nominal fee.

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

Thursday, January 8, 2015

Are you an in-patient or out-patient?

If you are in the hospital more than a few hours, always ask your doctor or the
hospital staff if you are an inpatient or an outpatient. 

Your hospital status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay for hospital services, including X-rays, drugs and lab tests. It may also affect whether Medicare will cover the care you get in a skilled nursing facility (SNF).

You’re an inpatient starting the day you’re formally admitted to the hospital
with a doctor’s order. The day before you’re discharged is your last inpatient
day. If you have a Medicare Advantage Plan, costs and coverage may be different.

My clients can always call me if they have questions at 440-255-5700 about their


Tuesday, January 6, 2015

Some famous folks who are turning 65!

If you are turning 65 this year you are in good company. Here are just a few famous people you may run into at the Medicare office:

Bill Murray, comic
Little Stevie Van Zant, actor & musician
Jane Pauley, newswoman
Dr. Phil, tv psychologist
Jay Leno, comedian
Joe Perry, guitarist for Aerosmith
Cybill Shephard, actress
David Cassidy, pop star
Natalie Cole, singer
Stevie Wonder, musician
Steve Wozniak, cofounder of Apple

If these people are like the typical Boomer  he or she doesn't even consider 65 to be old. According to a Pew Research study, the average Boomer believes that starts at 72. In fact, while only about half of all Americans say they feel younger than their years, 61 percent of Boomers feel that way - - - with the typical Boomer feeling about nine years younger than his or her chronological age.

As an FYI, you can enroll in Medicare up to 3 months before you turn 65. I strongly recommend you learn as much as possible about your Medicare options before you enroll. I teach a class called Getting Started with Medicare that explains all the basics. For a list of
class dates, times and locations click here:

Monday, January 5, 2015

Medicare needs your permission to share your private info

By law, Medicare must have your written permission to use or give out your personal medical information. If you want to allow Medicare to give out your personal health information to someone other than you, (including family members) you need to let Medicare know in writing.

For a copy of the appropriate form, go to, click on “Forms, Help and Resources” and download the “Medicare Authorization to Disclose Personal Health Information Form.”
Instructions and mailing address are included with the form.

Sunday, January 4, 2015

Affordable Care Plans include depression screening

All Affordable Care Marketplace plans and many other plans must cover numerous preventive services including depression screening without charging you a copayment or coinsurance. This is true even if you haven't met your yearly deductible.

For information on other preventive services or enrollment information, please email me at

Don't risk major medical bills or penalties for being uninsured. Open Enrollment ends February 15th for 2015.

Thursday, January 1, 2015

Adult and child dental insurance in the Marketplace

Under the health care law, dental insurance is treated differently for adults and children 18 and under.

Dental coverage for children is an essential health benefit. This means if you’re getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. While it must be available to you, you don’t have to buy it.

This is not the case for adults. Insurers don’t have to offer adult dental coverage.

Under the health care law, most people must have health coverage or pay a fee. But this isn’t true for dental coverage. You don’t need to have dental coverage, even for children, to avoid the penalty.

taken from