One goal of the Affordable Care Act was to offer small group health insurance plans (typically 20 employees or less) on the upcoming health insurance exchanges. This difficult task has proved unobtainable and has been pushed back to 2015 at the earliest.
While it appears that most of the state and federal exchanges will be up and running for 2014, small group plans will not take part in these government offerings. For small group employers, this simply means that group health insurance will need to be obtained through an agent.
Comparing Small Group Health Insurance
It is good to know that most small group brokers are able to help businesses shop coverage with several different carriers simultaneously. Quotes can typically be obtained using one set of universal applications.
Businesses can always request generic quotes without the use of underwriting, but this will not provide accurate information. If a business wants real numbers, then submitting medically underwritten apps on all employees is the prudent thing to do.
The Affordable Care Act – Obamacare
The Affordable Care Act requires all companies with 100 or more full-time employees to offer group health insurance. A full time employee is one that works 30 hours or more weekly.
Comprehensive group health insurance can be expensive for groups this size that lack the means to self-insure. In response to the ACA, some insurance companies are offering so called “skinny” or mini-medical plans.
It is unclear whether these less comprehensive insurance plans will stand up to the regulations of the ACA as the rules have not yet been finalized. If mini-med plans are deemed credible, then groups can still offer less expensive, less comprehensive coverage to their employees while avoiding the fees, fines and taxes associated with the ACA.
Talk With An Independent Insurance Agent
There is quite a bit of conflicting information regarding the rules and regulation surrounding the Affordable Care Act. If you own or operate a business of any kind, it is important to know what to expect.
By speaking with a knowledgeable group health insurance agency like ours, you can be prepared for what lies ahead. Keeping your employees off the health insurance exchanges while offering credible coverage that satisfies the ACA regulations will go a long way to saving your business time, money and frustration.
Contact Us For More Information
Hyers and Associates is a full-service, independent health insurance agency. We offer group insurance policies of all kinds as well as sponsored and voluntarily ancillary benefits.
Contact us today to learn more about your options so that your business is Obamacare compliant for 2014.
Category: Group Health Insurance
If you’re shopping for Medicare supplement insurance, Plan N might be a good option. With all Medigap coverage, you are weighing benefits vs. premiums.
It’s important to know that the gaps uncovered by Plan N are small. Rarely do they expose you to significant out-of-pocket yearly expenses.
Plan N does not cover three gaps. Below, we will explain the out-of-pocket costs and exposure associated with each one.
Understanding The Plan N Out Of Pocket Gaps
First, let’s examine the three gaps in Original Medicare that Plan N does not cover. They are:
- Part B Coinsurance (Plan N has a $20 doctor’s office copay and a $50 emergency room copay)
- Plan N does not cover the Part B deductible
- Plan N does not cover Part B Excess Charges
Those are the only gaps not covered by Plan N. It’s important to know that your out-of-pocket exposure is low and predictable with these three benefits.
Plan N Medicare Supplement Has Doctor’s Office Copays
Plan N is unique because it’s the only Medicare supplement with doctor’s office and emergency room copays. This means you may be responsible for a small copy when you visit your primary care doctor or any specialist. In this way, Plan N is like traditional health plans you see before age 65 that require copays at the doctor’s office.
The Plan N copay is $20 for a doctor’s office visit – and $50 for the emergency room. These fixed amounts have not increased or decreased since the inception of Plan N in 2010. Medicare (CMS) could choose to change these amounts in the future, but it’s unlikely they will. If they do, it will affect all N plans – both new and old.
It’s worth noting that your office copay could be less than $20, but never more. It depends on the billing practices of your doctor’s office. Specialist visits are also $20 – they are not allowed to charge more. You should also know there is no unique copay for Urgent Care. It would be $20 as well.
If you visit several doctors on a monthly/regular basis, then Plan N may not offer significant savings over Plan G or Plan F. However, for most, this supplement can help to keep their monthly premiums lower.
It Does Not Cover The Small Medicare Part B Deductible
Like Plans G and D, Medicare supplement Plan N does not cover the Part B deductible. Of the two Medicare deductibles, it is the much smaller one. Part A is the big one. Part B applies to doctor visits and outpatient procedures. Part A occurrences are for hospital and inpatient procedures.
For 2025, the Part B deductible is $257. It was only $240 in 2024 and $226 in 2023. The increases are usually small. It was $233 in 2022, $203 in 2021, $198 in 2020, $185 in 2019, $183 in 2017-18, and $166 in 2016. As you can see, it does not move much. That’s because it’s tied to inflation. The increases are not arbitrarily set; rather they are tied to inflation metrics which usually move slowly.
If the Part B deductible increases significantly, you should know that Medicare supplements covering this gap will increase their premiums to account for the change. They will not absorb this cost. It will be passed on to you. One way or the other you are paying for it. At least with Plan N, you have some control over it.
And you may know that no new supplements can be sold after 2020 covering the Part B deductible. This ensures consumers have more skin in the game. This change made Plan N more attractive since it only competes with Plan G as a top comprehensive Supplement.
Plan N Does Not Cover Part B Excess Charges
You would only face Part B Excess Charges if you choose to see a doctor who does not accept Medicare Assignment. This could be a doctor who charges more than what is allowed by Medicare. The maximum Part B Excess amount is 15% above what Medicare deems normal and customary.
Plan N does not cover Part B excess charges, but these fees are rarely encountered. In a few states, like Ohio for example, Part B excess charges are not allowed. If you are considering Plan N in a state like Ohio, you don’t need to worry about Part B Excess Charges. Doctors cannot charge them even if they wanted to.
The other states where Part B Excess Charges are not allowed, include: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. (You can compare the list of what each supplement covers here.)
Most doctors won’t charge Part B Excess – even if they are in a state where they’re allowable. It would be hard for them to stay in business. Consumers would find another doctor. We have several Plan N clients at our independent insurance agency. No one has told us this gap is causing them financial distress.
The Argument For Plan N Medicare Supplements
The argument for Plan N is a simple one: You can lower your monthly premiums without adding significant out-of-pocket exposure.
The premiums you save in most cases can more than account for the gaps not covered by this supplement.
The copays are small and have not increased since Plan N was released in June 2010. It’s unlikely they ever will.
The Part B deductible is the smaller of the two Medicare deductibles (Part A deductible is much higher and covered by Plan N) and will not break the bank.
Part B Excess charges are rare, and if you encounter them, you can always change doctors If you live in a state like Ohio, it’s a moot point – doctors are not allowed to charge Part B Excess amounts.
The Argument Against
This may be more of a “peace of mind” argument. Many of our clients want the best coverage money can buy. So they buy Plan F or Plan G. There is nothing wrong with that idea. We recommend drilling down a little further, however. Peace of mind today can lead to frustration tomorrow.
