Does Medicare Cover Flu Shots?

The Centers for Disease Control and Prevention (CDC) estimates that each year, there are over 31.4 million outpatient doctor visits due to the flu virus in the United States.

Anyone can get the flu, even the healthiest of people, which is why it’s important to take the necessary preventive measures. Getting an annual flu shot is the best way to prevent the flu. If you’re eligible for Medicare, you probably wonder, “Does Medicare cover flu shots?”

High Dose Flu Vaccine

With age comes beauty…and a weakened immune system! If you are 65 years or older, you are considered high risk for developing influenza.

The high dose flu vaccine is a great option for Medicare eligibles because it contains the three flu strains that are most likely to cause the flu. Plus, it contains four times the flu virus antigen than a regular flu shot. Research shows that the high dose flu vaccine leads to 25% fewer cases of the flu than the standard flu shot.

High Dose Flu Vaccine vs Regular Flu Shot

The regular flu shot is recommended for those six months or older while the high dose flu vaccine is designed specifically for those over the age of 65. Both vaccines take approximately two weeks to build immunity in the body. The peak of flu season is January through March but can start as early as October and extend as far as May, so it’s important to get vaccinated as soon as possible.

Flu vaccines are completely safe and have weakened viruses, meaning the flu shot cannot cause the flu. The high dose flu vaccine and the regular flu shot can both cause side effects, but, side effects may be stronger with the high dose flu vaccine. Getting any flu vaccination is the first step to protecting yourself against the flu.

Flu Shot Side Effects

The risk of developing side effects from the vaccine is higher in a high dose flu vaccine rather than the average flu shot. These side effects can include pain, swelling or soreness at the injection site, and headaches or muscles aches. These side effects may be less than ideal.

However, seniors and Medicare eligibles can have significantly higher complications from the flu. The phrase “better safe than sorry” certainly applies, because .

Flu-Related Complications

The flu can lead to several complications. These complications can range in severity, but should always be taken seriously.

Minor complications include fever, headache, tiredness, cough, body ache, and vomiting.

More severe complications include pneumonia, dehydration, muscle inflammation, and sinus infections. Plus, the flu can worsen long-term health conditions like heart failure, asthma, and diabetes.

Does Medicare Cover Flu Shots?

Medicare Part B covers outpatient care, preventive services, ambulance services, and durable medical equipment. Flu shots are considered a preventive service, so Medicare will cover 100% of the cost for one flu shot per year.

The Part B deductible does not apply to this service, so as long as you are enrolled in Medicare and the doctor or clinic accepts Medicare, you are fully covered.

Medicare Advantage plans are required, at a minimum, to provide the same benefits as Original Medicare (Part A and B). This means that if you are enrolled in a Medicare Advantage plan, your flu shot is fully covered, too.

The premiums and deductibles may vary per plan, however, if the plan has a deductible, a flu shot may not apply.

Where to Get a Flu Shot

If you don’t know where to get a flu shot, the CDC has a free resource to locate flu shot providers in your area. To get started, click here. Enter your zip code beside the red arrow. We used 37209, which is our corporate headquarters’ zip code in Nashville, Tennessee. Then click “Go”, which is beside the green arrow.

The next page lists the flu shot providers in your area complete with address and contact information. Call the providers with any questions about how to get your flu shot.

Let Us Help You Find the Right Medicare Plan

Getting an annual flu shot is just one of many ways to practice a healthy lifestyle. If you’re looking for coverage beyond Original Medicare that will help you become the healthiest version of you, a Medicare Advantage plan may be a perfect fit!

A MA plan can provide vision, dental, and hearing coverage. Plus, some may offer fitness classes like SilverSneakers®! Our licensed agents are highly trained can help you find the perfect plan that fits your needs and budget. Call us at 844-431-1832 or click here to get in touch with an agent!

This blog was originally published on November 6, 2018, by Kelsey Davis and updated on August 30, 2019 by Troy Frink .

Shingles in the Elderly: Signs & Prevention

According to the Centers for Disease Control and Prevention, nearly one-third of people in the United States will develop shingles at some point in their life. The risk of developing shingles increases as you age and is more likely in those who have had the chickenpox (Varicella) virus. Prepare yourself now by learning everything you need to know about shingles in the elderly.

