Medicare for Veterans If you’re a veteran, there are several unique Medicare Advantage plans worth consideration. These policies will reinforce your coverage when receiving care outside of the VA.

Many policies also reduce your Part B premiums and increase your monthly Social Security checks.

You can enjoy added benefits like dental, vision & hearing coverage as well as free gym memberships.

Understanding Your Insurance Options

We know many veterans receive most of their care (and medications) through the Veterans Administration. They might not need to pay for any additional coverage like a Medicare Supplement or Part D drug plan.

But you may want options if you do need care outside of the VA. And if you have Medicare alone, then your out-of-pocket exposure is significant. That’s where Medicare Advantage plans can help. They reduce your exposure while giving you access to other health care professionals.

These veteran-specific plans will have names like Honor, Patriot and Eagle. They are mostly offered by major insurance companies like Aetna, Humana, United Healthcare and Wellcare to name a few.

How Much Are The Monthly Premiums?

Here’s the good news: There are several Medicare Advantage policies designed for veterans with $0 monthly premiums. Advantage plans with no monthly premiums are abundant for all Medicare beneficiaries. These aren’t discount plans; they offer comprehensive coverage.

In other words, it’s not surprise to see $0 plans for veterans as well. Many of our clients choose Advantage coverage to keep their outlays low while shoring-up their out-of-pocket exposure for minor and major health events.

Taking Advantage Of The Part B Giveback

Not only are there no monthly premiums, many MA policies include the Medicare Part B Giveback benefit. This feature adds money back to your Social Security check each month.

Even if you have no intention of ever using the coverage, you can increase your Social Security deposits simply by enrolling. This is a great way to increase your monthly deposits from the government. Please be aware you have to be enrolled in Medicare Part B for this strategy to work.

Are There Any Risks To Adding An Advantage Plan?

Veteran focused Advantage plans are PPOs and HMOs. Outside of the VA, they become your primary coverage – not Original Medicare itself. This means you will need to see doctors and hospitals in your chosen plan’s network. The policy can pay less (or none at all) if you’re receiving care out of network.

Veteran Medicare Advantage plans do not usually include Prescription Part D Coverage. It’s assumed most veterans receive their prescriptions through the VA.

Enrolling in a Medicare Advantage plan will not disrupt your VA coverage. However, there are some limitations when using your Medicare Advantage plans outside of the VA. For most, there are more pros than cons when choosing to have an Advantage plan for secondary coverage.

What About Dental, Vision & Hearing Coverage?

Another valuable feature many Medicare Advantage plans offer is free ancillary coverage. It’s common to see dental, vision and hearing coverage included at no extra cost.

Dental, vision and hearing coverage is robust under many veteran oriented plans. Preventive, basic and major services are covered as well as eye exams, frames and lenses. Hearing benefits can include free exams and a significant allowance toward hearing aids. Many policies offer you a couple thousand dollars or more in combined benefits for all three.

Other ancillary benefits like free gym memberships (Silver Sneakers), quarterly over-the counter allowances, telehealth, meals during recovery, acupuncture, smoking cessation help, and chiropractic services are common as well.

You may never need to use the medical insurance, but the ancillary benefits add significant value.

Contact Us To Learn More

If you’re new to Medicare or searching for options during Open Enrollment, we can help. There are several veteran-specific Medicare Advantage plans in most areas of the country.

These plans can reduce your out-of-pocket exposure outside of the VA while adding valuable ancillary benefits like dental, vision and hearing. Increasing your Social Security take home pay through the Part B Giveback provision is helpful as well.

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Category: Medicare Advantage

5 Star Medicare Insurance You always want to examine all the details when shopping for a Medicare Advantage policy. There are networks, prescriptions, cost-sharing and plans ratings to consider among other important items.

The Centers for Medicare & Medicaid Services (CMS) help by using an annual ratings system. The rankings are 1-5 stars with Five Stars being the best. And if there are 5 Star plans offered in your area, CMS provides unique enrollment opportunities that are not otherwise available.

How Does The Medicare Rating System Work?

First a little background: Star Ratings only apply to Medicare Advantage, Part D and Cost plans. And rankings are not always based on a full Star. It’s common to see plans with 3 1/2 or 4 1/2 Stars. New Medicare insurance plans may have no rating at all. Usually a year is needed before CMS can provide this metric.

Star Ratings typically come out once a year and in the fall. They apply to plans offered the following year. Information from members, health care providers and the insurance plans themselves all influence plan rankings.

The system is designed to help consumers evaluate the quality of care, customer service and the overall performance of various policies. Health outcomes and consumer experiences go a long way in determining rank. A plan with many complaints will not rank well.

Note: Star rankings do not apply to Medicare Supplement insurance policies. There is no formal ratings system for Supplements.

Five Star Plans Offer A Special Enrollment Window

If a Five Star Medicare Advantage, Part D or Cost plan is available in your area, you can switch from your current coverage once (and only once) between December 8th and November 30th. This nearly year long Special Enrollment Period (SEP) can be beneficial if you’re having issues with your Advantage or Part D coverage.

It’s important to know only some areas have Five Star plans available. They are designated by the county where you live. And you must be careful when switching policies. It’s easy to make a mistake. For example, a switch to a new Medicare Advantage plan might cause you to lose your Part D Drug coverage.