But in other cases, you may consult with several doctors on a regular basis. You may worry about the copays adding up over time. Or perhaps you have a favored doctor who doesn’t accept Medicare Assignment and you’re running into frequent Part B Excess charges.
These are valid arguments against a Part N plan. It has more gaps you will need to cover than Plan G. In cases like this, you may benefit more from a more comprehensive Supplement.
Contact Us To Learn More About Medicare Supplements
Hyers and Associates is an independent insurance agent specializing in Medicare supplements, Advantage Plans, and Prescription Part D drug coverage. We license directly with all carriers and can help you compare Medigap quotes from several insurance companies.
If you are considering Plan N Medicare Supplement insurance or any other Medigap plan, contact us today. We can help you compare rates, benefits, and out-of-pocket exposure so you can enroll in the plan that best fits your needs and budget.
Compare Plan N Supplement Quotes Today →
Category: Medicare Supplements
Our independent insurance agency (Hyers and Associates) has offered Medicare supplement insurance from Standard Life and Accident Insurance Company for years. We offer this coverage direct to our clients – at no additional cost.
Our clients appreciate that they can shop for new or replacement coverage with us direct. And we appreciate their loyalty and that’s why we are always on the lookout for new carriers that are competitively priced in certain areas.
Standard Life High Deductible Plan F Supplement
Standard Life and Accident (SLAICO) offers several lines of insurance, but their High Deductible Plan F Medicare supplement insurance is very competitively priced in most states. Rates for applicants will vary depending on a number of factors including age, gender, zip code of residence, and tobacco use.
There are a number of reasons you might be considering HD Plan F for your supplemental insurance coverage, but the one we hear most often is low premiums. It does not make good financial sense to enroll in HD Plan F unless there are significant premium savings – and SLAICO’s rates hit the mark.
In many cases, HD Plan F with Standard Life can be more than $100 less per month than a traditional Plan F. For those who are looking to save premium dollars while still insuring against catastrophic claims, HD F can be a very good financial decision.
About Medicare Supplement High Deductible Plan F
HD Plan F works very much like a traditional Plan F save for the fact that is has a yearly deductible. For 2019, the deductible is $2,300 which is a $60 increase over year 2018. Benefits will not be paid until the policyholder has reached his or her deductible, but Medicare will continue to pay its portion first.
The deductible amount can change every year (as mandated by the government run Centers for Medicare and Medicaid Services) and those changes will affect all plans. This simply means that you cannot lock in your deductible based on the year when it was purchased. Once CMS makes changes, those changes affect all plans – both new and old.
It is also important to note that High Deductible Plan F does not have any network restrictions. One of the biggest issues consumers have with Medicare Advantage and Medicare Select plans is navigating their networks.
In many cases, HD Plan is as, if not more, affordable than many Select and Advantage plans, but without any network restrictions. This is an important issue for many Medicare eligible consumers. They like to know they can use any doctor or hospital that accepts Medicare assignment and HD Plan F allows them that freedom.
About Standard Life & Accident Insurance Company
SLAICO has been offering insurance policies in the senior market for over 50 years. They are highly rated with the AM Best ratings agency.
They offer several lines of insurance for those both over and under the age of 65, but providing affordable insurance to seniors is a priority. Other types of insurance offerings from SLAICO include life insurance, annuity policies, health insurance and various ancillary coverages.
SLAICO works with agencies like ours in order to provide insurance direct to consumer. There are no additional fees or commissions to place your business through us. You also get the benefit of working with someone with knowledge of the insurance industry at large.
Hyers And Associates Medicare Insurance Agency
We are an independent insurance agency specializing in the senior market and offering insurance policies in several states. We work extensively with Medicare supplements, Part D prescription drug policies, long term care plans and annuities.
Compare Medicare Supplement Quotes Now →
Category: Medicare Advantage, Medicare Supplements
Every year The Centers for Medicare and Medicaid Services (CMS) make changes to the Medicare program. CMS has posted the numbers for 2013 and there are no alarming changes, but it is important to know what out of pocket expenses to expect going forward.
Deductible and coinsurance amounts will increase January 1 and that will affect the cost sharing provisions of all Medicare supplement plans. Supplemental insurance plans are not “grandfathered-in.” Changes to Medicare by CMS affect all Medigap plans – both new and old.
2013 Medicare Part A and Part B Changes
| Medicare Feature |
2012 Amount |
2013 Amount |
$$$ Increase |
| Part A Deductible (Inpatient Hospital) |
$1,156 |
$1,184 |
$28 |
| Part B Deductible (Physician’s Services & Supplies) |
$140 |
$147 |
$7 |
| Hospital Coinsurance Days 61-90 |
$289 |
$296 |
$7 |
| Hospital Coinsurance Days 91-150 (lifetime reserve) |
$578 |
$592 |
$14 |
| Skilled Nursing Facility Coinsurance |
$144.50 |
$148 |
$3.50 |
At face value, there are no significant changes to the Medicare cost sharing amounts. As in past years, the limits to what certain Medicare supplement insurance and some Medicare Advantage plans must cover have only increased incrementally. However, these new numbers are something to keep in mind when you experience rates increase on your privately insured Medigap coverage.
The Part B Deductible For 2013 Is $147
The good news for those who purchased or are considering purchase of either Plan G or Plan N is the nominal increase in the Part B deductible. The increase was only $7 – moving to $147 for 2013 – up from the current amount of $140 for 2012.
This means that CMS is working to keep the Part B annual deductible low going forward – at least in the short run. Consumers worried about high out of pocket costs with Medicare supplement plans that do not cover the Part B deductible (like Plans G & N) can rest easy. The cost share is low and will continue to remain that way.
Thus, paying more for traditional Plan F is not necessarily the best option for some seniors. If Plan G is more than $12.25 less per month than Plan F, then Plan G can make good financial sense. There may little reason to pay more for Plan F considering that it only covers an extra $147 for 2013. As always, it’s important to keep in mind that the Part B deductible will likely increase going forward.
What Is the Plan F High Deductible For 2013?
The new deductible for HD Plan F is $2,110 which is a $40 increase from 2012. For comparison sake, the amount was an even $2,000 in year 2010. This is a modest increase by most measures, so High Deductible Plan F will continue to be a popular option for many seniors.
The HD version of Plan F is a good choice for those who want to keep their monthly premiums low while eliminating the worry of a network driven plan. The trade-off is the potential for higher out of pocket expenses however. Those who are in good health and are comfortable with a $2,000+ deductible oftentimes purchase HD Plan F. Premiums in many parts of the country can be near $30 a month for those in their mid to late 60’s.
