How Much Should You Be Spending on Ancillary Insurance?

Ancillary Insurance Costs

How much should you be spending on ancillary insurance policies? The short answer is, it depends. It depends on a lot of factors.

Everything from your weight to your gender matters when determining your health insurance costs, and ancillary products like vision coverage and life insurance vary drastically.

Dental, Vision, and Hearing

If you have Medicaid or a Medicare Advantage plan, you may already have dental, vision, and/or hearing included in your coverage. If not, you may want a separate plan. Keep in mind that these plans are commonly bundled, so you may not need to pay three premiums.

Dental coverage costs will average at about $350 per year or $30 per month. That may seem like a high cost for one type of service, but consider that one crown can cost about $1,000, and a dental plan will cover anywhere from 80-100% of that. It’s worth the cost.

Without insurance, a vision appointment will cost an average of $200, and glasses and contacts can cost over $300 per year depending on prescription strength and brand. Monthly costs average at about $30 per month. Hearing coverage falls into the same range.

More on dental, vision, and hearing policies.

Cancer, Heart Attack, and Stroke

Cancer plans can start as low as $15/month, but can reach up to $40 or $50/month.  Heart attack and stroke coverage are usually bundled together for about $20/month. These three types of plans are among the most wallet-saving as care costs for these conditions can total in the upper thousands.

More on cancer, heart attack, and stroke policies. 

Short-Term Care and Hospital Indemnity 

Monthly premiums for short-term care policies generally fall in the $30-$40 range for basic coverage and can be over $100 to include homecare and other services. Since these policies are only active for a year or less, total costs may be smaller than those for a long-term policy.

Hospital Indemnity plan premiums vary based on how much coverage you need. They can be as little as $12 per month or as much as $300 per month.

More on short-term care and hospital indemnity. 

Life & Final Expense

Life insurance costs vary more drastically than any other form of coverage because consumers have so many options. You can request $500,000 worth of coverage or $1,000,000’s worth.

One of the first questions a carrier will ask is whether or not you are a smoker. Insurance rates for smokers are much more expensive than for nonsmokers because a smoker has much higher health risks. A 35-year old non-smoker may pay about $735 per month for a lot of coverage or closer to $200 per month for less coverage.

Final expense policies are based on personal choice. Funerals can cost upwards of $10,000, so you’ll end up paying anywhere from $10 per month to $20 per month depending on how much coverage you want for your final expenses.

More on life insurance and final expense insurance. 

How much are you spending on ancillary insurance? Visit our post about getting ancillary coverage for FAQ’s and information about what you may need. If you need more questions answered, set up an appointment to speak with one of our agents by calling 1-844-431-1832.

Make The Most Of Your Medicare

Take Advantage Of Your Medicare

Do you know how to make the most of your Medicare plan? Do you know all of your benefits? Millions of people who enroll in Medicare pay their monthly premiums but don’t take advantage of their available services.

When you have a Medicare plan, you should use doctors in your network and prescription drugs on your formulary to save as much money as possible. You should visit your doctor even when you feel completely healthy or have minor concerns. Get your vaccinations, get tested for diseases that your family has a history of, and take advantage of other benefits like gym memberships.

Read on to discover what coverage you’re missing out on:

Find Doctors In Your Plan Network

Some carriers have doctor and hospital search engines so you can see which doctors are covered under your plan. ZocDoc is a great non-affiliated doctor search website as well. If you continue to use a doctor that is outside of your plan, you’re wasting potential savings that you’ll receive if you visit a doctor who is within your plan’s network.

Prescription Drug Coverage

The same goes for pharmacies and drugs. Your coverage is likely much higher for generic brand prescription drugs, so ask your doctor for a generic version when he gives you a prescription. Your coverage includes mail-order prescriptions as well. Mail-order is often cheaper because there are less labor costs! Plus, you can buy bigger supplies.

Take Advantage of Preventative Benefits

Medicare coverage isn’t just for help in the event of illness or injury – It’s also great for prevention. That means you have coverage for well-visits with your doctor, vaccinations (like flu shots), screenings and tests, and prescription supplements. Why not take advantage of those benefits and get ahead of potential illnesses? As a bonus incentive, staying healthy can keep your life insurance rates low.

[clickToTweet tweet=”Take advantage of your Medicare and see your doctor for a well-visit or screening. ” quote=”Take advantage of your Medicare and see your doctor for a well-visit or screening. “]

Know Your Additional Benefits

Some Medicare plans include discounts and freebies like gym memberships, massages, nutrition classes, support groups, and even LASIK surgery. Some even provide “rewards” in the form of discounts if you stay healthy.

Understand Your Coverage

If you have questions about your Medicare coverage, don’t be afraid to contact your carrier or agent. If you are enrolling for the first time or hoping to change your plan, set up an appointment with one of our experienced agents by calling 1-844-431-1832.

