Can I have a Health Savings Account if I'm on Medicare?

An HSA (Health Savings Account) is a practical way to save for medical expenses and reduce your taxable income. It’s like an IRA for your health care costs. To be eligible for an HSA, you must have a qualifying HDHP (High Deductible Health Plan).

The 2016 annual HSA contribution limit for individuals with HDHP coverage is $3,350 (no change from 2015), and the limit for individuals with family HDHP coverage is $6,750 (a $100 increase from 2015). If you are 55 or older, you can make “catch-up” contributions, meaning you can deposit an additional $1,000 per year. If your spouse is also 55 or older, he or she may establish a separate HSA and make a “catch-up” contribution to that account. You have until the tax-filing deadline (generally April 15) of the following year to make allowable contributions.

Once you are on Medicare, you no longer can contribute to an HSA, however you can use funds already in your account to cover some Medicare costs, including deductibles, copays, vision and dental care. Those on Medicare can also use HSA funds to reimburse themselves for money that’s deducted from Social Security to pay Medicare Part B premiums. Although HSA funds cannot be used for Medicare Supplement insurance plan premiums, they can be used to pay Medicare Part D premiums, Medicare Advantage plan premiums and a portion of long-term-care insurance premiums.

Unlike other Flexible Spending Accounts, money you do not spend each year stays in your account providing you with a tax-advantage. Your money goes in tax-free, grows tax-free and comes out tax-free when you use it for qualified medical expenses.

Once an HSA reaches a certain threshold, the funds can be invested in mutual funds. The earnings from these funds are tax free as long as they are eventually used for qualified medical expenses.

If you have a High Deductible Health Plan (HDHP) and are interested in setting up an HSA, talk to your employer or contact a local bank for details.

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

How do I pay for my Medicare premiums?

If you are like most Medicare beneficiaries, you do not pay a premium for Medicare Part A.  Medicare Part B premiums are deducted from your benefit payments if you are on Social Security or Railroad Retirement Board benefits. If you are not receiving

Social Security or Railroad Retirement Board benefits, you will be billed monthly and will be responsible for paying your premiums using one of the following options.

1. Pay by check or money order by mailing your Medicare premium payments to:

Medicare Premium Collection Center
P.O. Box 790355
St. Louis, MO 63179-0355

2. Pay by credit or debit card by completing the bottom portion of the payment coupon on your Medicare bill and mailing it to the Medicare Premium Collection Center address listed above. You’ll need to provide the account information and expiration date as it appears on your card.

3. Set up online banking. Contact your bank or go to their website to set up online bill payment services. You will need to provide your bank with your Medicare account number, your monthly premium, the biller name which will be CMS Medicare Insurance, and a remittance address which will be the same address listed above for payment by check or credit card.

4. Sign up for Medicare Easy-Pay, a free service that automatically deducts your premium payments from your savings or checking account each month. You will need to complete an authorization form available online at www.Medicare.gov. Mail the completed Authorization form to:

Medicare Premium Collection Center
PO Box 979098
St. Louis, MO 63197-9000

5. If you are billed by the Railroad Retirement Board, mail your premium payments to:

RRB, Medicare Premium Payments
P.O. Box 979024
St. Louis, MO 63197-9000

If you are a Civil Service retiree and NOT entitled to Social Security, you may have your premiums deducted from your Civil Service annuity. To do this, send an email to OPMMailbox@cms.hhs.gov.

Please keep in mind that you risk losing your Medicare benefits if you fail to pay. If your premium is late you will get a Second Notice. If you don’t pay the premium by the due date for the Second Notice, you'll get a Delinquent Notice. If you get a Delinquent Notice and you don’t pay your premium by the 25th of the month, you’ll lose your Medicare coverage.

If you have questions concerning premium payments call Social Security at 1-800-772-1213. For all your insurance questions including Life, Health, Vision, Hearing or Medicare Advantage Plans, contact me at 440-255-5700

Why do I need Medicare if I'm covered at work?

In most cases, once you become eligible for Medicare, most retiree policies from an employer or union will require you to sign up for Medicare. In general, retiree insurance plans act as supplemental insurance and pay after Medicare, filling in some of the gaps in Original Medicare’s coverage.

How your specific retiree group health plan coverage will work will depend on the terms of your plan.  It’s best to talk to your human resources staff or your health insurance plan administrator to find out how Medicare and your plan coordinate. Here are a few things for you to ask about:

1.      Find out if you are required to sign up for Medicare Part A, Part B or both to get the full benefits from your retiree coverage. Some retiree coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it.

2.    Ask what your plan covers that’s not covered by Medicare. Does it cover deductibles or co-insurance? Can you see any doctors you choose or are you restricted to a network of doctors and health care providers? Does it cover extra days in the hospital? Does it include coverage for vision, dental or prescription drug coverage?

3.    Don’t assume that your coverage and costs as a retiree will be the same as an employee. Verify this. If you have a spouse, check whether he or she will also be covered. Employers aren't required to cover retirees, and they may provide different benefits, premiums, or even cancel coverage.

4.     Find out if your retiree plan provides ‘creditable coverage’ for prescription drugs. If it is not creditable coverage (as good as, or better than Medicare Part D) you will be charged a penalty should you need to enroll in Medicare Part D (drug coverage) in the future.

Your decisions about health care coverage are some of the most important choices you’ll make in the retirement planning process. I invite you to learn more about Medicare and the options you have. Please join me for my class, Getting Started with Medicare, presented at local colleges, libraries and community centers. For a complete list of upcoming dates and times for classes, you can click here to visit my website. . I look forward to seeing you in class.

Does Medicare cover rehab after a heart attack?

While heart disease is the leading cause of death every year in the U.S. for men and women, it can often be prevented when people manage their choices and health conditions.

If you have already had a heart attack, you and your physician should discuss a comprehensive Cardiac Rehabilitation Program (CR) that includes exercise, education, and counseling. This program is covered by Original Medicare Part B.

Medicare Part B also covers Intensive Cardiac Rehabilitation (ICR) programs that, like regular Cardiac Rehabilitation programs, include exercise, education, and counseling. ICR programs are typically more rigorous than CR programs. These programs may be provided in a hospital outpatient setting (including a critical access hospital) or in a doctor's office.
People with Medicare Part B are covered, but must be referred by their doctor and have had any of the following conditions:

• A heart attack in the last 12 months
• Coronary artery bypass surgery
• Current stable angina pectoris  
• A heart valve repair or replacement
• A coronary angioplasty or coronary stent  
• A heart or heart-lung transplant
• Stable chronic heart failure

Intensive Cardiac Rehabilitation (ICR) programs are also covered if your doctor orders it or if you have had any of the conditions listed above, with the exception of stable chronic heart failure, which applies only to CR programs.

Those with Original Medicare will be responsible to pay 20% of the Medicare-approved amount if you get the services in a doctor's office. If you receive care in a hospital outpatient setting, you will be responsible to pay the hospital a copayment. The Part B deductible applies.
     
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them
.
If you have questions concerning insurance including Life, Health, Vision, Hearing or Medicare Advantage Plans, contact me at 440-255-5700 or Lmutsko@mutskoinsurance.com. I look forward to assisting you.

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

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.

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. 

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.