Shingles Complications

Shingles is caused by the varicella-zoster virus and results in painful blisters on your body. This is the same virus that causes chickenpox. If you had chickenpox, the virus remains inactive in nerve tissue near your spinal cord and brain. Years later, this virus can reactivate as shingles. What causes the dormant virus to reactivate? The exact reason is unclear, but researchers suggest that weakened immune systems, certain diseases such as HIV/AIDS or cancer, radiation, chemotherapy, and certain medications, like steroids, can contribute to the development.

Shingles can result in severe complications, the most common being postherpetic neuralgia (PHN). Those with PHN continue to have pain on the surface of their skin even after the blisters have subsided. PHN can take weeks, months, or even years to resolve. Other shingles complications include vision loss, facial paralysis, balance problems, and bacterial skin infections.

How long does shingles last in the elderly?

The average case of shingles lasts between three to five weeks. According to the National Institute on Aging, shingles follows a pattern. The first sign of shingles is often an itching or burning sensation on the side of the body. About one to five days later, a red rash will start to develop. A few days after that, the rash will turn into blisters. These blisters will last for roughly ten days before drying up and scabbing. Within a couple of weeks, the scabs should clear up. In some cases, shingles can then lead to other conditions (like PHN, mentioned above) that can last longer, but the shingles virus should clear up after about five weeks. Most people only get shingles one time, if at all, but it is possible to develop shingles more than once.

Shingles in the Elderly Symptoms

There is no cure for shingles, but early treatment can help fight the virus and limit the amount of pain you have. It’s important to understand the symptoms so you can talk to your doctor as soon as possible. Common shingles in the elderly symptoms include:

• Burning, itching, or numbing area on the skin
• Skin sensitivity
• Itching
• Fever
• Headaches
• Light sensitivity
• Fatigue

Is shingles contagious to the elderly?

No. Shingles itself cannot be passed from one person to another. However, the virus that causes shingles can be spread through direct contact with the fluid from the blisters. A person with shingles is only contagious during the blistering phase. However, only those who have not had the chickenpox can contract the virus this way, and they would develop chickenpox as a result. Those who had chickenpox previously actually already have the virus, though it is inactive! If a person who has had chickenpox develops shingles, it will most likely be from the virus that is already in the body, not through contact with someone else who has shingles.

Shingles in the Elderly Prevention

Preventing shingles can be difficult, especially since those who have had chickenpox already have the virus in their body! However, there is a vaccine that can drastically lower your risk of developing shingles. The vaccine is recommended for those over the age of 50 and it comes in two doses. The second dose should be administered between two to six months after the first. The shot doesn’t completely eliminate your risk for shingles, but it lowers your risk and can reduce the severity of the virus if it does surface.

Original Medicare (Part A and B) does not cover the shingles vaccine. However, a Medicare Advantage or Part D plan may cover it! These plans are great options that include coverage beyond Original Medicare and help you live the healthiest life possible! Our agents can help you understand all of your plan options and enroll you in a plan that fits your specific needs and budget. If you interested in arranging a no-cost, no-obligation appointment, fill out this form or call at us 844-431-1832.

What is the Cigna and Express Scripts deal?

Cigna and Express Scripts announced their 54 billion dollar merger in March of 2018. Cigna provides coverage to 95 million beneficiaries around the world and Express Scripts helps fill 1.4 billion prescriptions annually. The goal of this merger is to create both affordable and personalized healthcare for consumers.

Cigna and Express Scripts Merger Close Date

On December 18, 2018, Cigna and Express Scripts received approval from New Jersey, the final state needed to move forward. The deal closed two days later on December 20, 2018. Cigna plans to start offering new products to its customers including access to Express Scripts pharmacy in 2019.

Cigna’s CEO, David Cordani, believes the deal with Cigna and Express Scripts will allow Cigna to offer additional benefits to customers while monitoring their prescription usage and medical costs. Cordani said in a statement that the addition of Express Scripts provides a “more integrated approach that addresses the whole person.” While doing this, Cigna strives to improve affordability and increase drug price transparency.

What is Express Scripts?