Out Of Pocket Cost Increases For Plans K and L
By many estimates, supplemental Plans K and L were designed to mimic Medicare Advantage coverage. These two coverage options have more out of pocket and cost sharing amounts than most other Medigap plans. In return, the monthly premiums are lower and can be well under $100 for seniors in their 60’s and 70’s.
The 2013 out-of-pocket maximum for Plans K and L are $4,800 and $2,400 respectively. This is a $140 increase for Plan K and a $70 increase for Plan L. Again, these appear to be reasonable numbers when compared year over year and compare favorably with most Medicare Advantage plans.
Summary
For those who are new to Medicare or who have been enrolled for several years, it is important to note that there are no dramatic changes to the 2013 cost sharing amounts. Medigap Plan, F, G, N, K, L and High Deductible F are and will remain good choices for coverage.
First year premiums and renewal rates will vary depending on several factors. It is always a good idea to speak with an independent agent before purchasing; or while shopping around for new supplemental coverage. This way, you can learn more about the nuances and history of competing insurance carriers that you might be considering.
Contact Our Independent Medicare Supplement Agency
Hyers and Associates, Inc. is an independent insurance brokerage specializing in the senior market. Contact us today to discuss Medicare supplements, Advantage plans, and Part D prescription policies.
Category: Medicare Advantage, Medicare Supplements
Editors Note: AFLAC Medicare supplements have been taken off the market and are no longer for sale until further notice. Our independent insurance agency is now offering Medicare supplement insurance from AFLAC direct to seniors. We provide enrollment for those who are new to Medicare as well as those who would like to lower rates on their existing coverage.
AFLAC is best known for disability and voluntary insurance coverage, but they are now offering very competitive supplemental insurance prices in several states. There are several reasons that they may be a good choice for your Medicare insurance needs.
More About The AFLAC Insurance Company
American Family Life Assurance Company of Columbus was founded in 1955 and is most associated with their ubiquitous duck commercials and advertisements. AFLAC is a Fortune 500 company with over $117 billion dollars under management. They have an A+ rating from A.M. Best which translates to “excellent.”
For many years, their business operations focused on ancillary benefits in the group and individual marketplace. Their primary focus was on disability income replacement, life insurance, and specialty reimbursement policies. A logical next step was to offer ancillary coverage in the senior markets.
AFLAC Medicare Insurance Quotes And Rates
Medicare supplement policies are straight-forward in what must be covered. A Plan F is a Plan F. No company can offer more or less coverage than what is mandated by the Centers for Medicare and Medicaid Services – CMS for short. When CMS updates the coverage requirements, all companies and plans most change accordingly.
AFLAC offers the most commonly purchased supplemental plans purchased by most seniors. Medigap Plans A, C, D, F, G, and N are all available. At this time, they are not offering Medicare Select (network driven) coverage or High Deductible Plan F.
Traditional policies from AFLAC will be accepted by any doctor or hospital that accepts Medicare assignment. In other words, it does not matter who you purchase your Medicare supplement insurance from – you will be covered by any medical professional that accepts Medicare. This is true whether your carrier is United Healthcare, Anthem or any other smaller Medigap insurance provider.
All companies use different actuarial methods to calculate your rates. Most companies (AFLAC included) will determine your rates based on your current age, state and zip code of residence, marital status, and payment method.
Spousal Discounts For Married Applicants
AFLAC is somewhat unique in that they offer a 7% discount when both spouses purchase Medicare supplement insurance and are accepted. In many areas of the country, this marital discount will help to offer much lower rates than their competition.
You and your spouse do not need to purchase the same plan to enjoy this savings. One spouse can enroll in Plan F and the other in Plan G. So long as both are accepted, then each spouse will receive 7% off of their premiums. You can also reduce your rates by $2 a month if you choose to pay using a monthly bank draft.
Request Medicare Supplement Prices & Information
Our independent agency offers the direct rates from all carriers we partner with. You will not find better rates anywhere else online or in person. We are proud to be a one stop shop for all types of senior specific policies.
We represent several companies in several states to help our clients find the Medigap insurance that best suits their needs and budget. Contact us today to find out more about AFLAC Medicare supplement insurance in your area.
Category: Medicare Supplements
If you are in the workforce beyond age 65 and covered by your employer’s group health insurance coverage, it is important to be aware of your Medicare insurance options. There are a few common penalties (both monetary and temporal) that you might face should you miss your enrollment deadlines.
Penalties and Medicare enrollment delays can easily be avoided so long as you are proactive. It is wise to talk with your human resources manager when you turn 65. You will want to ask specifically about your group health insurance eligibility. You can also talk with an insurance agent who is knowledgeable about group plans and Medicare eligibility.
If you are still not satisfied, then you might also reach out to your local social security office. Oftentimes the representative there can provide valuable advice. Additionally, it is a good idea to read about your options online and at Medicare.gov.
Employer Group Size – Twenty Is The Magic Number
As it relates to Medicare decisions, the most important factor is the size of your company in terms of employees when you turn 65. If your group is under twenty employees, then you will need to enroll in Medicare Parts A and B.
You can no longer stay on your group health insurance even if it goes undetected. Once your group insurance carrier figures out that you are Medicare eligible and that your group does not meet the 20 employee requirement, then the insurance company will no longer pay benefits and can recoup costs for benefits already provided.
In a nutshell, if you are within 3 months of your 65th birthday and still plan on working at a company with fewer than 20 employees, then you should enroll in Medicare Parts A and B and you should also consider Medicare supplemental coverages.
Employer Groups With More Than Twenty Employees
If you are soon to be 65 and working for a group with more than 20 employees that provides group health insurance, then you can safely maintain this coverage if you wish.
Some will choose this option in order to avoid paying Medicare Part B premiums. Medicare Part B premiums are means tested, so those in higher income brackets will pay more for this coverage as well as Part D prescription drug plans.
If you are happy with your group health plan, then you can delay enrollment into Medicare Part B and stay on your group health plan while also avoiding the cost of Medicare Part B, supplemental, and Part D premiums.
You may choose to enroll in Medicare Part B at age 65 even if you are still under your large group health plan, but it is important to know that you are not forced into Medicare when you continue working for a large employer group that offers group health insurance.
The COBRA Health Insurance Conundrum
One simple piece of advice is this: Don’t take COBRA health benefits when you retire and are over age 65. COBRA usually lasts 18 months, but by the time these benefits expire, then you will have missed your individual deadline to enroll in Medicare Part B.
If you are over 65, then there are very few reasons, if any, to stay on COBRA for an extended period of time. Your Medicare Part B enrollment window begins when you leave your job, not when your COBRA benefits end.
If you have waited beyond your 6 month Medicare open enrollment window (after separating from employment) to enroll in Part B, then you will be subjected to a 10% Part B late enrollment penalty when you do try to enroll with the government. The 10% penalty will be for your lifetime. And you will have a new waiting period before you can enroll in Part B. It’s a double whammy and it’s not good.
