There’s nothing wrong with not knowing what certain words mean when you’re looking into healthcare. A lot of the terms and phrases are ones that you would never see anywhere else! Medicare and all its parts can be confusing, but that’s why we’re here. These are some of the Medicare terms that we want to help you understand.
Ancillary – A policy that is not Original Medicare or Medicare Advantage (Medicare Supplements, cancer policies, and dental policies are just some examples). You can usually enroll at any time
COBRA –An act that requires your employer to keep your healthcare coverage for a limited time after you are fired to help you avoid a lapse in coverage
Coinsurance – The healthcare costs that you are personally responsible for
Copayment – The amount you pay out of pocket when you visit your doctor or purchase a prescription
Deductible – The amount you have to spend before your coverage kicks in
Dependents – Family members who can benefit from your plan (does not apply to Medicare)
HMO (Health Maintenance Organization) Plan – You will need to select one primary physician to turn to for all of your healthcare needs and can only see another provider if you have an official referral
HSA (Health Savings Account) – A separate bank account set up by your insurer that allows you to set aside tax-free money to use for healthcare expenses
In-network – A provider that is in agreement that your plan will provide coverage for the services that you receive there
Medicare Advantage – A Medicare plan offered by private insurers (not government-owned) that includes all Medicare benefits PLUS additional benefits like prescription drugs, dental, vision, hearing, fitness, etc.
Medicare Supplements – If you have Original Medicare only, you can add a Medicare Supplement plan to help you pay for your premiums, deductibles, and copayments
Out-Of-Pocket Limit – The maximum dollar amount you will be responsible for paying for your healthcare
Policyholder – The person whose name is on the plan
POS (Point-Of-Service) Plan – You will have a small network of providers to choose from but will be able to see any of those providers instead of choosing just one
PPO (Preferred Provider Organization) Plan – You can see any doctor, but some will be significantly cheaper for you than others
Premium – The regular payment (usually monthly) you are responsible for to keep your coverage
Medicare and Telehealth
Do you have trouble getting to your doctor’s appointments? Do you have a disabling condition or a lack of adequate transportation? Medicare and Telehealth may be the solution for you.
What is Telehealth?
Telehealth is a way for you to access quality care without having to leave your home. It began as a way for patients in rural areas and those who are too sick to leave home to speak with their doctor, but now it’s becoming a way of the future.
“Telemedicine” refers to diagnosis and monitoring through technology, while “telehealth” refers to any and all digital health management or education. There are four main types of telehealth:
Live Video – a real-time interaction between patient and provider.
“Store-and-forward” – recorded photo and video (like x-rays) sent to a specialist
RPM (Remote Patient Monitoring) – an electronic transfer of medical data
mHealth (Mobile Health) – care and education (like alerts) via cell phone, tablet, or computer
Telehealth Growing in Popularity
AARP reported that in 2013, the Telehealth industry was earning only $14.3 billion. It is expected to reach $36.2 billion by next year! It has been said that the baby boomer population, who are all around the age of 65 in 2020, have greatly contributed to telehealth’s popularity. Seniors are excited about the idea of not having to leave home to speak with their doctors because leaving home has frankly gotten difficult.
Telehealth Providers
It’s always best to see a doctor in person so that they can perform the best physical examination possible. However, if you find yourself in a situation where you can’t get to your doctor’s office, you can schedule an appointment or speak with a doctor at a digital clinic. HealthTap, Teladoc, and MDLive are just a few examples of virtual clinics. If you think you need a prescription or if you want to talk to a physician or counselor but can’t find a way to go do it, log into one of these websites instead!
Keep in mind that if you are hoping for a controlled medication prescription, such as for a steroid or antidepressant, you will most likely need to see a provider in person.
What Kind of Doctors use TeleHealth?
Telehealth isn’t just for primary physicians. You may be able to find a specialist doctor on a telehealth service as well!
Mental Health: Psychiatrists and therapists can talk to you via webcam or even phone call. A webcam is always ideal so that your therapist can read your body language and look you in the eyes while talking to you. Not only is this more convenient for everybody, but depressed patients may have an easier time picking up the phone than having to leave the house.
Teledermatology: Webcams may not be clear enough for a doctor to spot a skin issue, but telehealth also allows your doctors to coordinate care. If your primary physician spots a skin condition but wants you to see a dermatologist for a second opinion, your doctor may be able to use a telehealth system (the store-and-forward method) to send a high-quality picture of your skin condition to a dermatologist, saving everyone time and money.