Express Scripts is a pharmacy benefit manager (PBM). A PBM acts as a middleman between pharmaceutical companies and consumers. They negotiate drug pricing from the pharmaceutical companies for pharmacies. Their role can also include operating mail orders, ensuring patient compliance, managing distribution, negotiating rebates, processing claims, and managing formularies.

PBMs are one of the largest proponents of lowering drug costs. PBMs started as a benefits card and mail-order pharmacy in the 1970s and are responsible for the shift in demand from brand-name drugs to generics. Express Scripts is the country’s largest PBM. OptumRx, CVS, and Express Scripts together control 72% of the U.S. pharmacy benefit manager market. OptumRx is a part of United Healthcare, and CVS purchased Aetna on November 28, 2018. Express Scripts was the final, stand-alone PBM at this size.

Express Scripts provides great benefits to beneficiaries like you. They allow you to pick up your prescription at your neighborhood pharmacy or have it shipped to your home quickly and conveniently. They can also alert you of any drug recalls, price out your medications, and schedule automatic refills for you. Plus, Express Scripts is more than just a PBM and pharmacy – they are a dedicated team of pharmacists, nurse, and advocates who work to give you the personal care you deserve.

How will the Cigna and Express Scripts deal impact you?

This deal was formed amid the CVS and Aetna deal which was finalized in November 2018. Insurance companies have started looking for alternative ways to adapt to the ever-changing health care industry. We expect to see many more deals like this over the next few years. Walgreens and Humana are already rumored to be in talks about merging. These deals are proof that health companies need to respond to customer demand.

It will take time for new plans to be implemented and the results are speculative at this time, but the Cigna and Express Scripts deal is a great example of how Medicare and the healthcare industry can evolve. Amazon has been rumored to be entering the pharmaceuticals business which could lead to increased competition. This may result in lower costs and streamlined services for you. As competition increases, companies will provide additional benefits to keep your business.
If you have any questions or concerns about your Medicare coverage or prescription drug plan, our agents are happy to help! Call us at 844-431-1832 or fill out this form to get in contact with a licensed agent.

Home Care Services vs. Senior Assisted Living

Nearly half of everyone over the age of 65 needs some form of assistance in their daily routine. That’s approximately 18 million seniors! When choosing between home care services and senior assisted living, it’s important to consider the costs, qualifications, and available services before making a final decision.

Home care services allow you to get the assistance you need in the comfort of your own home and is great for anyone who is chronically ill, disabled, recovering from surgery, or needing basic assistance. Senior assisted living is an affordable way to get 24/7 care that includes interaction with other residents and eliminates the need of hiring, scheduling, or managing caregivers. This is great for those who have difficulty moving around and require more medical supervision. Both home care and assisted living focus on providing care, but the specifics of what is provided differ.

What Services Does Home Care Provide?

The three major types of home care services are:

Personal Care and Companionship

Personal care and companionship can provide assistance with self-care including bathing, grooming, and dressing. They also help with fall prevention by assisting with movement around the home. Meal preparation, cooking, light housekeeping, laundry, and other errands are included. Plus, this type of care allows you or a loved one to have companionship which can help with isolation issues, especially in the winter. Personal care and companionship can be long or short-term and is great for those who need basic help around the home.

Private Duty Nursing

Private duty nursing can help with basic medical services inside the home. This includes monitoring vital signs and administering medications. Ventilator, tracheostomy, gastrostomy, catheter, and feeding tube care may also be included. Private duty nursing care is typically long-term and is ideal for those who have a chronic illness, injury, or disability.

Home Health Care

Home health care includes several short-term nursing services. This includes physical therapy, occupational therapy, speech-language pathology, medical social work, and other home health aide services. Home health care is often short-term and is recommended by a physician. Home health care can help patients recover from an injury, illness, or hospital stay.

What is Assisted Living for Seniors and Medicare Eligibles?

Senior assisted living provides 24/7 care, meals, housekeeping, laundry, transportation, recreational activities, and wellness programs. Plus, facilities may offer on-site pharmacies, physical therapy, and even salon services.

Another large benefit of assisted living is social activities and entertainment. Many facilities have common areas including libraries, cafes, and game rooms. Plus, there are several social activities offered like gardening groups, book clubs, and movie nights.