By avoiding COBRA and talking with your local social security office upon separation from employment or turning age 65, you can be sure that you are enrolling in Medicare at the appropriate time. You will also want to use this guaranteed issue period to find the supplemental coverage that you feel best fits your Medicare needs.
What About Medicare Supplemental Coverage?
Medicare covers roughly 80% of most health bills. This is why most seniors purchase a Medicare supplement, Medicare Advantage, and/or Part D plan. These coverages can help pick up some or all of what is not covered by Medicare.
Supplemental plans are sold by insurance agents (like us) and are private policies whereas Medicare Parts A and B are federally sponsored public plans. Supplemental plans can also have late enrollment penalties and delays. And in some cases, you may not be able to purchase any supplement if you have waited beyond your open enrollment or guaranteed issue period of time.
Medicare Parts A and B are only the first half of the Medicare puzzle. Once you have enrolled in Original Medicare with the government, you will want to use your open enrollment window to explore your supplemental plan options. It is wise to speak with an independent agency (like us) to decide which plan(s) best fit your needs and budget.
Medicare Is A Little Complicated
There is no doubt that if you are new to Medicare, the enrollment process can be somewhat intimidating. Above all else, it is most important to enroll at the appropriate time. Missing your open enrollment window will add a premium penalty and delay your eligibility.
If you are unsure, it is wise to lean on the experts who work with senior insurance programs everyday. Talk to a chosen insurance agent, human resources manager and/or a Medicare representative over the phone or in person.
Contact Us
Hyers and Associates, Inc. is a full service independent insurance agency specializing in health coverage for seniors. Contact us today to learn more about your options.
Category: Medicare Advantage, Medicare Supplements, Retirement Planning
Our independent agency now offers United American Medicare supplement insurance direct to consumer in several states. There are no markups or additional costs to request quotes and/or purchase Medigap policies while using our services.
That is one of the primary advantages of working with an insurance agency like ours; you can view the direct rates from several different carriers side by side without having to contact each company directly. And several companies (like UA) only offer policies through their agents.
About The Company And Its Products
United American was founded in 1947 and has an A+ rating with A.M. Best. They have kept this rating for 35 + years which is a testament to their financial strength, size and stability. Very few insurance companies can boast of such a high rating for such a long period of time.
UA offers a wide variety of insurance products in the life and health markets. Policy offerings include life, health, critical illness, cancer, Part D, group retiree and Medigap coverage. They may be best known as a Medicare supplement provider however.
Like many insurance providers, UA offers a few niche products in certain states that are very competitively priced. One such product is High Deductible Plan F and one such area is the state of Florida.
United American Medicare Supplements In Florida
The demographics and cost of health care in Florida usually make for expensive insurance products for seniors. There are only a handful of Medicare supplement insurance providers in Florida that offer competitively priced policies.
Fortunately, United American is one of those companies. At present, they offer some of the lowest priced High Deductible F Plans across the state. That is great for seniors who want a low priced Medicare insurance plan with a reasonable deductible. (As of 2012, the HD Plan F deductible is $2,070 yearly.)
In fact, High Deductible Plan F will usually be nearly $100 less per month than a traditional Plan F. For those who are looking for lower monthly premiums, but are leery of Medicare Advantage coverage, then HD Plan F with United American can be a very good choice.
High Deductible Plan F Medigap Expenses
With HD Plan F, seniors know exactly what their out-of-pocket exposure will be on a yearly basis. There is the added benefit of not having to worry about network or restrictions for care out of state.
Like all traditional Medicare supplements, HD Plan F has no network restrictions. Policy holders can receive care from any doctor or hospital that accepts Medicare assignment – both in state and out of state.
Like all Medigap plans, High Deductible Plan F premiums are likely to increase year over year, but it helps when the percentage increase affects a much smaller starting number.
And The Centers for Medicare and Medicaid services can increase the HD F deductible, but any changes will affect all plans – both new and existing. For instance, the HD F deductible was $2000 in 2011.
Contact Us For Quotes And Coverage
Hyers and Associates is a full service Medicare supplement insurance brokerage offering policies direct to consumer across the United States.
We license with dependable and reputable providers so that our clients can purchase the Medigap coverage that best suits their needs. We can also help with prescription Part D coverage.
Contact us for quotes and information today!
Category: Medicare Supplements
Now that the Supreme Court has upheld the Affordable Care Act (otherwise known as Obamacare) there are many questions about the individual mandate as it relates to new taxes and/or penalties for those who have not purchased health insurance.
It is important to understand that these new taxes (or penalties) will be phased in over the next few years and do not take affect right away. And with a program that is so politically charged, there could be changes by Congress or the president after the elections in November 2012.
Understanding The Individual Health Care Mandate
The Supreme Court has allowed for significant latitude when it comes to Congress’ ability to tax its citizens. While Congress cannot force consumers to buy health insurance under the Commerce Clause, it can assess a tax or penalty for those who do not comply.
Beginning in January of 2014, individuals and families must have “essential” health insurance coverage each month or be subjected to a financial penalty. Those who are below the federal poverty level, can prove hardship conditions or are part of a few other small minorities will be exempted from the new legislation, but not many.
How Much Is The Obamacare Tax Penalty?
Those who choose not to purchase health insurance under the Affordable Care Act will face a financial penalty enforced by the Internal Revenue Service.
The yearly tax penalty for not having essential coverage will be the greater of a flat dollar tax per individual or a percentage of the individual’s income. In other words, the penalty will vary from household to household.
In 2014, the flat dollar tax amount per individual is $95; in 2015 the amount is $325; and in 2016 the maximum is $695. For dependents under age 18, the flat dollar amount is half of the individual amounts above.
After 2016, the tax penalty will be indexed to inflation and capped at 300% of the flat dollar amount for families who choose not to purchase health insurance. Thus, the amount of the penalty will vary for families depending on the number and age of dependents as well as if the maximum cap applies.
- For example: A family with two adults and one child under age 18 would pay a penalty of $1737.50 in 2016. (1/2 of $695 for the dependent plus $695 x 2 for each adult = $1737.50)
- A family with two adults and two children over age 18 would cap out and pay $2,085 in yearly penalties in 2016. ($695 x 300% = $2085)
Factoring In Taxable Income To Calculate The Penalty
Here is where it gets a little tricky. The higher your household income, the higher your penalty for not complying with the health care mandate. This wrinkle begins in 2014 when the majority of the Affordable Care Act will be implemented.
The law states that the percentage of taxable income is the amount in excess of a household’s tax filing threshold phased in at 1% in 2014, 2% in 2015, and 2.5% in 2016.