When in doubt, consult with an experienced broker – someone like us. You don’t want to run into monetary penalties or network issues when switching plans.

Should I Be Concerned About Three and Four Star Plans?

The short answer is no. Many comprehensive and reliable Medicare plans are ranked 3.5 – 4.5 stars. In fact, Five Star plans are somewhat rare in many parts of the country.

Even though a Medicare plan might have a high rating, it does not mean it’s the most suitable for you. There are important questions to ask, like:

Are all of my doctors in network?
Are my prescriptions covered?
What are the travel benefits?
Does it include dental, vision, hearing & gym benefits?

In other words, it’s not always wise to enroll in a Medicare Advantage plan based on Star Ratings alone. Plans are nuanced and coverage with a lower ranking might be much more appropriate overall. Some policies designed for veterans do not offer Part D drug coverage. Those might not be a good fit for you. It pays to explore all plan benefits before enrolling.

Star Ratings Also Affect Part D Drug Coverage

You might enroll in a stand alone Part D drug plan for a couple of reasons. Maybe you chose to pair one with a Medicare Supplement – or maybe your Advantage plan does not offer drug coverage. Medical Savings Accounts and PFFS plans are two examples of Advantage plans with no Part D benefits.

Whatever the case, you can compare Medicare Drug plans by star ratings as well. Almost all plans will fall in the 3-4 star area. It’s rare to find a 5 Star Medicare Part D drug plan. These policies have too many moving parts and consumers have more issues with them overall. Plans change their prices, formularies and other factors every year causing more issues for consumers.

Contact Us To Compare Your Medicare Options

There’s a lot to know when shopping for Medicare insurance policies. At Hyers and Associates, we make it easy. We’ll take the guesswork out of the process – and there are no charges whatsoever to use our services.

Whether you’re interested in moving to a 5 Star plan – or you just want to evaluate your coverage options, we can help. Contact us today!

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Category: Medicare Advantage, Medicare Part D

Medicare Giveback Benefit If you’re on Medicare, you’re likely hearing about the Medicare Part B Give Back benefit.

This new feature is only offered by a select few Medicare Advantage plans and only in some areas of the country.

If you qualify, this unique benefit can reduce your monthly premiums owed to the government each month.

How Does Part B Premium Reduction Work?

First, you must be eligible for and enrolled in Medicare Parts A and B. And you must already be paying the full amount for your Part B premiums. You won’t qualify for the Part B Give Back benefit if you receive government assistance that pays for your Part B premiums.

Next, you select and enroll in a Medicare Advantage plan that offers the Part B premium reduction benefit.

It’s important to note that only Medicare Advantage plans offer this premium reduction benefit. And it may not be offered where you live. While there are 48 states offering plans, they won’t be available in every county across the U.S. Some areas have no plans at all.

It should also be noted that Medicare supplements currently do not offer any giveback provisions. This benefit is only available if you enroll in certain Medicare Advantage plans. And, of course, there are only certain windows when you can shop for and enroll in a Part C Medicare Advantage plan.

Which Insurance Companies Offer This Benefit?

As this is a relatively new feature, there are only a few insurance companies offering the Medicare give back benefit. Aetna, Cigna and Humana are three companies leading the way.

We imagine more insurance companies will get approved to offer this popular benefit next year – and in more areas of the country. It’s a great way to help those who want to keep their Medicare costs down.

⇒ Learn six ways to save on your Medicare costs ⇐

How Much Can My Medicare Premiums Decrease?

Reduce Medicare Premiums If you qualify and there are plans available in your area, you will see monthly Part B Giveback amounts range from $0.10 up to the maximum yearly standard premium.

This benefit is designed to work with Social Security. Your premium reduction is reflected in your Social Security check each month. In other words, your check will increase by the amount the giveback benefit decreases your premium.

Typically, plans do not pay you directly. If you defer Social Security, then you would see the credit amount applied to what you owe the government. Your monthly or quarterly premiums owed to government are simply reduced by the amount that applies to your chosen Advantage plan.

The give back benefit does not reduce IRMAA charges, unfortunately. Those with higher incomes can only have their premiums reduced by the same amounts listed above; so $148.50 is the maximum amount available this year.

Are There Any Concerns With The Part B Give Back?

We’ve been helping our clients understand their Medicare choices for over two decades. One plan does not fit all. The mistake consumers sometimes make is enrolling in a plan based on cost only. The benefits and network availability must also be considered.

While it’s tempting to choose a plan with a large giveback benefit, it might be unsuitable if your doctors or hospitals are not in their network. And you should also make certain any Advantage plan covers your most important prescriptions. Especially if you take anything expensive or on a higher Tier.

Also, you want to be sure you’re comfortable with Medicare Advantage plans in general. Some people prefer the flexibility of a Medicare Supplement. And switching back and forth between the two is not guaranteed. There are many variables to consider when choosing a supplemental policy.

Contact Us To Discuss Your Medicare Insurance Options

Hyers and Associates is an independent agency located in Columbus, Ohio. Our knowledgeable and experienced agents service clients across the U.S. If you’re new to Medicare, in an Open Enrollment or Guaranteed Issue window, or just have questions about your options – we can help.

We’ll assist you in comparing Supplements and Advantage plans with or without the Part B Giveback benefit. Contact us today!