Home Health Services Covered by Medicare

If you’ve been following our blog, you know that Original Medicare encompasses Part A, hospital care, and Part B, doctor care. Thankfully, hospital and doctor care covered under Original Medicare is not limited to in-office care. Most of your home care needs will also be covered by your Original Medicare.

Do You Need Home Health Care?

Home health care is usually equally as effective as the care you would receive in a hospital or facility. If you have an injury or illness that prevents you from leaving your house, you’ll want to consider home health care.

Home health care is not limited to treatments and doctor visits. It can also mean care education for you and/or your caregiver. You may have a relative or friend taking care of you who needs help to give you the best care possible.

However comfortable it may be to have a friend take care of you, if you need injections or close monitoring, it may be in your best interest to hire a professional to check in on you at your home. A home nurse or doctor will also communicate with your other doctors and health care professionals to keep everyone on the same page and keep all documentation updated. It’s all in the interest of promoting good health for you.

[clickToTweet tweet=”Home health care does not only include treatments and doctor visits, but also education for you and your caregiver. ” quote=”Home health care does not only include treatments and doctor visits, but also education for you and your caregiver. “]

Home Health Services Covered By Medicare

To be eligible, you must have Medicare Part A and Part B, and a doctor must certify that you need the service that you are requesting coverage for and that you are homebound. With your Part A, you will pay $0 for home services and 20% of the Medicare price for any required medical equipment.

Included:

• Skilled nursing care
• Physical therapy
• Speech-language pathology
• Occupational therapy

Not Included:

• 24-hour home care
• Delivered meals
• Homemaker or personal services

You will stop receiving coverage for your home care if your treatment is no longer medically necessary or if you are no longer homebound.

Choosing Your Home Care

Your doctor will probably recommend a home health care service to you if he doesn’t provide those services himself. Otherwise, Medicare has a Home Health Agency finder so you can locate the care you need in your area. When choosing an agency for yourself or for a loved one, make sure you’re asking the right questions, such as:

1. Are you Medicare (or Medicaid) certified?
2. Do you offer ____ service?
3. What are your hours and do they align with my needs?
4. Will you have emergency staff available on weekends and after hours?
5. Do you perform background checks on staff? Do you have credentials?
6. Will I have to pay anything out of pocket?

Once you’ve narrowed your choices down, you may want to inquire about an agency’s quality of care. Any home care agency who services Medicare clients and has serviced at least 20 patients will have a star rating. Patient Care Star Ratings are based on patient health improvement and the outcome of home treatments and care.

If you have more questions about your home care costs or are considering adding coverage, like a Medicare Supplement plan to help with costs, speak to one of our agents today. Call 1-844-431-1832.

What is Medicare Fraud, Waste, and Abuse?

Medicare Fraud, Waste, and Abuse

The government loses millions each year due to Medicare fraud, waste, and abuse, causing prices to rise. Medicare fraud, waste, and abuse come from a series of laws designed to protect all parties involved in Medicare and Medicaid. The laws promote healthy relationships between agents, carriers, and clients and prevent the insurance industry from becoming profit-based, instead of care-based. Your coverage should be more important than profits.

Penalties for committing Medicare fraud can reach nearly $100,000 and result in extraction from all government health care programs.

What Is Medicare Fraud?

• Knowingly making false claims or misrepresenting data
• Knowingly giving or receiving rewards for goods and services
• Promoting one health service over another
• Billing Medicare for appointments that never happened or for more than what actually happened

What Is Medicare Waste and Abuse?

Waste and Abuse surrounds unnecessary costs or fees. Some examples are:

• Billing for unnecessary services
• Excessive supply purchases
• Misusing codes

What Are The Laws?

• False Claims Act (FCA) – Protects the government from being overcharged on goods or services. No proof of intent is required.
• Anti-Kickback Statute (AKS) – Agents cannot knowingly reward referrals for health care programs.
• Physician Self-Referral Law (Stark Law) – Doctors cannot make referrals to health care companies in which they have an interest.
• Criminal Health Care Fraud Statute – Cannot defraud; bill for unnecessary medical goods and services (like drugs that are not needed or wheelchairs for those who are not impaired).

[clickToTweet tweet=”The government loses millions each year due to Medicare fraud, waste, and abuse, causing prices to rise. ” quote=”The government loses millions each year due to Medicare fraud, waste, and abuse, causing prices to rise. “]

What Can You Do?

Don’t become a victim! If you aren’t sure about a health agent’s validity, find your agent through a field marketing organization (or FMO) like Senior Market Advisors. FMOs contract with trained, certified agents.

To help fight Medicare fraud, waste, and abuse report any suspicious activity to 1-800-HHS-TIPS (1-800-447-8477). You can also describe the incident in up to ten pages and email it to HHSTips@oig.hhs.gov.

[clickToTweet tweet=”Did you know? You can report suspicious Medicare activity to 1-800-HHS-TIPS (1-800-447-8477) or HHSTips@oig.hhs.gov.” quote=”Did you know? You can report suspicious Medicare activity to 1-800-HHS-TIPS (1-800-447-8477) or HHSTips@oig.hhs.gov.”]