- For example: Assuming the tax threshold is $10,000 in 2014 and $50,000 of income for a single filer, the tax penalty would be calculated by subtracting the $10,000 threshold from the $50,000 in taxable income to arrive at $40,000. That $40,000 would be subject to the 1% penalty rate in 2014 for a total of $400.
An individual with a household income of $50,000 would owe roughly $400 in 2014, which of course is higher than the flat dollar amount of $95 mentioned previously.
Again, the penalty is the greater of the flat dollar amount per individual or a percentage of the individual’s income. In a nutshell, this tax is begin means tested by the ACA.
However, the annual penalty is to be capped based on an amount equal to the national average for premiums of a qualified health plan with a “bronze level” rating by the government and offered through state or federal health insurance exchanges. As these exchanges have not been setup yet, these numbers are still unknown.
How Will The Health Care Tax Be Implemented?
If an individual or family does not purchase essential health insurance coverage while also not meeting any provisions that allow for an exclusion, then they will be subjected to the tax/penalty.
The fine will be administered federally and reported/calculated on the non-compliant person(s) tax return. The mandate is to be enforced by the Treasury Department via the Internal Revenue Service.
The fine can be withheld from the offender’s yearly tax rebate if one is due from the Federal government or if none is due, then collected through normal and customary means. In other words, one could expect a letter from the I.R.S in the form of a past-due notice.
It is important to note that at this time the law states that individuals cannot be subjected to criminal penalties, fines, or levies when found to be in non-compliance.
At this point, it is somewhat unclear as to whether late penalties would be implemented for those who do not comply with the mandate or if their maximum penalty would simply carry over to the next year.
Purchasing Health Insurance To Avoid Penalties
While the new health care rules and regulations are yet to be implemented, what is clear is that health care will likely be forever changed by the approval from The Supreme Court of this sweeping legislation. Most consumers will simply buy health insurance in order to avoid I.R.S. fines/taxes/penalties etc.
Hyers and Associates, Inc. is a full service independent insurance agency and will help you find the coverage you need at the best rates available in your area. Contact us today for assistance with your health insurance needs.
Category: Health Care Reform, Health Insurance
We offer Central States Indemnity Medicare supplement insurance direct to consumer. As an independent insurance agency offering Medigap plans, we are always looking for new companies with the lowest rates for our clients.
We like Central States Indemnity as they are a highly rated carrier with strong financial backing. As a consumer, it can be difficult to compare rates with several carriers on your own. We have created a one-stop shop to help you find the plan(s) that best suit your needs.
Central States Indemnity Company Of Omaha
CSI was founded over 35 years ago and has an A+ rating with AM Best. Their high rating can be explained by the fact that CSI is a Berkshire Hathaway company and therefore have significant financial strength behind them.
Berkshire Hathaway is of course the large investment conglomerate run by Warren Buffett. In 1992, Berkshire acquired Central States to gain a foothold into the large and growing senior markets. CSI benefits from their size and scope and has grown into one of the most stable Medicare supplement providers.
Agents: Get Licensed →
Understanding Medicare Supplement Insurance Trends
Warren Buffett is known for his investment savvy. With so many baby boomers aging into Medicare, it makes senses that Berkshire Hathaway would enter this growing market. There will always be a need for affordable and stable Medigap carriers.
After all, it does not matter where you purchase your supplemental insurance – a Plan F is a Plan F. Insurance companies cannot adjust plan designs nor offer differing networks. Medigap benefits are controlled by law and traditional supplemental insurance plans have no network restrictions.
Thus, you are simply shopping for a reliable, well-rated carrier offering affordable rates and reasonable premium increases. CSI has a good reputation when considering those factors which helps to explain their popularity with consumers and agents alike.
Now Offering Popular Plan G In Many States
CSI offers Plan G across the U.S. as consumers become more aware of the savings and stability it provides. Plan G is a very good choice for those who would rather exchange lower premiums for slightly more exposure to out of pocket expenses.
Plan G covers everything Plan F does except for the Medicare Part B deductible – which is only $166 for 2016. In many cases Plan G’s premium savings can more than make up the difference, however.
Notably, Plan G is not a guaranteed issue plan. Unless the applicant is in their open enrollment window and new to Medicare Part B, then s/he will need to undergo medical underwriting to enroll in G. This results in members with fewer claims which keeps rates low for everyone.
Their Sister Company: Central States Indemnity Life
Some insurance carriers tend to carve out certain niches for themselves. That is to say not all carriers offer the lowest prices in every state, but some are known for keeping rates stable for their members.
It’s not uncommon for insurance companies to offer plans from one or more subsidiaries. CSI Life Insurance Company was introduced in 2015 to offer yet another competitive choice in many states. It’s not uncommon to see both companies in the top 5 for rates in many areas of the country.
We encourage our clients to shop on more than just price at purchase. Choosing a supplement can be a decision for the long haul. Sometimes it’s better to pay a little more upfront in order to have more stability in the future. Both CSI companies are good examples of this idea in practice as their G and N rates have held steady.
It should be noted that the CSI family of companies is very competitively priced in Arizona, Illinois, Indiana, Ohio, Tennessee, Texas, the Carolinas and several other states in the Southeast as well.
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Hyers and Associates, Inc. is an independent insurance agency offering Medicare insurance coverage across the United States. We license direct with all carriers in order to offer the lowest rates to our clients.
We can help you compare Medigap plans from several carriers while also discussing the nuances of purchasing insurance and keeping your premiums low now and in the future. Contact us today for more information.
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Category: Medicare Supplements
Vanishing deductible benefits are not for car insurance policies only. Health insurance providers are also offering policies with a deductible that decreases over time when the chosen limit has not been reached by the insured(s).
This is being done in an effort to make older health insurance polices more attractive and to retain healthy customers with the added benefit of lower out-of-pocket expenses.
The two most prominent providers offering this new benefit are Anthem Blue Cross Blue Shield and United Healthcare, but others are sure to follow. These two carriers always have the option of reducing or changing this benefit as it is not built into the policy for its lifetime.
Health Insurance Policies With A Vanishing Deductible
It is no secret that many healthy consumers reprice their health insurance each year in hopes of locking in lower premiums. If the deductible has been reduced by 20-50% however, then the lesser amount will need to factor into the search for a new policy.
In order to obtain an apples to apples premium comparison, the insured will need to compare matching deductibles. If their current plan has been in force long enough for the deductible to decrease, then a matching number would need to be chosen with the new carrier.
Like all insurance policies, premiums will need to be weighed against the potential for out-of-pocket expenses. Most consumers will usually put more weight on their premium payments, but this new metric may prevent some rapid policy changes.
How Does A Decreasing Deductible Work?