Teleophthalmology: Similarly to dermatology, doctors can exchange high-quality photos of your eyes so that you can get the care you need even if there is not an ophthalmologist nearby. This is most useful for people living in rural settings where there is not an abundance of doctors and specialists.
Teleoncology: A cancer diagnosis may mean that frequent doctor trips are required, which can be tough for those living in more remote areas and for those who have a hard time leaving home. Teleoncology can allow doctors and patients to discuss care plans, monitor vital signs, and even exchange important images without ever having to meet in person. This can drastically cut down on costs and the toll that it can take on a person with a cancer diagnosis to have to frequently travel to a doctor’s office.
What Illnesses can be Treated by TeleMedicine?
Since doctors can prescribe treatments electronically, common illnesses like diabetes, allergies, arthritis, infections, and depression can be treated through telemedicine. As long as your doctor is able to connect with you and prescribe the appropriate treatment, telehealth works.
Telehealth Medicare Coverage
Medicare has strict guidelines as to what telehealth service can be covered.
The “store-and-forward” system is only covered by Medicare in Alaska and Hawaii. That means that if a patient who lives in Alaska or Hawaii has a medical concern but there is not a specialist available in those states, a doctor can use the store-and-forward system to submit medical records and imaging to a specialist in the continental United States.
To be eligible for coverage for telehealth medical appointments, you must live in an area that is outside of a metropolitan statistical area or is in a rural area with a primary or mental health care shortage. This tool can help you determine whether or not your address is eligible.
Additionally, the 2018 CHRONIC Care act allowed Medicare Advantage plans to provide more alternate coverage. This includes telehealth for anyone who lives in an HPSA, or Health Professional Shortage Area.
To find a Medicare Advantage plan with telehealth coverage, contact us! We can have an agent help you pick the best plan that is best for your needs. Just click here to request a call or call us now at 844-431-1832
*This blog was originally published on May 17, 2018, and updated on September 13, 2019.
Why You Need A Final Expense Policy
Did you know that final expense is completely separate from life insurance? That’s right – even if you already have life insurance, you may not be completely covered for costs you incur at the end of your life.
We know planning for the end of your life can be upsetting, so we want to make it easy for you. Final expense policies are sort of like a way to pay for your funeral in advance. You’ll pay a monthly premium, and then when you pass away your policy will pay for your burial expenses and other related bills.
Planning for Final Expense
There are two main questions you’ll need to answer before you purchase a final expense policy. You’ll need to know what type of funeral your family will hold for you, and who your beneficiary will be (the person who uses the policy after you pass away). If you only expect a small ceremony or cremation, you won’t need as much coverage as you would for a large memorial service.
Keep in mind that when you purchase final expense, you’re really helping your family. Your family members are the ones who will be paying for your funeral and final costs. Investing in a final expense policy will help them greatly.
Other Benefits
If you’re still not convinced that you need final expense, keep in mind that these types of policies, much like life insurance, build cash value. If you have a financial emergency before you pass away, you can take out the cash value of your final expense policy and use it to cover your expenses.
Additionally, you should know that when you pass away and your beneficiary uses your final expense policy, the payout is tax-free. It’s a good way to help your family at least save money on your final expenses if not cover them altogether.
Get Started with Final Expense
Ready to buy a final expense policy? Our agents are not limited to Medicare sales; they can also help you with final expense, life insurance, cancer insurance, heart attack coverage, and more.
Planning is crucial to having a successful financial life. You should always strive to leave room in your budget for potential health concerns, your retirement lifestyle, and your senior living facility if you find yourself needing one. You may be perfectly healthy now, but we as humans have to face reality: we can’t live forever, and our bodies and minds will start to deteriorate.
For Veterans – Aid & Attendance
Any veteran who is eligible for a pension from the VA and who is either housebound or needs help at home may be eligible for payments. It acts as an increased monthly pension and can help pay for either home care costs or nursing home fees. You can apply by visiting your local veteran benefit office. You’ll need evidence of your need for nursing care (any evidence of your disease or injury).
Life Insurance
Some life insurance plans allow you to take money out (tax-free) while you’re still alive. That means that you can use your life insurance policy as sort of a savings account for your future long-term care.
The younger you are when you purchase life insurance, the lower your premiums can be. If you don’t already have life insurance, buy now. Even if you don’t use it for your long-term care costs, you can use it to make sure your family is not left with your debts when you pass away.