Simply Explained: Medicare Savings Programs

Medicare Savings Programs

Are you eligible for a Medicare Savings Program? You could be saving hundreds each month by getting help to pay for your Medicare premiums. In some cases, these programs can even pay for other Medicare costs, including deductibles, copayments, and coinsurance.

Medicare Savings Programs, or MSPS, may sometimes be referred to as Medicare Buy-In Programs or Medicare Premium Payment Programs. Enrolling in an MSP means that you will also be automatically enrolled in the Low Income Subsidy (LIS), also called “Extra Help,” an assistance program to help you pay for Part D prescription drug costs. To qualify, you will need to already be enrolled in Original Medicare, or at least Medicare Part A.

MSPs are state Medicaid-funded, and whether or not you’re eligible for enrollment depends on your income and resource level. This is usually based on the Federal Poverty Level (FPL), but some states may have slightly different required income and resource levels.

Resources that are considered in eligibility include:

• Money in a checking or savings account
• Stocks and bonds
• Individual Retirement Accounts (IRAs)

Resources that are not considered include:

• House or car
• Burial plots
• Furniture or other personal property

Our guide will help you determine your eligibility for MSPs. But feel free to ask your agent if you still have any questions.

The are four types of Medicare Savings Programs, each with its own eligibility requirements and benefits:

1. QMB (Qualified Medicare Beneficiary) Program – Pays for Part B premiums, and potentially Part A premiums, deductibles, coinsurance, and copayments as well. You may qualify if you meet these requirements:
   • Single monthly income of less than $1,084
   • Married monthly income of less than $1,457
   • Single resources of less than $7,860
   • Married resources of less than $11,800
2. SLMB (Specified Low-Income Medicare Beneficiary) Program – Pays for Medicare Part B premiums. You may qualify if you meet these requirements:
   • Single monthly income of less than $1,296
   • Married monthly income of less than $1,744
   • Single resources of less than $7,860
   • Married resources of less than $11,800
3. QI (Qualifying Individual) Program – Pays for Part B premiums. You must reapply every year, and the program operates on a first-come, first-serve basis with priority to renewals. You cannot enroll in the Qualifying Individual Program if you are also eligible for your state’s Medicaid program. You may qualify if you meet these requirements:
   • Single income of less than $1,456
   • Married income of less than $1,960
   • Single resources of less than $7,860
   • Married resources of less than $11,800
4. QDWI (Qualified Disabled and Working Individuals) Program – Helps pay for Part A premiums. You may qualify if you meet these requirements:
   • Working disabled person under 65
   • Lost premium-free Part A eligibility after returning to work
   • Do not receive state medical assistance
   • Meet state-based income and resource limits
     • Single income limit of a little over $4,000
     • Married income limit of about $5,500
     • Single resource limit of about $4,000
     • Married resource limit of about $6,000

Still have questions? Speak with an agent today if you aren’t sure if you are eligible for a Medicare Savings Program. Just dial 1-844-431-1832 and one of our licensed agents will help you discover your options.

Updated on November 3, 2020.

Prescription Drug Plans For Seniors

You may have noticed by now that Original Medicare (Parts A and B) does not include prescription drugs. Even though it isn’t included in your initial plan, you will encounter penalty fees if you do not purchase a prescription drug plan during your initial eligibility period (up to three months before and after your 65th birthday).

There are a couple of ways for you to get the prescription drug coverage that you need.

How To Get A Drug Plan

Medicare Advantage plans encompass Original Medicare (parts A and B) and additional coverage for costs such as dental care and prescription drugs.

Note: Even though Medicare Advantage includes supplemental pieces, it is not the same thing as Medicare Supplements.

If you have Original Medicare, you can also get your prescription drug coverage with a Part D-only plan. Prescription drug plans, or PDPs, can also be purchased as an addition to an MSA (Medicare Savings Account), or PFFS (private-fee-for-service) plan.

What’s Covered?

Each individual plan will have a formulary, or a list of all the prescription drugs that are covered. The list is often divided into tiers according to cost. Keep in mind that your out-of-pocket drug costs will vary according to the plan you choose, whether or not your pharmacy is in your network, and whether or not you are eligible for Medicare Extra Help. Costs will also depend on your premium, deductible ($400 max in 2017), copayments, and coinsurance.

What’s The Donut Hole?

The donut hole is a limit on what your prescription drug plan will cover. It applies to all Medicare clients who don’t have Extra Help. In 2019, the donut hole limit is $3,820.

In 2020, the donut hole will be going away.

You will pay for 100% of your drug costs until you hit your deductible, $435 in 2020. Once you spend your deductible, you will have coverage based on your chosen plan. Once you’ve spent $4,020, you’ll be responsible for up to 25% of your brand-name drug costs and up to 25% of your generic drug costs.

Click here for a more in-depth look at tips for saving money on prescription drugs.