Senior assisted living can help you or a loved one rest easy knowing that all care is personalized to meet any and all health needs.  Emergency first aid, medication management, pharmaceutical services, and maintenance of medical records is often provided to residents. Some facilities have a staff physician who provides routine checkups.

Senior Assisted Living and Home Care Services Costs

It’s important to look at the price tag when making a decision. Home care and assisted living offer different services and their prices reflect that.

What Does Home Care Cost?

The cost of home care services is unique to each situation. According to NPR, the average costs for home care services are:

• Personal Care and Companionship: $70/day or $18,200/ year
• Private Duty Nursing: $19/hour or $19,760/year
• Home Health Care: $21/hour or $21,840/year

There are several companies that provide home care services, but the prices will vary. Plus, there are several other costs that are not included. Keep these in mind when looking at your budget. These costs include groceries, personal hygiene items, household items, transportation, rent or mortgage, utilities, and maintenance.

What is the Average Cost of Senior Assisted Living?

The type of residence, size of the apartment, services included, and location of the community are all factors that can increase the overall cost of senior assisted living. Costs can range from $2,200 to $6,000 per month depending on the cost of living for each state. However, keep in mind these are all-inclusive costs and eliminate the cost of rent, utilities, maintenance, meals, and personal care if you or a loved one lived at home.

Senior Assisted Living and Home Care Services Qualifications

Assisted living and home care each have a specific set of qualifications. Before finalizing on a plan option it’s crucial to know if you qualify.

How Do You Qualify for Home Care?

Within the three types of home care, personal care and companionship is the only type that doesn’t require a prescription. Plus, if Medicare or Medicaid is covering some of the costs, there are different qualifications. To qualify you must meet the “homebound” criteria as established by the Centers for Medicare and Medicaid and require skilled care on a part-time basis in order to improve or maintain your health issue. If you meet these requirements, Medicare will cover your costs, but only if you receive your care from a Medicare-approved home health agency.

Who Qualifies for Assisted Living Facilities?

Qualification for senior assisted living is largely dependent on the level of care a resident needs. You or a loved one may qualify if assistance with daily living facilities like personal care, hygiene assistance, mobility, meals, and medication management is needed.

Those who require daily nursing services from extensive medical needs may not qualify. The application process is the same regardless if you or a loved one lives in a private residence, rehabilitation center, nursing facility, or a hospital. The typical application process includes facility admission paperwork, medical history, physical, and tuberculosis (TB) test or chest x-ray.

Role of Medicare and Medicaid

Medicare only covers the third type of home care services: home health care. The only cost you may have is 20% of the Medicare-approved amount for durable medical equipment. Medicare typically does not cover the costs of senior assisted living. However, Medicare may cover qualified healthcare costs while living in the facility. This includes doctor visits, lab tests, certain preventive services, physical therapy, and medical supplies.

Medicaid may cover some of the costs of home care services, but the coverage will vary by state. In some cases, Medicaid can be used to pay for some assisted living costs through a Medicaid waiver, but there is often a waiting list.

Making a Decision

Home care services and senior assisted living are two options that could greatly impact you or a loved one’s quality of life. There is an abundance of information available which can make finzaling a decision difficult. Are you a caregiver and looking to help a loved one? Our Ultimate Aging Parents Checklist can help you prepare for what is often a tough decision and discussion.

Medicare and Medicaid may only cover a small amount of the total costs. However, Medicare Advantage plans may provide additional coverage beyond Original Medicare and include benefits like hearing, dental, or vision coverage.

At Medicare Plan Finder, our goal is to make sure you have the coverage and benefits that enable you to live the healthiest lifestyle possible. Plus, we make sure you are informed on important information like the Medicaid look-back period and how Medicare and Medicaid work together. Our licensed agents can help answer any questions you may have about Medicare Advantage, prescription drug coverage, and Medicare supplements. If you’re interested in arranging a no-cost, no-obligation appointment, call us today at 844-431-1832 or fill out this form.

Vitamin D for Seniors and Medicare Eligibles

Vitamin D, also known as the “sunshine vitamin,” is essential. It helps absorb calcium, which is necessary for bone health and strength. Over an extended period of time, vitamin D deficiency can result in obesity, diabetes, hypertension, depression, Osteoporosis, and more. Vitamin D for seniors and Medicare eligibles becomes increasingly important with age, so it is important to understand the recommended dosage and the symptoms of deficiency.