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Category: Medicare Advantage

Medicare Extra Benefits It’s Open Enrollment, so expect to see endless advertisements about the free extra Medicare benefits you might be missing. Things like prescriptions, dental, vision, hearing aids, meals, gym memberships & transportation. But are the benefits actually free?

The answer is complicated. Like most things, there’s a trade-off. What these commercials are referring to are the extra benefits you receive with certain Medicare Advantage plans. In order to receive these “extras”, you need to sign up for a certain type of insurance.

Understanding Your Two Medicare Options

First, a little background. Once you’re on Medicare there are two different ways to fill in the gaps. You can either purchase a Medicare Supplement (also referred to as Medigap) or you can enroll in a Medicare Advantage plan. You can’t have both. It’s one or the other.

Medicare Supplements (like Plans F, G & N) are simply secondary payers. They fill in the most common gaps in Medicare, but don’t include much else. If you want/need prescription coverage, dental, vision or other benefits, you have to purchase those separately. Some Medicare Supplements will pay for a gym membership like Silver Sneakers, but that’s about it.

Medicare Advantage Plans (also referred to as Part C coverage) are more easily explained as replacement plans. They cover and replace your Medicare Parts A & B benefits privately and then fill in some of the gaps. These are private insurance plans from companies like Aetna, Anthem BCBS, UHC AARP, Humana, etc.

However, these policies are allowed to offer much more in the way of extra benefits. Many are provided at no additional cost. Some benefits, like comprehensive dental & vision insurance, can increase your monthly premiums, however.

The Extra Benefits Associated With Advantage Plans

The simple fact is Medicare Advantage insurance policies, per government rules, can offer many more perks than a Medicare Supplement plan. The list is comprehensive and growing. There’s nothing inherently wrong with this trend. Advantage plans serve many people very well.

Not all policies include everything below, but here’s a list of common benefits:

Part D prescription drug coverage
Dental care like routine cleanings and x-rays
Vision care including eye exams & allowances for glasses
Hearing exams and money towards hearing aids
Free gym memberships, fitness classes and Silver Sneakers
Telehealth appointments for $0
Wellness & preventive care
Post hospital discharge meals
Nurse hotlines and disease management
Quarterly allowances for over-the-counter items
Diabetic supplies
Transportation to doctor’s appointments
Community based programs
Monthly premiums of $0 with some policies
A Medicare Medical Savings Account to cover costs
Medicare Part B Give Back premium reduction

This isn’t an all-encompassing list. And you are not entitled to all of these benefits with every Advantage plan. Some policies are better in certain areas than others. And it helps to live in an area where several companies compete for your enrollment.

But should you choose an Advantage plan on the benefits alone? Probably not, but they are enticing. There’s more to the story…

What Are The Tradeoffs?

We understand the benefits listed above are attractive to consumers. They can provide significant savings throughout the year. So what’s the catch?

The main issue is you must enroll in a Medicare Advantage plan to get these benefits. It’s the only way. And these types of policies have some drawbacks of their own. First and foremost, most are private, network-driven, HMO & PPO plans. This means it’s prudent to stay in their network for your care. If you’re out of network for anything other than an emergency, you’re responsible for more, if not all, of the costs.

And Advantage plans have more out of pocket costs than most Medicare Supplements insurance policies. That’s okay for some consumers, but if you have health issues – or are anticipating future procedures – know that you’ll likely have higher cost-sharing.

It’s common to see many Advantage plans with a yearly in-network out-of-pocket maximum of around $4,000 for the year. Some are higher. And if you go out of network? It can be $10,000 or more with many PPO plans – or not covered at all with a HMO policy. These are the amounts you’re responsible for each year should they arise.

Thus, there are the two major issues: Networks and out of pocket costs. Again, most members don’t encounter serious problems here, but we talk with some that do. Sometimes their preferred doctor group or hospital won’t accept their plan – or later leaves the network. Other times, they’re running into big bills after a hospital stay or a procedure with significant after-care.

Can’t I Switch Back Later To A Medicare Supplement?

Change Medicare Insurance There’s the Open Enrollment window every year, right? Yes, every year from October 15th through December 7th.

This window does not necessarily allow you to jump from an Advantage plan to a Supplement, however.

The rules state you get 12 months to try an Advantage plan. After that time, you must pass medical underwriting to qualify for an enrollment into a Medicare Supplement. In other words, the insurance company offering the Supplement does not have to accept those with preexisting conditions or ongoing health issues. This can make it difficult to switch back and forth.

Why might you want to switch? Perhaps you’re having issues with their network of doctors and hospitals. Or maybe you’re running into significant of out of pocket costs year in and year out.

Contact Us to Learn More About Your Options

While it’s true there are several low-cost (and even $0 monthly premium) Medicare Advantage plans with desirable extra benefits, there are some strings attached. It’s a little misleading for commercials to say you’re entitled to these benefits, but our friend Joe Namath has to make a living too.

There’s a lot to know. Decisions you make now will determine your insurance options later. If you would like to learn more about Advantage plans with extra benefits in your area, contact us today. We’ll do a deep-dive and share with you all there is to consider during the Open Enrollment window.