Long-Term Care
Medicare will cover certain services based on your needs. For extra coverage, you may want to consider a long-term care policy. Long-term care policies will give you a daily allotment of money to spend on anything from your skilled nursing facility to an at-home aid. The catch is that you have to purchase long-term care insurance before you actually need it. If you’ve already had cancer, a stroke, Alzheimer’s, or another serious ailment, you might be denied long-term care insurance. Pre-existing conditions can prevent you from getting a good policy. If you buy now, you’ll be covered for when you get older and really need the help.
Ready to make a purchase? We can send an agent to your home to help you sort through your options and solidify your financial future. To get started, give us a call at 844-431-1832.
What Are Your Chances Of Developing Cancer?
Did you know that your chances of developing cancer are largely due to your DNA?
Last month, CMS (the Centers for Medicare and Medicaid) announced that Medicare can now cover genetic testing for cancer (as long as tests are FDA-approved). If you are aware of your chances of developing cancer early on, you can watch for it and be better prepared. Plus, cancer is almost always easier to cure when caught early on.
Is Cancer Hereditary?
Not necessarily. Scientists believe that inherited DNA only gives you about a 5 to 10% chance of developing cancer. The rest of your chance of developing cancer usually comes from your environment. Genetic testing looks for mutations in your DNA that reflect a chance of developing cancer. DNA mutation does not mean that you will definitely develop cancer, but it means that there is a chance that you will.
Genetic Testing For Cancer
Genetic testing is non-invasive. Sometimes it involves a simple cheek swab, and sometimes (depending on the test), the tester may need to draw blood. You may be able to complete a genetic test at home, but speak to your doctor first.
If you have any family history of cancer, or if you have lived in an environment with harmful chemicals or heavy smoke, it may be a good idea to seek out genetic testing. Always speak with your doctor before making these types of decisions. A doctor who knows your medical history may tell you that it’s not necessary or may encourage testing.
Cancer Coverage
Original Medicare (Part A and Part B) will cover hospital costs and doctor visits, and Medicare Part D will cover prescription drugs. However, cancer treatments generally are not kind on your piggy bank. You can purchase a Medicare Advantage plan that combines Part A, Part B, and Part D all into one plan. Then, purchase an additional cancer policy to cover extra items like physical therapy, ambulance transportation, surgeries, and replacement of lost income.
Cancer policies are usually reimbursement policies. The carrier will send you a check upon your diagnosis. That means that you can use your coverage for anything. If your family history or genetic testing tells you that you are at a high risk of developing cancer, you may want to invest in a cancer policy now so that you can be more financially prepared.
Our agents can help you decide what policies are best for you. Set up a free appointment by calling us at 844-431-1832.
New Medicare Benefits Thanks To CHRONIC Care Act
Last month, Congress introduced the CHRONIC Care Act. The title “CHRONIC” stands for “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care.” It is designed to help seniors and Medicare beneficiaries with chronic illnesses and disabilities and those who benefit from both Medicare and Medicaid.
New Medicare Advantage Benefits
With the CHRONIC Care Act, Medicare Advantage plans can now cover “nonmedical” benefits. Before the act passed, your Medicare Advantage plan would only cover “Durable Medical Equipment (DME).” DME includes items like blood sugar monitors, wheelchairs, hospital beds, and other items deemed medically necessary and durable (reusable for at least three years). Now, Medicare Advantage plans can cover home modifications (like wheelchair ramps, chair lifts, and bathroom handlebars) if medically necessary.
Additionally, Medicare Advantage plans can now provide more telehealth services. That means that your plan may provide coverage for virtual health services, like talking to your doctor via phone or video chat. Previously, Medicare had very strict guidelines about who was eligible to receive coverage for telehealth from Medicare. Now, the CHRONIC Care Act is expanding telemedicine.
Additional Home Care
The CHRONIC Care Act also expands your access to home care. Kidney disease patients can now access in-home dialysis treatments. This means that in the future, it may be easier for your doctor to come visit you.
Additionally, the Independence at Home program is expanding from 10,000 patients to 15,000. Independence at Home is a small program that allows doctors to visit patients on house calls and receive Medicare coverage. The program increases care quality and lowers care cost. While the program is still quite limited, this expansion means that more and more chronically ill patients are gaining access to home care.