Why is Vitamin D Important in the Elderly?

If you are deficient in vitamin D, your body may start to lose bone tissue. This can lead to bone pain, muscle weakness, and even skeletal deformity. Seniors and Medicare eligibles who get the recommended dose of vitamin D every day are more likely to lower their risk of cardiovascular issues, cancers, bone disorders, and diabetes. Plus, it can lower the chance of early nursing home admission, encourage physical independence, and act as a form of fall prevention.

How Much Vitamin D Does a Senior Need?

It can be extremely difficult to get enough vitamin D through diet alone. Sunshine and vitamin D supplements are beneficial alternatives. The recommended dose of vitamin D for seniors age 70+ is, at a minimum, 800 IU* per day. For those less than 70 years old, the adequate intake is, at a minimum, 600 IU per day. Blood tests are a great way to see if you are getting the right amount of vitamin D. However, it’s important to understand that you can have too much vitamin D. An excess can cause vomiting, weakness, and excess urination. Your daily vitamin D intake should never exceed 4,000 IU per day.

*IU stands for international units and is used to measure fat-soluble vitamins. This includes vitamins A, D, and E. You will notice that these vitamins will use “IU” on their labels instead of MG.

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Typical D3 Dosage for Seniors and Medicare Beneficiaries

There are two main forms of vitamin D for seniors and Medicare eligibles – vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). D2 can be found in plant foods like mushrooms and D3 can be found in sunlight and animal foods like salmon or eggs. D2 does not occur naturally in your body, but D3 is produced in the skin when exposed to sunlight. Experts believe that D3 is at least three times more potent than D2 and is more stable, safe, and beneficial to the body.

Symptoms of Vitamin D Deficiency in Elderly People

Vitamin D Deficiency in elderly people is common due to smaller food intake, less exposure to sunlight, and reduced skin thickness. It’s important to listen to your body so you can take the proper steps to rectify the issue. Symptoms of vitamin D deficiency in elderly people include:

Weak Muscles

In general, adults often feel their muscles get heavier with age. This can actually be linked to a Vitamin D Deficiency. This means that if you have difficulty standing up or climbing the stairs, you may not be getting enough vitamin D.

Common Sicknesses

Vitamin D makes sure your immune system is strong and helps fight off illness-causing viruses and bacteria. If you get sick easily and often, especially with colds or the flu, low vitamin D could be a contributing factor. Plus, researchers have found links between vitamin D deficiency and respiratory infections. Studies have shown that increasing your vitamin D intake can decrease your risk of infection.

Weight Gain

Researchers claim that vitamin D and a hormone called leptin work together to regulate your weight. Leptin works by signaling your brain that you are full and to stop eating. If you are deficient in vitamin D, the leptin signaling process may not function properly. Overeating and weight gain can be an indicator that you need more vitamin D.

Fatigue

There are many reasons you may be feeling tired, but a vitamin D deficiency is often overlooked. There have been several observational studies that show correlations between low vitamin D levels and fatigue. When the vitamin D dosage was increased, the tiredness and fatigue subsided.

Stomach Problems

Since vitamin D is a fat-soluble vitamin, a deficiency can trigger digestive problems like inflammatory bowel disease. Digestion problems can be extremely uncomfortable and negatively impact the fat absorption process.

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Medicare Advantage and Part D Plans

If you think you may have a vitamin D deficiency, visit your doctor before taking corrective action. A blood test is the most accurate way to measure vitamin D in your body. Unfortunately, in most cases, Original Medicare only covers blood tests for at-risk individuals.

Medicare Advantage plans can provide additional coverage for bloodwork. In some cases, MA plans with prescription drug coverage will even include some coverage for over-the-counter medications like vitamin D supplements! Talk to a licensed agent about finding out whether a plan in your area offers these benefits. A great first step is to download our Part D checklist that can help you figure out what prescription coverage you need out of your health care plan.

Our licensed agents can help you understand all of your plan options and enroll you in a plan that fits your needs and budget. If you’re interested in arranging a no-cost, no-obligation appointment, fill out this form or call us at 844-431-1832.

What is the CVS and Aetna deal?