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Category: Medicare Advantage

Medical Mutual and OSU Networks Every year there are changes to provider networks for many Medicare insurance plans. The biggest change for 2021 is Ohio State University will no longer be in network for Medical Mutual Medicare Advantage plans. This does not affect all of their insurance plans, however.

It’s not uncommon to see large providers move in and out of network with Medicare Advantage plans. This might happen due to high costs or low utilization by the insured population. But for 2021, OSU hospitals and affiliates won’t be in network for Medical Mutual Advantage plans. This includes both their HMO and PPO plans.

This means that beginning Jan. 1, 2021, all PCPs, specialists and facilities associated with the Ohio State University Wexner Medical Center (including Ohio State University Hospital, Ohio State East Hospital, The James Cancer Hospital and The Ohio State University Physicians) will no longer participate in Medical Mutual’s Medicare Advantage network.

What If I Want To Change Plans?

The good news is that Medicare Open Enrollment is right around the corner. It runs from October 15th thru December 7th. If you’re enrolled in a Medical Mutual Advantage plan and wish to continue to see doctors in the OSU network, then switching plans is advisable. Any change you make will be effective January 1, 2021.

In Central Ohio, there’s a lot of competition for Medicare Advantage plan enrollees. Aetna, United Healthcare, Humana, Anthem BCBS, and a few others all offer comprehensive coverage. And many of these include Ohio State hospitals and doctors in their networks. And many also offer $0 HMO and PPO plans that include prescription drug coverage just like Medical Mutual.

In other words, it should not be hard to find a new Advantage plan with your same doctors and hospitals in network while also including OSU. And the benefits should also be similar. Many Advantage plans are structured in similar ways in terms of out of pocket costs and the ancillary benefits offered.

Copays, coinsurance, out of pocket maximums may not differ much. And these plans typically include the dental, vision and hearing coverage (among other perks) you’re used to.

Does This Affect Their Medicare Supplements?

The answer is, no. Almost all Medicare Supplement plans do not have networks to worry about. They are simply a secondary payor after Medicare. This means you can go see any doctor or hospital you choose so long as they accept Medicare.

If you own a Medical Mutual Medicare Supplement plan, you can still go to Ohio State University. This change only affects their network-driven Medicare Advantage plans. This is one of the pros of having a Supplement (also referred to as Medigap coverage). You don’t have to worry about being bounced in and out of networks like you would with an Advantage plan.

You do not need to worry about changing insurance if you own a Medicare Supplement with Medical Mutual of Ohio. You can still go see every provider you’re used to seeing – same as before.

What About Individual & Group Health Insurance?

OSU has not been in network for Med Mutual’s individual and family insurance plans for some time. In Central Ohio, all plans sold today only offer Ohio Health as a network of choice. This gives you access to Riverside, Dublin Methodist, Grant and several other facilities, but not Ohio State.

So there are not changes there. Those on individual and family MMO plans sold on the exchange will continue to have access to Ohio Health facilities in and around Central Ohio for 2021.

And group health plans sold off the exchange will continue to have OSU in their network. There should be no disruptions there either. Again, this change only affects Medicare Advantage enrollees.

Contact Us to Discuss Your 2021 Medicare Insurance Options

Network changes are inevitable in today’s insurance environment. In many cases, the two parties later reach an agreement and things return to normal. However, if you’re utilizing OSU and own a MMO Advantage plan, you may want to shop for new coverage. We can help. Contact us today to learn more about your 2021 options.

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Category: Medicare Advantage

Inexpensive Medicare Plans Let’s face it, Medicare insurance can be expensive. Original Medicare Part A is free due to earned work credits, but Part B costs nearly $150 a month for most.

And Medicare Parts A & B only cover so much. There are still gaps like deductibles, coinsurance, prescriptions, dental, vision, hearing and so on.

So how do you fill these gaps, reduce your out-of-pocket, and not break the bank? Below we discuss six inexpensive ways to shore-up your Medicare coverage.

1) The Case For $0 Medicare Advantage Plans

Also referred to as Part C, Medicare Advantage plans offer an affordable way to strengthen your Medicare coverage with little or no premiums. There are some things to know first, however.

When choosing an Advantage plan, you’re turning your Medicare benefits over to a private insurance company like Aetna, Humana, UHC, or one of many others. This means you need to stay in their networks and use their doctors and hospitals. And these plans usually have more out of pocket exposure than staying on Original Medicare and purchasing a Medicare Supplement policy.

However, the good news is many Advantage plans have very low premiums. Several can be found for $0 a month. If your healthcare providers are in network, this coverage can be a good overall fit. And most policies also offer a wide array of ancillary benefits.

Most policies include prescription Part D drug coverage at no extra cost. It’s also common to see dental, vision and hearing benefits included as well. Still others include meals during recovery, quarterly stipends for medical supplies, and free transportation to doctor’s appointments.

All of these benefits can be found in many parts of the country for $0 a month. So that’s an all-in-one plan with nothing else to purchase. You may face more out of pocket exposure for major health issues, but the premiums and ancillary benefits are hard to beat.

2) Medicare Advantage With Part B Reimbursement

A new wrinkle to some Medicare Advantage plans (like the ones mentioned above) are those that offer Part B give back provision. We know government run Medicare is not free.

Most people are entitled to Part A at no cost, but almost everyone pays Part B premiums to the government each month.