Better Care Coordination
Lastly, the new act allows Accountable Care Organizations (doctor and hospital groups) to pay patients up to $20 when they come in for primary care services. This is an incentive to get people to visit Accountable Care Organizations. While ACOs may not be the best solution for everyone, they are beneficial because you can find all your doctors and providers located in one convenient place.
All of these updates and changes mean that it’s going to be much easier for seniors and Medicare beneficiaries with chronic conditions and illnesses to access the best possible care and coverage.
We are making every effort to help people like you enroll in the right plan with the right coverage.
Looking for help picking a plan? Give us a call at 1-844-431-1832.
Is Medicare Better Than Individual Plans?
Are you turning 65 soon and preparing to switch from your individual marketplace plan to Medicare? Or are you eligible for Medicare but trying to decide if you want to keep an alternative form of coverage? Generally, there are four types of health care plans and it can be hard to figure out which one you need. Your options are employer coverage, private coverage, Medicaid, and Medicare (additionally, Tricare and VA coverage for Veterans). Some people can have more than one of those options at any given time.
Let’s talk about the differences.
Employer Coverage
You can purchase health insurance through your employer, as long as it meets the coverage limits set by the federal government.
Private Coverage
You can purchase insurance from an exchange like Healthcare.gov, directly from your state, or directly from a health insurance company. Generally, purchasing private insurance is more expensive than employer coverage, and much more expensive than Medicare and Medicaid.
Medicaid
Medicaid is a federal health program. Each state has slightly different rules and each state has its own funding. It can cover any person of any age with low income (according to the Federal Poverty Level). Most Medicaid beneficiaries will have either no or very small premiums. If you have a low monthly income AND are over 65, you may qualify for both Medicaid and Medicare!
Medicare
Medicare is a federally funded health program for adults with disabilities, end-stage renal disease, or kidney failure. It also covers any person over the age of 65. Some parts of Medicare are free, while others require premiums. Most people will not have to pay nearly as much for Medicare as they would with an individual or private health plan.
You may think that individual plans provide more coverage due to the higher premiums, but that is not always the case. All Medicare plans include preventative services. Plus, you can choose to enroll in Medicare Advantage, which is like a private plan for Medicare. With Medicare Advantage, you can roll all your benefits – medical, dental, vision, prescription drugs, and even fitness – into one convenient plan.
We specialize in Medicare and serving the underserved senior and Medicare-eligible population. Do you or a loved one need help selecting a Medicare plan that truly helps? Set up a free appointment with one of our licensed agents in your area to get bias-free assistance. Call us to set it up at 1-844-431-1832.
How Seniors Can Combat Addiction
Are you or a loved one suffering from addiction? It’s actually quite common for seniors to suffer from addiction to drugs or alcohol due to lack of mobility, isolation and loneliness, and depression. Plus, seniors are more likely to have prescriptions for addictive drugs and are more likely to receive prescriptions that they don’t really need and become overmedicated.
The Recovery Process
The recovery process for seniors to combat addiction is not much different than the process for younger adults. There are two steps to every addiction recovery process: physical and psychological. Affected seniors will have to train their bodies to not be dependent on alcohol, drugs, or whatever they’re addicted to, but that starts with psychologically training the mind to not want those items. Most affected individuals will go through a withdrawal period that can bring symptoms like nausea, shakiness, sweating, loss of appetite, and anxiety.
Treatment centers often coach not only the affected senior but also the person’s family members or friends. That way, people can learn how to take care of their loved ones. Group therapy options are also available.
Treatment Coverage
Mental health and addiction treatment is one of the ten required services under the Affordable Care Act. That means that Medicare marketplace plans are required to cover addiction treatment. As long as services come from a provider or facility who participates in Medicare and a doctor states that the services are medically necessary, addiction treatment must be covered.
The Breakdown
Medicare Part A will pay for any hospitalization related to substance abuse and addiction treatment, but out-of-pocket costs (according to your individual plan) will apply. That means that you have to pay any copays or deductibles that you are normally responsible for. However, there is a limit. Medicare will only cover up to 190 days spent in a psychiatric hospital for an entire lifetime.
Medicare Part B will pay for substance abuse and addiction treatment at a doctor’s office or if you are a hospital outpatient. As usual, Medicare will pay 80% and you will be responsible for the other 20%. This coverage includes things like therapy, hospital follow-up visits, and hospital drugs. For other drugs, you will need a Part D or Medicare Advantage plan.