Last year, CVS provided prescriptions to an estimated 94 million customers while Aetna provided coverage to an estimated 22 million. In a $69 million dollar deal, CVS officially purchased Aetna on November 28, 2018. The CVS and Aetna deal will strengthen the two companies, create better care coordination, and improve costs for beneficiaries like you.

CVS and Aetna Merger Status

CVS and Aetna had a long road ahead starting in December of 2017 when CVS first announced its plan to purchase Aetna. In March of 2018, shareholders for both parties approved the merger. In early October, the Justice Department granted approval. Finally, on November 26, 2018, New York was the last state to approve the merger. CVS completed the acquisition of Aetna on November 28, 2018.*

*There has been a delay in the integration of Aetna and CVS. We will update with more information as it becomes available.

Change in CVS Stores

Many CVS stores currently offer healthcare services through their Minute Clinics. The Aetna and CVS deal will allow CVS locations to become a one-stop-shop for all health and wellness needs. This includes clinical and pharmacy services, vision, hearing, etc. Aetna’s CEO, Mark Bertolini, has plans to create healthcare-focused hubs similar to Apple’s Genius Bars. Apple focuses on concierge-style support and CVS plans to follow suit. These hubs will provide basic healthcare products and information. If you have questions or concerns about health conditions, prescription drugs, or coverage, the hub can answer quickly and effectively.

Change in the Healthcare Industry

CVS plans to address several issues that surround the healthcare industry. They want to introduce competitive Medicare Advantage and Part D offerings and create more market access for beneficiaries. They also strive to promote lower-cost care and enhance their clinical care programs.

Both companies agree that the Aetna and CVS deal, with the help of their data, will lower costs and provide better care. When this data is combined with the expected changes to CVS stores, you may be offered new health products at lower prices. The data from the Aetna and CVS deal is also expected to create tech-focused projects like remote monitoring tools. For example, if you have diabetes, you could have your blood glucose levels monitored remotely and receive text messages if your levels are too high or low. This allows patients to have additional medical supervision beyond their average appointment.

How will this deal impact you?

The CVS and Aetna merger is a great example of how Medicare and the healthcare industry can evolve. However, it will take time for these new plans to be implemented and the results are speculative at this time. If you have any questions or concerns about your Medicare coverage, our agents are happy to help! Call us at 844-431-1832 or fill out this form to get in contact with a licensed agent.

Remembering President George H.W. Bush

President George H.W. Bush was a humble and ambitious leader who died on November 30, 2018, at the age of 94. He was responsible for walking the U.S. through important milestones like the Americans with Disabilities Act, Strategic Arms Reduction Treaty, and Operation Just Cause. He will be remembered as a veteran, congressman, vice president, legacy leader, and of course, our 41st president.

President George H.W. Bush’s Top Accomplishments

1941: Joined the U.S. Navy and the fight against the attack on Pearl Harbor.

1948: Graduated from Yale University.

1966: Elected into the House of Representatives.

1971: Appointed as Ambassador to the United Nations by President Nixon.

1976: Appointed as Director of the Central Intelligence Agency (CIA).

1981: Elected as Vice President alongside President Ronald Reagan.

1988: Elected as the 41st president of the United States. Fun fact: President George H.W. Bush was the second president, after Martin van Buren, to be elected while sitting as a vice president.

1989: Sent troops to Panama for Operation Just Cause to oust the dictator of an international drug trade.

1990: Signed the Americans with Disabilities Act into law.

1990: Negotiated a budget deal to reduce the federal deficit.

1991: Signed the Strategic Arms Reduction Treaty with Soviet President Mikhail Gorbachev.

History and Impacts of Americans with Disabilities Act

The Americans with Disabilities Act (ADA) signed into law on July 26, 1990, is considered George H.W. Bush’s landmark presidential legislation. The law ensures that individuals with disabilities have the same rights and opportunities as everyone else and are not discriminated against. This equal opportunity applies to housing accommodations, employment opportunities, public transportation, government services, and telecommunications.

The ADA classifies a disabled person as “a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.”

An estimated 55 million Americans are protected by the ADA and are directly impacted by this life-changing law. Many changes brought by the ADA are seen everywhere we look, including the use of wheelchair-accessible transit, braille in public buildings, closed captioning for television and movies, and fire alarms that can be both heard and seen.