However, when you enroll in certain Medicare Advantage plans (even those with $0 premiums), the insurance company will pay a portion (or all) of your monthly Part B premiums. The amount reimbursed varies, but it can be up to the full $148.50, however. This offers a tremendous savings to consumers.

You’ll of course want to make sure the plan is a good overall fit for your needs. Purchasing any Advantage plan on cost alone may be unwise, but reducing your premiums through Part B reimbursements is a great way to lower your monthly outlays.

These policies aren’t available everywhere, but they’re worth considering if you live in a county where one is offered.

3) Enroll In A Medicare Medical Savings Account

Cheap Medicare Insurance Another new gift to the over 65 market are Medicare Medical Savings Accounts. These are high deductible $0 Medicare Advantage plans that offer a separate tax-advantaged account funded by the insurance company.

The insurance company’s contributions always belong to you – even if you disenroll and choose different coverage later. You can spend your allocated funds on a tax-free basis for Qualified Medical Expenses. The coverage works much like a Health Savings Account for those under age 65.

Each year the insurance company contributes a couple thousand dollars to your account. These contributions could be used to meet the deductible, pay for prescriptions, vision & dental care, and a host of other items.

If you don’t utilize much healthcare, your savings account can grow significantly over time. The insurance company will continue to contribute each and every year. And by government rule, your premiums must remain at $0 a month.

The amount contributed depends on which policy you select and when during the year you sign-up. Contributions are prorated if you sign up in the middle of the year.

These no-network Advantage plans work well for savers in above average health who like to keep control of their finances. Medical Savings Accounts don’t include Part D drug coverage, so you will need to purchase that plan separately. Overall, there’s a lot to like about $0 MSA policies.

4) Inexpensive Medicare Supplement Coverage

If you’re worried about the network restrictions you can encounter with some Medicare Advantage plans, you might consider an inexpensive Medicare supplement plan. Depending on your age, gender and State of residence, you can often find Medigap plans for under $50 a month.

One such policy is High Deductible Plan G. It has a one-time, yearly deductible near $2,340 a year. Worst case scenario, that’s the most you would face in any given year. That’s much less out of pocket than several Medicare Advantage plans – and much less exposure than having nothing at all. All of that for a very reasonable price. We see a lot of interest in this particular policy.

And no matter which supplement you might choose, it’s wise to shop when your rates increase. Medical underwriting will likely be required, but it you pass, you can lower your rates dramatically. We help our clients shop whenever their rates increase significantly.

5) Keeping Tabs on Your Part D Drug Plan

If you own a Stand-Alone Part D Drug policy, then it can be advantageous to compare plans each Annual Election Period (AEP) in the fall. Failing to do so can cost you money. We see a lot of consumers with old Part D drug plans paying $50-$80 a month. Oftentimes a newer plan with much lower premiums would provide them with similar, if not better, coverage.

Insurance companies quietly change drug plans almost every year. Old policies are discontinued and you can get automatically mapped into a much more expensive plan if you’re not paying attention. This sometimes results in higher premiums, larger deductibles, and higher copays on your prescriptions.

If you have an older Stand-Alone Part D Drug plan, then it’s wise to shop for new coverage during the Medicare Annual Election Period. This window runs from October 15th thru December 7th each year. It’s usually the only time you can make this change and save money.

6) Low Income Subsidies & Extra Help

There are several programs available from Federal and State Governments for those below certain income thresholds. The Federal Government will send notification if you qualify for Low Income Subsidy – or LIS for short. This program works on a sliding scale and can reduce your Medicare premiums and/or out of pocket expenses.

Others may qualify for Medicaid. This is a state run program and consumers typically need to apply as this enrollment may not happen automatically. If you’re not sure about eligibility standards, call your State Medicaid office to discuss and apply.

Outside of Medicaid, there are other state-run programs that help with pharmaceutical costs. It’s wise to investigate those as well as any discounts you might receive from the drug manufacturers themselves. This information isn’t always volunteered, so you’ll need to inquire and apply. When and where provided, these programs can reduce costs significantly for those who qualify.

Contact Us For No Obligation & No Cost Insurance Assistance

The bottom line: The worst thing you can do is nothing. There are several no-cost and low premium plans that will reduce the gaps in your Medicare coverage. If you do nothing, you’ll likely be on the hook for much larger bills than if you had chosen one or more of the options above.

If you’re not sure which route might be best for you, contact us today. There is not cost whatsoever to use our services for guidance, advice and enrollment.

Category: Medicare Advantage, Medicare Supplements, Retirement Planning

medicare card The 2020 Medicare open enrollment period is fast approaching. It runs from October 15th through December 7th – plan changes will not be effective until January 2021. Our agents are busy training so we can discuss important new plan benefits, costs and features.

In insurance speak, this period of time is also referred to as the Annual Election Period or AEP for short. It is the one time during the year when certain insurance changes can be made for Medicare beneficiaries.

Allowable Insurance Changes During AEP

There are several changes Medicare beneficiaries can make during the 2020 Medicare open enrollment window:

Changing Medicare Advantage Plans
Enrolling in a new Prescription Part D Drug Plan
Leaving Medicare Advantage to rejoin Original Medicare
Leaving Original Medicare to join a Medicare Advantage Plan
Shopping for less expensive Medicare Supplement coverage

If this if your first AEP, it may seem confusing, but if you’re happy with your current insurance coverage, there is nothing that you need to do. The list above is only stating your options.