In a nutshell, policy deductibles will decrease by a predetermined percentage each year so long as the insured has not reached the allotted amount. In most cases, the maximum credit will be half of the chosen deductible.
If for instance, you chose a plan with a $5,000 deductible, then the maximum credit that could be earned over a three years time would be $2,500. Should you reach your deductible after three years, then the insurance company would credit you (or a family member) with $2,500 for not having reached your deductible in the past.
Insurance companies have different means of crediting the allotted amount, but it is a nice feature that rewards good health and frugal shopping for medical related expenses.
Anthem’s Deductible Credit Program
This benefit is simply designed to incentivize good health while retaining customers. The plan is free and available for those enrolled in traditional plans with a $2,500 deductible and those on their Lumenos HSA plans with a $3,000 or greater amount.
Each year that the insured does not reach their deductible, even if it’s only by $1, his or her plan’s deductible will decrease by 20% in the following year – up to a maximum of 50%. By year three, the deductible will be halved.
If the deductible is reached, Anthem cuts a check to the insured for the qualifying amount and the program starts over. Thus, the incentive to change policies after a couple of years is less. And consumers who don’t often meet their deductible may shop for less expensive health care providers to make sure they qualify for this credit in close circumstances. See their flyer here.
United Healthcare Deductible Credit Program
United Healthcare offers this benefit for all of their deductible choices. The credit cannot reduce a health savings account deductible below its required limit by law.
Unlike Anthem, they do not cut a check to the recipient, rather the plan credits 20% reduction each year, up to a maximum of 50%, for the insured. With either company, your maximum reduction can be 50% after only three years.
In essence, UHC is encouraging consumers to purchase more affordable plans with higher deductibles. Someone who chooses a very inexpensive plan with a $10,000 deductible can have that number to $5,000 in three years assuming reasonably good health.
This benefit might also affect when the insured chooses to have an elective surgery or procedure. It could save them thousands simply by waiting until their next policy anniversary if they are in nor harm by doing so.
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We will help you find the health insurance and deductible that best suits your needs.
Category: Health Insurance, Health Savings Accounts
What are Medicare Select insurance policies? They are traditional Medicare supplement policies (like Plans F, C and N for instance) that require the use of a preferred network of doctors and hospitals for routine care.
Medicare Select Plans are sometimes popular as they are less expensive than traditional non-network driven supplemental plans. They are appropriate for those who are comfortable using a preferred network of doctors and hospitals for regular care.
Understanding Medicare Supplement Insurance Select Networks
Supplemental select policies work much in the same way as Health Maintenance Organizations (HMOs). The insurance company negotiates service contracts with a network of doctors and hospitals in the area where the supplement is offered – usually larger cities. These negotiations result in lower medical costs.
The cost reductions are then passed on to the consumer in the way of lower monthly premiums on their Medigap select policies. There is no additional cost sharing however. A Plan F is still a Plan F – the insured simply needs to stay in-network for his or her medical services.
How Are Emergency Costs Covered Under Medigap Select Plans?
It is important for the consumer to use the approved network for all routine services. If not, then the select plan may not pay its share of the bill. In some cases, referrals from a primary physician may be needed to see certain practitioners. If you travel extensively or winter in a different location, a Select Plan may not be appropriate.
Emergency services are covered out of network so long as the insurance company agrees that the situations was an emergency. Routine care will not be covered out of the approved network. Regardless of how or where medical care is needed, Medicare Parts A and B will always cover its share of approved expenses first.
Advantages & Disadvantages Of Medicare Select Plans
The primary advantage is simply cost. By agreeing to use the approved network, consumers can save money on their Medicare supplement insurance. In some cases however, traditional supplemental plans may be less expensive than even some select plans. It is wise to shop around.
Much like Medicare Advantage plans, the primary disadvantage is simply the constraints of the network. It is important to be certain of any network limitations by first checking with the insurance company and/or the agent before purchasing a policy. And consumers must be aware that certain doctor groups and facilities may be in the approved network one year and out the next.
Consumers who move out of the approved service area will be afforded a 63 day window to purchase a new supplemental plan without the need for medical underwriting. Not all plan designations will be available during a “guaranteed issue” period such as this one, but the consumer will have certain rights to purchase new coverage.
Comparing Supplemental Select Plan Networks And Quotes
Not all carriers offer select plans as they simply do not have the size or scope to build network driven plans. It is usually the larger companies with existing health insurance and Medicare Advantage networks who offer these types of plans, but they are somewhat rare.
A few companies worth considering if you are in the market for a Select plan will be Anthem Blue Cross and Blue Shield, AARP United Healthcare, Assured Life, Gerber Life, Mutual of Omaha and a handful of others.
By working with an independent Medicare brokerage like ours, you can compare both select and traditional Medicare supplements online. We can help you compare the direct rates for both types with several carriers.
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Category: Medicare Advantage, Medicare Supplements
It’s almost a new year which means changes to the Medicare Part A and B deductible amounts for 2012 are here. The Part A deductible is increasing by a nominal amount, but the Part B deductible is decreasing.
You read that correctly, the Part B deductible is going down which means that some Medicare supplement insurance plans will become more attractive based based on their monthly premiums. We’ll address that benefit later in this post.
Medicare Part A and Part B Deductible And Coinsurance Increases and Decreases For 2012:
| Medicare Feature |
2011 Amount |
2012 Amount |
Percent Change |
| Part A Deductible (Inpatient Hospital) |
$1,132 |
$1,156 |
2.12% |
| Part B Deductible (Physician’s Services & Supplies) |
$162 |
$140 |
(15.71%) |
| Hospital Coinsurance Days 61-90 |
$283 |
$289 |
2.21% |
| Hospital Coinsurance Days 91-150 (lifetime reserve) |
$566 |
$578 |
2.21% |
| Skilled Nursing Facility Coinsurance |
$141.50 |
$144.50 |
2.21% |
Part B Deductible Decrease for 2012 and Plan G Supplement Premiums
The most significant change to the Medicare deductibles for 2012 is the somewhat dramatic decrease for the Part B deductible out-of-pocket. This lower amount makes plans that do not already cover the Part B deductible more attractive. Typically the difference in premiums and coverage will dictate your purchase.
One such Medigap option available for purchase is Plan G. Plan G covers everything that Plan F does except for the Part B deductible. If Plan G happened to be $300 less (as can be the case) per year than Plan F and Plan F only covers $140 more in costs, then Plan G is a wise choice. Plan N might also fall into this category if you live in a state (Ohio for instance) that does not allow for Part B Excess charges.
High Deductible Plan F Changes
The Medicare supplement Plan F high deductible amount is also increasing in 2012. The deductible was $2,000 in 2011 and will be $2,070 for 2012. This is not too significant of a change if you already own this plan or if you are considering purchasing it.