Dual-Eligibility and Special Needs Plans

If you are one of the 55 million Americans protected by the ADA, you may qualify for a Special Needs Plan. These plans are a type of Medicare Advantage plan and help cover doctor, hospital, and prescription drug costs. Plus, you may have a special enrollment period which means you can enroll during almost any time of the year! If you have questions regarding your special needs plan eligibility or plan options, a licensed agent may be able to help! Call us today at 844-431-1832 or fill out this form.

The Medicaid Look Back Period: What You Need to Know

What is the Medicaid look back period?

Medicaid is designed to provide health care to those with low income or limited assets and is administered through each state. When applying for Medicaid, the state social security office is responsible for confirming you have limited income and assets. The Medicaid look back period is a period of time the office will review to see if you sold, donated, transferred, or gifted any of your assets. The period is 5 years for every state except California where it is 2.5 years. This period starts on the date you apply for Medicaid.

Is there a penalty?

Yes, there is! If the social security agency finds that you sold, donated, transferred, or gifted any of your assets beyond the granted exemptions, you will have a penalty. The penalty is a length of time that you will be ineligible for Medicaid. This is called the penalty period, and there is no limit on the amount of time you can be penalized for.

The penalty is based on the dollar amount of sold, donated, transferred, or gifted assets divided by the monthly private patient rate of care in a nursing home. For example, if you gifted $60,000 during the look back period and the average monthly cost of nursing home care is $4,000, your penalty would be 15 months of Medicaid ineligibility ($60,000 gift/$4,000 average month cost = 15 months).

 Can you avoid the penalty?

Planning is key in an attempt to avoid the penalty. Did you know you can gift up to $15,000 a year without paying a gift tax? This is a great option if you’re wanting to leave a certain amount of your savings to a child or loved one. If you want to gift $60,000 it will take 4 years to avoid taxation. This means that you would need to start gifting 9 years before applying for Medicaid to avoid the look back penalty.

Are there exemptions?

Fortunately, there are exceptions that allow applicants to transfer assets without a penalty. The exceptions include:

• Spouses

Medicaid applicants can transfer a certain amount of their assets to their spouse. The spouse cannot be in the Medicaid application process and must plan to live independently in the community. The total amount of assets able to be transferred will change annually, but in 2018 the limit is $123,600.

• Disabled Children

Applicants can transfer their assets or establish trust funds for disabled children who are under the age of 21, including children who are legally blind.

• Siblings

A home can be transferred to a sibling who has equity in the home and resided in the home for a minimum of one year prior to a nursing home placement.

• Caregivers

Applicants can transfer their home to their adult children if they lived in the home for a minimum of two years before the Medicaid application was started. The child must be the primary caregiver.

• Debt

Applicants can pay off their debt without a penalty.

If you’re interested in learning more Medicaid information that is specific to your state, visit our Medicaid by State page. Plus, you may be eligible for both Medicare and Medicaid! Our licensed agents can help answer any questions you may have and help you sort through your health care options. To get started, fill out this form or call us at 844-431-1832.

Drug Price Transparency: Everything You Need to Know

Drug Price Transparency: Everything You Need to Know

The Henry J Kaiser Family Foundation estimates that $1 out of every $6 in Medicare spending is for prescription drugs. These medications play an important role in the health of 59 million seniors and Medicare eligibles. Drug price transparency is crucial in informing consumers and developing new strategies that address the issue of rising drug costs.

How is CMS involved?

Earlier this month, CMS proposed a new drug price transparency rule that was targeted at direct-to-consumer television advertising. This rule would require drug manufacturers to publish wholesale prices during commercials. This will allow beneficiaries to make informed drug purchasing decisions, especially beneficiaries with high deductibles and drug costs.

Direct-to-consumer television advertising can dramatically impact a beneficiary’s purchasing decisions. These commercials can spark informational discussions between beneficiaries and their health care providers, but understanding the costs is crucial when making a final decision.

State vs Federal Legislation

Several states across the US are implementing new bills and laws that require drug companies to not only report but also justify any dramatic increases in their drug prices. Since early August, there have been over 100 bills introduced into legislation addressing the different issues of drug price increases. 30 states have drafted a total of 60 drug price transparency bills.