The most important advice to keep in mind is following the rules. Enrolling in some plans will make you ineligible for others. Missing certain dates can also have consequences. It is a good idea to work with a knowledgeable agent or agency (like ours) if you are considering any of the above. There is no cost to do so.

Switching Medicare Advantage Coverage During AEP

If you are already enrolled in Medicare Advantage Prescription Drug (MAPD) coverage, you can shop for and enroll in similar coverage with another (or the same) carrier if you find a plan that better meets your needs. Sometime plans change year over year and there are plans that reduce your premiums and/or out of pocket exposure. Other times a new plan might offer a better network of doctors and hospitals.

We can help you compare plans starting October 1st, but enrollment must take place between Oct. 15th and Dec. 7th. Your new coverage will become effective as of January 1st 2021.

It is important to learn all the details of any new coverage you might be considering. Medicare Advantage plans can differ quite a bit. That is to say a PFFS plan will differ from a HMO, PPO or Medical Savings Account. And you’ll also want to ask how any changes will affect your prescription drug coverage.

And some plans offer new benefits like a free gym membership, rides to your healthcare provider, meals during recovery periods and/or dental and vision insurance. There’s a lot to compare

Purchasing A New Prescription Part D Plan

Your options for changing Part D coverage may differ depending on whether you are enrolled in a Medicare Advantage or Medicare Supplement plan. Some Advantage plans offer drug coverage and some do not.

If you are considering changing your Part D coverage, you will want to make sure it does not affect any MA (Medicare Advantage) plan you are considering. Enrolling in a stand-alone Part D plan can automatically dis-enroll you from some MA plans!

By rule, all Medicare supplements sold today do not offer drug coverage. Typically, prescription Part D policies are offered on a stand-alone basis. They are separate from traditional Medicare supplements life Plans F, G, and N. Changing to a new Part D plan will have no effect on your Medicare Supplement plan.

Finally, there can be penalties for those who enroll late in Part D drug coverage. If you’re not sure about how enrollment deadlines personally affect you, then contact us.

Leaving Or Joining Original Medicare A & B

During the 2020 Medicare AEP open enrollment window, you can leave original FFS (Fee for Service) Medicare to join a Medicare Advantage plan.

You can also plan leave your MA plan to rejoin FFS Medicare A & B and purchase a stand alone Part D plan.

Either change will become effective January 1, 2021.

There are several reasons you might consider making either of these changes and each decision has its own ramifications. This is not to say one is better than the other, rather that it’s important to know how these changes affect your ability to enroll in other types of Medicare insurance.

The ins and outs of the two scenarios above can be somewhat complex. If you are considering either for the first time, please make sure you understand how that might affect your ability to make changes the following year. It’s best to talk with someone who does this on a daily basis. It’s easy to make mistakes.

Shopping For A New Medicare Supplement Plan

If you are currently enrolled in a traditional Medicare supplement insurance plan and shopping for lower rates, then the 2020 Medicare open enrollment window will have little bearing on your options.

In most states, you can change Medicare supplements any time you wish. The process will be the same as insurance companies will require some amount of medical underwriting to prove you are insurable.

In some states (like MO and CA) there are specific, individual yearly anniversary periods when you can switch Medicare supplement insurance coverage without medical underwriting. These states are the exceptions to the rule. Most times, you must pass medical underwriting to switch to a plan with lower premiums.

The Annual Election Period does not provide you with a window to purchase a new Medicare supplement without medical underwriting. And this is the time of year when Medicare supplement prices are typically going up for the next year. Thus, it can be advantageous to shop for and change your supplemental coverage before the fall season when possible.

2020 Medicare Open Enrollment Assistance

Hyers and Associates is an independent insurance agency specializing in Medicare insurance policies of all kinds. We work in several states and are licensed with many, many insurance companies.

If you are unsure of your options during the 2020 Medicare open enrollment window, then contact us. We will be happy to help you compare plans and advise you on your options.

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Category: Medicare Advantage, Medicare Supplements

Which Medicare Insurance Is Best? Currently, there are approximately 66 million Americans enrolled in Medicare. And that number is climbing daily.

Medicare is a government-backed health insurance program helping those 65 and older afford health care. However, it does not cover all of your expenses.

You’ll usually want to supplement your coverage. Unless you have group, retirement coverage, or VA Benefits, this means you’ll want to compare Medicare Supplements to Medicare Advantage plans.

The Case For Medicare Advantage Plans

Medicare Advantage is one way to round out your Medicare benefits. Medicare Advantage insurance is private, but includes coverage for Vision Insurance, Dental Insurance, Hearing Insurance, and qualified Wellness Programs, such as Silver Sneakers.

They can also cover expenses such as transportation to doctor’s visits, over-the-counter medications, and adult daycare services. These policies can even be found for $0 a month. They are affordable and help close many gaps for seniors.

However, there can be network restrictions as these plans are usually HMOs and PPOs. And your out-of-pocket exposure can be higher for hospital stays and other medical expenses.

The Case For Medicare Supplement Insurance

Medicare Supplements, or Medigap, are another great way to help you pay for out-of-pocket expenses not covered by Medicare, such as deductibles, copayments, and coinsurance.