Are you or your loved one covered?
If you or someone you know has a problem with substance abuse or addiction, we can help make sure they have the best coverage possible. Our agents are licensed to sell products from multiple carriers, so we can supply the unbiased care they deserve. Call to set up a no-cost appointment at 1-844-431-1832.
What Is The Scope Of Appointment Form?
What Is The Scope Of Appointment Form?
Health care is personal, financial, and crucial. It can be difficult to hand your information over to strangers so they can start charging you fees, so you’re probably cautious about signing forms and documents. However, the Scope of Appointment form, or SOA, is an important one for you to sign.
The Centers for Medicare and Medicaid Services, CMS, requires that Medicare and Medicaid sales agents fill out the SOA at or before every appointment. The form documents exactly what the parties plan on discussing. The information is confidential but required for the agent to proceed.
Why?
SOA forms are just one way that CMS tries to protect you, the consumer. It prevents agents from trying to sell you more than you need or start discussing products illegally. By law, Medicare and Medicaid sales agents are only allowed to discuss the information they agreed to on the SOA form. The form is not required for Original Medicare enrollment. However, it is required for Medicare Advantage, Medicare Supplement, Part D (Prescription Drug) plans, Hospital Indemnity, and Dental/Vision/Hearing plans.
Fraud, Waste, and Abuse
SOA forms are one of the countless rules that Medicare and Medicaid sales agents are required to follow. An agent who breaks a CMS rule is considered guilty of fraud, waste, or abuse.
If an agent attempts to sell you a product that you did not agree to discuss, you can file a fraud, waste, and abuse complaint with The Centers for Medicare and Medicaid Services.
At MedicarePlanFinder, we’ll set you up with a Medicare Health Benefits agent who knows to always file an SOA and stick to it when meeting with you. Do you have any questions at all about your Medicare plan? Are considering changing or adding a plan? Call us to set up a meeting with one of our licensed and experienced agents at no cost to you. Call us at 1-844-431-1832.
Closing Your Medicare Coverage Gaps
Did you recently purchase a new health care plan, or are you reevaluating your existing plan? You may have noticed by now that your Medicare plan does not cover all of your health care needs.
If you only have basic Medicare, your plan only covers hospital treatments and doctor visits. If you have Medicare Supplements, your plan covers hospital treatments, doctor visits, and copayments and deductibles. If you have Medicare Advantage, your plan probably includes additional items like prescription drug coverage, dental and vision benefits, and physical fitness incentives.
Your prescription drug coverage can also leave you in the Donut Hole!
Thankfully, we can help you close your coverage gaps. This is how:
Ancillary Products
Even if you have Medicare Advantage, your Medicare plan is missing items like final expense coverage, life insurance, and more! If you don’t have Medicare Advantage, your Medicare plan definitely does not have items like dental, vision, and hearing insurance. These are all items that you can buy separately to give yourself additional coverage!
Dental, vision, and hearing policies are a great place to start, but you’ll really want to consider your other health care needs. Are you at a high risk for a stroke or heart attack? Do you have a family history of cancer development? If so, you may want to consider adding on a cancer, heart attack, or stroke policy.
Individual hospital indemnity policies are a great way to protect yourself for the event that you need to spend a long period of time in the hospital, and final expense policies are a great way to ensure that your family does not have to shell out thousands of dollars to pay for your burial expenses and any outstanding bills at the time of your death.
Extra Help
Thousands of seniors who qualify for Extra Help don’t even know it! We want to help you figure out if you’re missing out on great Medicare savings. If you qualify for Extra Help, otherwise known as LIS (Low-Income Subsidies), you can get help paying for prescription drug premiums, deductibles, coinsurance, and copayments.
Additionally, you can have an SEP, or Special Enrollment Period. This means that you’ll be able to change or add a plan outside of the Annual Enrollment Period (once per quarter during the first three quarters of the year).
LIS can also help you pay for late enrollment fees and cover you when you fall into the Donut Hole (the gap we mentioned earlier). Any Medicare beneficiary who has LIS does not have to worry about the Donut Hole coverage gap!
Thankfully, we can help you with all of this! Our Medicare Health Benefits agents can come directly to your home, so you don’t even have to go anywhere. We’ll send them your way so they can help you pick the best plan from the best carrier for your individual needs. Our agents can also help you apply for LIS!
To get started, set up an appointment by giving us a call at 1-844-431-1832.