States are feeling the pressure to improve the sustainability of their budget and promote coverage access to all of their residents. As the push for drug price transparency rises, more states may begin to explore new laws and federal legislation could be impacted. Many of these proposed changes are in the works and may be finalized in the near future.

How should you choose a pharmacy, doctor, or Part D plan?

Do you already have a primary pharmacy? Are you concerned about enrolling in a plan where your doctor is out of network?  Our agents at Medicare Plan Finder work with nearly every carrier in your state. Agents can help you enroll in the plan that best fits your needs, budget, and network requirements. Ready to learn more? Call us at 844-431-1832 or fill out this form to arrange a no-cost, no-obligation appointment with a top agent.

Original Medicare vs Medicare Advantage

The Annual Enrollment Period is quickly approaching and starting October 15, you are able to switch your Medicare coverage. Which do you favor in the battle of Original Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each option you will be better prepared to make that decision.

What is Original Medicare?

Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage). Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.

Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.

If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescriptions drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.

What is Medicare Advantage?

Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.

HMOs:

An HMO is a closed provider network. Your primary care provider must fall into this network. Additionally, you must use this network in the event of an emergency. HMOs may require you to get a referral for more severe injuries or illnesses.

PPOs:

PPOs allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.

Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.

Differences between Original Medicare and Medicare Advantage

It is easy to confuse Original Medicare and Medicare Advantage. By understanding a few key differences you will be able to better evaluate which option is best for you.

Out of Pocket Costs

Original Medicare has no set limit for how much you will spend out-of-pocket. This means that if you need more medical attention for any given reason, you may exceed what you budgeted. However, Medicare Advantage plans have a maximum out-of-pocket limit. Once you reach this limit on out-of-pocket costs for covered services, your costs will be covered for the remaining calendar year. It is important to note that some Medicare Advantage offers lower limits- that means more money saved for you!

Health Questions

Original Medicare plans require you to answer numerous health questions. However, Medicare Advantage plans do not require any health questions. The only question they can ask you is if you have end-stage renal disease. Medicare Advantage plans will not cover this disease because the Center for Medicare and Medicaid Services (CMS) defines end-stage renal disease as “permanent kidney failure that requires a regular course of dialysis or a kidney transplant.”

Supplemental Insurance

You can not purchase a Medigap plan and a Medicare Advantage plan. You must choose one or the other. Medigap coverage helps fill in the gaps that Original Medicare doesn’t fill. However, Medicare Advantage plans allow you to get a more customized plan that gives you the benefits you need for your budget.

Extra Services

With Original Medicare, you get what you get. With Medicare Advantage plans, you get what you want. Original Medicare does not cover extra services, however, MA plans may allow you to get additional vision and dental coverage and group fitness classes.

Providers

As previously mentioned, there are over 900,000 physicians nationwide that accept Medicare coverage.  Medicare Advantage plans require you to stay within the plan’s network. If you go out of your network there may be a significant price increase. If you traveling and are rarely in the same area, this may not be the best option for you.

Part D Coverage

Original Medicare is only Part A and B. If you want prescription drug coverage, you must purchase Plan D through a private provider or a Medicare Advantage plan.

Pros of Medicare Advantage

Throughout this article, there may have been a few pros of Medicare Advantage plans that caught your attention. In case you missed anything, we’ve compiled a list of the top reasons you should consider purchasing a Medicare Advantage plan.

Potential Lower Costs

Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have the maximum-out-of-pocket limit, saving you even more in the long run!

Prescription Drugs

Drug coverage is often included in Medicare Advantage plans. This allows you to bundle your coverage – saving you money and creating more convenience for you!

Additional Coverage

Medicare Advantage plans offer extra coverage that Original Medicare cannot. If you’re looking for vision, hearing, or dental coverage – an MA plan may be right for you!

Maximum Flexibility

Medicare Advantage plans include the benefits you want and need. The plans are flexible and ensure you get the coverage and the cost that fits your budget.  

Get covered today!

Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon! From October 15 to December 7 you are able to make changes to your Medicare coverage. If you’re interested in purchasing a Medicare Advantage plan or hearing more about coverage options available to you, complete this form or call us at 844-431-1832 to arrange a no-obligation appointment with an agent.