The premiums associated with High Deductible Plan F are usually very inexpensive and can be a good choice if you are comfortable with a little more out-of-pocket exposure. It is important to remember if you wish later to enroll in a more comprehensive Medigap plan, some medical underwriting may be required with almost all insurance companies.
If you own High Deductible Plan J (no longer sold from any company by law) then your deductible will also be increasing to $2,070 f0r 2012.
Medicare Part B Premiums From The Government
Medicare Part B monthly premiums will be $99.90 for most beneficiaries in 2011. This is slightly more for those who have been paying $96.40, but slightly less than was originally projected by the Centers of Medicare and Medicaid services earlier in the year.
Medicare Part B premiums are means adjusted however and will be higher if you reach certain income levels. For individuals the percentage increases start with an adjusted gross income of $85,000 and for those who file jointly the increase begins at $170,000 of AGI.
Prescription Part D premiums will also be higher if you are earning the above listed amounts or higher. If you are turning age 65 and still employed with access to employer group coverage, it is wise to weigh all of your options before automatically signing up for Medicare Part B. Depending on the size of your group, it may be necessary to enroll in Part B however.
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Hyers and Associates is a full service, independent agency specializing in Medicare supplement insurance.
We work in in several states and help consumers enroll in the Medigap and Part D plan of their choice direct – at no additional cost.
Category: Medicare Supplements, Retirement Planning
The 2011 Medicare open enrollment window is almost upon us. Otherwise known as the Annual Election Period or AEP for short, this period of time can be used by Medicare beneficiaries to switch insurance plans.
The dates are a little different this year as the window starts and ends early. AEP will run from October 15, 2011 to December 7, 2011. It is important however to remember what changes can and can’t be made during this window of time.
Disenrolling From Medicare Advantage Insurance
AEP is most commonly used to disenroll from a Medicare Advantage (MA) plan. Unless there are other extenuating circumstances, Advantage plans can only be cancelled during the yearly Annual Election Period. Most MA carriers will require a letter of disenrollment in writing from the insured; a phone call is not always accepted.
Upon disenrollment, a Medicare eligible person can enroll in a new Advantage plan that better suits their needs or return to Original Medicare. If the latter, then a Medicare supplement and/or prescription Part D drug plan might be purchased in order to fill the gaps in Original Medicare Parts A and B.
It is very important to note, that if someone has been in an Advantage plan for longer than one year, they may need to be medically underwritten in order to enroll in a traditional Medicare supplement insurance plan. This means that the applicant could be turned down if they are in poor health.
It is usually a good idea to get an application for traditional supplemental coverage in early to make sure that certain health qualifications can be met. Underwriting requirements will differ between various providers, so working with an independent Medicare supplement agency (like us) can be a wise choice to ensure coverage is obtained. This way Medicare eligible consumers can ensure a seamless transition to new coverage that will become effective January 1, 2012.
Switching Prescription Part D Insurance Plans
The Annual Election Period (open enrollment) also allows consumers to purchase a new Part D drug plan and drop their old coverage. This time period can also be used by consumers who did not purchase Part D coverage during their initial open enrollment window to find a plan.
For those who did not enroll when they were supposed to, there can be late enrollment penalties however. These penalties amount to a 1% per month addition for each month that coverage was not elected. For example, if someone (without credible coverage) waited 16 months to purchase a Part D plan, then their monthly premiums will be 16% higher than someone who enrolled on time.
Open enrollment allows those who have stand alone Part D drug plans to purchase more suitable (or less expensive) coverage if their current plan is no longer meeting their needs. If Medicare Advantage coverage that is coupled with a Part D plan (MAPD) is dropped, then a new Part D plan will likely need to be purchased as well.
Enrolling In Medicare Supplement Coverage
For those who qualify either medically or through their open enrollment window, AEP can be used to purchase Medicare supplement coverage as well. If someone is dropping an Advantage plan, then most supplemental insurance providers will require a letter of disenrollment signed by the applicant. This same letter can then be sent off to the MA provider for processing.
One common misconception about AEP is that this period of time can be used to switch Medicare supplement providers without any medical underwriting. This is not the case. Consumers can switch supplemental insurance coverage any time of the year, but most companies will require some amount of underwriting. If a change is desired, there is no reason to wait until the end of the year to do so.
The only exception to this rule is for those who are dropping a Medicare Advantage plan after one year and re-enrolling back into Original Medicare. The Centers for Medicare and Medicaid Services allow for a one year Medicare Advantage trial period. If after one year the consumer is not satisfied, s/he can purchase most Medicare supplement insurance plans without the need for medical underwriting.
It is important to note that there are a couple of states that offer a yearly open enrollment window for changing Medicare supplement coverage without underwriting (Missouri and California for example), but these states have specific individual anniversary windows that will not necessarily coincide with the yearly Annual Election Period.
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Hyers and Associates, Inc. is a full service, independent insurance agency offering Medicare insurance and Part D prescription drug policies direct to consumer in many states across the country.
Contact us today if you have questions or assistance with your Medicare coverage.
Category: Medicare Advantage, Medicare Supplements
Rising group health insurance rates are one of the most significant expenses facing businesses and groups of all sizes. Premiums can increase year over year by 10% or more as insurance carriers struggle with rising medical costs and new benefit requirements.
Companies and groups who wish to offer low deductible, high benefit plans are experiencing rate increases that are in many cases forcing them to switch providers, increase employee contributions, and/or enroll in less comprehensive coverage.
Secondary Payer Insurance For Group Coverage
One simply way for employers to reduce their monthly outlays for group health insurance is to implement a secondary payer plan. These plans can be combined with high(er) deductible health insurance coverage and then used to cover the larger deductible and coinsurance amounts.
In a nutshell, secondary payer insurance is coverage for out-of-pocket deductible and coinsurance costs. A company with a low deductible, benefit-rich plan can move their employees to coverage with a higher deductible in order to lower the monthly premium with their current (or new) carrier. A secondary payer plan can then be combined with their new coverage in order to offset the potential for increased out of pocket expenses.
In most cases, the out of pocket exposure to the insured will be nearly the same (if not less) but the overall premiums for the two combined coverages will be much less for the employer and/or employees. Secondary payer plans take the burden off the original carrier and shift it to the new insurance company. The new provider is only responsible for covering the higher out-of-pocket amounts.
The exposure is limited and predictable for the secondary insurance carrier and that helps them extend lower premiums to the group. Employees will be comfortable knowing their out-of-pocket expenses are not greater than they were before the change was made.
Health Savings Accounts And HRA Qualified Plans
A common practice for groups wanting to lower their monthly premiums is to switch to a high deductible HSA or HRA qualified plan. In order to account for the higher out of pocket exposure, the employer might agree to partially or totally fund the HSA or HRA.