There are 10 different plan options, the most popular of which are Plans F, G, and N. All three offer the most comprehensive coverage.

There are no networks to worry about. You can see any doctor or hospital that accepts Medicare. And you have very little out-of-pocket exposure with most Medicare Supplement policies. There will be less to pay when you go to the doctor or require hospitalization.

Which Coverage Should I Choose?

While you may say, “that’s great, I’ll take both!”, unfortunately, you are only eligible to choose one or the other.

Because of that, one question that may better serve you is, “What’s the cost difference between Medicare Advantage and Medigap?”

Medicare Advantage plans usually have lower premiums, but may not have as broad of coverage. This results in more out-of-pocket expenses.
Medigap offers more expansive coverage across the United States, as well as more flexibility with out-of-network physicians. Medigap makes it very easy to file a claim, but often has higher premiums.

However, Medicare Advantage policies offer prescription drug coverage with most plans, where Medigap users must purchase separate Stand Alone Part D coverage.

Contact Us With Questions

Which is better? The answer is not the same for everyone. Some may benefit more from a Supplement while others save money with an Advantage plan.

One size does not fit all. A lot depends on your utilization and overall health. And you’ll want to know how your decision today affects your options for change tomorrow. There’s a lot to know!

Hyers & Associates can help you work through the options. Call or request a no-cost, virtual appointment today!

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Category: Medicare Advantage, Medicare Supplements

Medicare IRMAA Fees If you are approaching your Medicare eligibility, you should be aware of the Medicare Income-Related Monthly Adjustment Amount – IRMAA for short. It applies to higher income earners and results in increased Part B and Part D premiums.

These increases might affect your decision to stay on your employer policy. If that’s not an option, then you may pay more for your Medicare premiums until your income decreases. View the charts below and read more to see what you can expect from your Medicare premiums in 2020.

How Does IRMAA Affect Part B Premiums?

This means-tested program operates on a sliding scale and is based on your income from two years ago. Even if your income was lower last year, your Part B premiums will be higher until you have two years of lower income behind you. You can expect to pay the adjusted amount so long as your income is above certain thresholds. The amount you pay is based on whether you file single or jointly.

The table below illustrates the Part B premiums for those with certain income levels. These amounts can, and usually do, change each year based on inflation metrics.

Individual Filers	Joint Filers	Married - File Separately	Your 2024 Monthly Premiums
AGI Less Than Or Equal To $103,000	AGI Less Than Or Equal To $206,000	AGI Less Than Or Equal To $103,000	$174.70
AGI Greater Than $103,000 And Less Than Or Equal To $129,000	AGI Greater Than $206,000 And Less Than or Equal To $258,000	N/A	$244.60
AGI Greater Than $129,000 And Less Than Or Equal To $161,000	AGI Greater Than $258,000 And Less Than or Equal To $322,000	N/A	$349.40
AGI Greater Than $161,000 And Less Than Or Equal To $193,000	AGI Greater Than $322,000 And Less Than or Equal To $386,000	N/A	$454.20
AGI Greater Than $193,000 And Less Than Or Equal To $500,000	AGI Greater Than $386,000 And Less Than or Equal To $750,000	AGI Greater Than $103,000 And Less Than or Equal To $397,000	$559.00
AGI Greater Than $500,000	AGI Greater Than $750,000	AGI Greater Than $397,000	$594.00

Part B is a cornerstone of Medicare. You should only defer Part B enrollment if you have qualifying group coverage (more than 20 employees) through your employer. If not, then it’s wise to begin Part B along with your Part A. For most, that happens at age 65, but there are circumstances when it can begin before or after age 65.

The IRMAA fee is not assessed by insurance companies, but rather the government itself. You pay them. The government will send you a letter as you approach Medicare eligibility stating what your IRMAA costs will be. The only way to avoid IRMAA is by not enrolling in Part B.

That’s not usually an option unless you have creditable group health insurance through work or retirement. If you don’t enroll in Part B when you’re supposed to, you’ll be assessed a late enrollment penalty for life.

(It should be noted there are no IRMAA fees for Part A. This program is free for most as it is earned through work credits or via spousal benefits.)

IRMAA Costs & Medicare Part D Drug Premiums

The second (and only other piece) subject to Medicare IRMAA increases are your Medicare Part D Drug plan premiums. Most consumers opt for a drug plan in order to reduce their prescription costs.

Whether you enroll in a Stand Alone Part D Drug plan or one that is part of a Medicare advantage plan, IRMAA can increase your monthly premiums. Here are the amounts:

Individual Filers	Joint Filers	Married - File Separately	Additional Monthly Amount Owed
AGI Less Than Or Equal To $103,000	AGI Less Than Or Equal To $206,000	AGI Less Than Or Equal To $103,000	$0.00
AGI Greater Than $103,000 And Less Than Or Equal To $129,000	AGI Greater Than $206,000 And Less Than or Equal To $258,000	N/A	$12.90
AGI Greater Than $129,000 And Less Than Or Equal To $161,000	AGI Greater Than $258,000 And Less Than or Equal To $322,000	N/A	$33.30
AGI Greater Than $161,000 And Less Than Or Equal To $193,000	AGI Greater Than $322,000 And Less Than or Equal To $386,000	N/A	$53.80
AGI Greater Than $193,000 And Less Than Or Equal To $500,000	AGI Greater Than $386,000 And Less Than or Equal To $750,000	AGI Greater Than $103,000 And Less Than or Equal To $397,000	$74.20
AGI Greater Than $500,000	AGI Greater Than $750,000	AGI Greater Than $397,000	$81.00

While it’s not mandatory to enroll in a drug plan, late enrollment penalties apply here as well. So if/when you do enroll later, Medicare will assess lifetime penalties – just like with Part B premiums.