Over a few years, this can be a significant outlay for the employer, especially with a health reimbursement account as these contributions are irretrievable when they are not used. And employees with money left in a HRA toward the end of the year will oftentimes find ways to spend these funds so as not to lose them.
Unfortunately, a secondary insurance plan cannot be implemented with most qualified health HSA, HRA, or FSA plans. However, employer groups who are not satisfied with their tax qualified plans could consider moving back to a high deductible plan (with a secondary payer) and then provide the usual benefits employees prefer – like a small copay for doctor’s office visits and immediate coverage for prescription drugs.
Filing Claims With A Secondary Payer
Filing claims is usually no more difficult than with any other traditional carrier. The insured will carry their secondary insurance card and give it to the medical provider when benefits are received. In most cases, the medical provider will then bill the secondary carrier as they would any other.
In other cases, the insured can file the claim if they wish. The will only need an explanation of benefits (EOB) and the itemized bill from the medical provider. Both can then be sent to the secondary payer administrator for reimbursement.
Networks And Underwriting Requirements
There are no network restrictions with these plans. Employees can continue to use their regular doctors and hospitals as before. In fact, the administrator will contact often used medical facilities beforehand in order to insure a smooth transition for the employer and employees.
There are no underwriting requirements needed to enroll in most secondary payer plans. If some of the employees have significant preexisting health conditions, this will not increase the rates for any of the others. Rates are based on demographics, gender and age, but not previous health issues. In many cases, renewal premiums have been lower on a percentage basis when compared to major medical coverage.
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Hyers and Associates is full service, independent insurance agency representing several group health insurance providers. We can help your business reduce its monthly premiums by shopping for coverage with several carriers, changing plans, and/or implementing a single payer plan.
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Category: Group Health Insurance
Upon retirement, you may lose the group health insurance coverage offered from your employer. In some cases, the insurance can be extended for a short period of time, but in most others it may discontinue altogether or become too expensive to maintain.
The dividing line for most retirees is age 65. If you are younger than age 65 and you cannot continue your group health insurance coverage for any reason, the next best option is to purchase an individual or family plan from a provider such as Aetna, Anthem Blue Cross, or United Healthcare among others.
If you are over age 65 and losing group coverage, then you will need to enroll in Medicare Part B (if you have not already done so) and purchase supplemental coverage. The two options available for retirees over age 65 are traditional Medicare supplements and Medicare Advantage plans.
Retiree Health Insurance Over Age 65
Many retirees are age 65 or older when they lose their group health insurance coverage. In some cases, they can maintain their current group coverage, but in many cases they are involuntarily dropped from the plan.
In fact, many large companies are discontinuing health insurance benefits altogether for retired workers over age 65 whether they recently retired or were offered health benefits in the past.
The good news is that those who are both voluntarily and involuntarily losing group health insurance can almost always purchase a supplemental plan on a guaranteed issue basis. In this case, Medicare will be their primary coverage. Those over age 65 must first be enrolled in both Medicare Part A and Part B and then they can best decide how to supplement the gaps in Medicare.
Medicare Supplement Coverage for Retirees
The first option is to purchase a traditional Medicare supplement. There are ten plans to choose from and each offer a varying degree of coverage.
There are no traditional Medigap or supplemental plans that cover prescription drug coverage, so it is wise to purchase a stand-along Part D drug plan unless credible rx coverage is available elsewhere.
Supplemental plans and Part D coverage can both be compared on price and purchased direct (at no additional cost) from independent agents who represent a wide array of insurance carriers.
Medicare supplements are popular because the potential out-of-pocket expenses associated with these plans is very limited and predictable for the insured. Plan F is often purchased as it covers all of the gaps in Original Medicare Part A and Part B.
Additionally, almost all supplemental plans have no network restrictions to navigate. This means the insured can see any doctor or hospital that accepts Medicare patients. Those who purchase traditional Medigap plans can rest assured that they will not need referrals nor will they be turned away because of any network restrictions.
Medicare Advantage Coverage For Retired Seniors
Advantage plans are not quite as popular as traditional Medicare supplements based on enrollment figures. Typically, this coverage is less expensive on a monthly basis and covers all what Part A and Part B cover and some of what they do not.
Those who purchase an Advantage Plan can have the potential for larger out-of-pocket expenses. It is wise to ask the insurance provider about the yearly maximum for out-of-pocket expenses both in and out of network.
It is also preferable to know about any network limitations that might exist with any Advantage Plan under consideration. In some cases, certain medical facilities and doctors will choose not to accept one or more Medicare Advantage Plan. These limitations can become an issue for the insured if an out-of-network specialist or facility is recommended by their primary care physician.
Many Medicare Advantage Plans will include prescription drug coverage thus eliminating the expense of purchasing a stand-alone Part D plan. When deciding between the two options (Medigap and Advantage) it is wise for seniors to speak with an independent agent about both and consider their options both now and in the future.
Understanding Medicare Open Enrollment (AEP)
Typically, Advantage Plans can be changed each year during open enrollment, but the insured is only allowed a one year free-look period if they wish to return to Original Medicare and purchase a traditional supplement.
That is to say, if the insured was enrolled in an Advantage Plan longer than one year and then desired to purchase a traditional supplement, the Medicare supplement provider can decline their application due to ongoing or past health concerns.
Retired Under Age 65 Health Insurance Plans
If you are under age 65 and losing your group health insurance due to retirement, then you will need to purchase coverage in the individual market. There are several well known and highly rated carriers providing both individual and family health insurance.
Health care reform has changed the landscape somewhat, but many plans are still available. Unfortunately, the cost of these same plans has increased with the implementation of the reform efforts, but no longer can children be turned down for coverage. However, health insurance providers can still charge significantly higher premiums for those under age 26 who have preexisting conditions.
Conversely, retirees under age 65 can still be turned down for coverage and/or issued policies with exclusionary riders. It is wise for retirees to shop around with an independent agent and to disclose their health backgrounds.
An experienced agent can recommend suitable and cost effective options for those under and over age 65. And remember, there is no additional cost whatsoever to use an agent to purchase health insurance coverage.
Should no provider be willing to offer health insurance coverage to the retiree, then the high risk pool in the state where the retiree resides can be investigated. The high risk health insurance pool can be the stopgap coverage that will bridge the time until Medicare eligibility at age 65 or until other reform laws allow for better access to health insurance.
Information And Insurance Quote Request
Hyers and Associates, Inc. is a full service, independent agency offering Medicare supplement and individual and family health insurance policies direct to consumer.
We work with the leading insurance providers in several states in order to offer comprehensive and affordable coverage from several highly rated carriers. Contact us today to discuss your best options.
Category: Medicare Supplements, Retirement Planning
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