Even if you don’t need drug coverage, it can be wise to purchase an inexpensive policy to stay compliant. These plans start around $13 a month in most areas of the country. The adjustments listed above would be in addition to the cost for your chosen plan. They are also collected by the government.

What About Medicare Advantage Plans?

Yes, IRMAA can affect the cost of your Medicare Advantage coverage. Many (not all) Medicare Advantage plans include a Part D prescription drug program. These are referred to as Medicare Advantage Prescription Drug plans – or MAPD for short. As mentioned above, it’s wise to have a Part D plan whether it’s on a stand-alone basis or one that’s part of an Advantage plan.

Even if you enroll in a $0 MAPD policy, you’ll still see the IRMAA charge tacked-on to the Part D piece of the policy. It’s unavoidable unless you enroll in a MA plan with no Part D coverage, but that could result in a lifetime of Part D penalties if you do enroll in one later.

Simply put, here are financial traps with Medicare. The government forces participation in order to avoid late enrollment penalties and coverage delays.

What I If I Still have Insurance Through Work?

Your ability to defer Medicare enrollment beyond age 65 depends on a couple of factors. To defer Part B, your employer group must be more than 20 employees. If not, the government says you must enroll in Part B. From there, you can work with a knowledgeable agent as to your next steps.

To defer Part D enrollment, you must have creditable drug coverage elsewhere. This could also be through work, a union, or even the Veterans Administration.

Many consumers are able to defer one or both programs until retirement beyond age 65. If you’re not sure, then it’s a good idea to ask a professional. We’ve seen many mistakes made with enrollment deadlines and requirements. Those can be costly now and/or in the future.

What About Medicare Supplement Premiums?

The short answer is they are not affected by IRMAA. If you choose to enroll in an Medicare supplement insurance plan, then there will be no IRMAA fees based on your income.

Several different factors will determine your Medicare supplement premiums, but income is not one of them. Medicare has a lot of gaps, so it’s wise to fill them.

And there is usually only one time (your personal 7 month open enrollment window) when you can purchase a Medicare Supplement no questions asked. If you don’t take advantage of that opportunity, it might be difficult to qualify later due to medical underwriting qualifications.

Talk With An Independent Agent

Undoubtedly, Medicare can be confusing. There are many decisions to be made, but they must be made carefully. One wrong step at the wrong time can lead to delays, penalties and extra costs.

If you want to speak with a Medicare expert, contact us today and we’ll walk you through your options. Our independent agency specializes in Medicare enrollment and can guide you through the entire process.

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Category: Medicare Advantage, Medicare Part D, Medicare Supplements, Retirement Planning

It’s the time of year when Medicare announces changes that affect Medicare beneficiaries and the insurance plans they own. Like most years, the 2020 changes are incremental, but larger than what we saw for 2019. We will discuss them below and how they will affect your out of pocket exposure.

(It’s important to note that when the officials at CMS (Centers for Medicare and Medicaid Services) make changes, it affects all insurance plans – both new and old. It doesn’t matter when you purchased your coverage – all plans must abide by any new cost sharing rules.)

2020 Medicare Premiums, Deductibles & Coinsurance

MEDICARE FEATURE	2019 AMOUNT	2020 AMOUNT	$ INCREASE
Medicare Part B Premiums (For Most People)	$135.50	$144.60	$9.10
Medicare Part B Premiums (New Enrollees)	$135.50	$144.60	$9.10
Part A Deductible (Inpatient Hospital)	$1,364	$1,408	$44
Part B Deductible (Physician’s Services)	$185	$198	$13
Hospital Coinsurance Days 61-90	$341	$352	$11
Hospital Coinsurance Days 91-150	$682	$704	$22
Skilled Nursing Facility Coinsurance	$170.50	$176.00	$5.50
High Deductible Plan F	$2,300	$2,340	$40

Medicare Part B Premiums in 2020

2020 Medicare Updates Medicare Part B premiums will be increasing for many Medicare beneficiaries in 2020 due to the increase in Social Security monthly payments.

Those who fall under the “hold-harmless” provision, by rule, must have their Part B premiums offset by increases in Social Security payments. Some will have their premiums raised to $144.60 a month while others will see smaller increases based on a sliding scale.

Those who are new to Medicare in 2020 will pay $144.60 per month – a $9.10 increase from 2019. This amount will be more for high income earners. The Income Related Monthly Adjustment Amount (IRMAA) requires individuals making more than $85,000 – and couples filing jointly making over $170,000 – to pay more for Part B coverage. There are four tiers to the IRMAA payment schedule. You can view them here.

Medicare Part A and Part B Deductibles

Most of our clients ask about the Medicare Part B deductible each year. The good news: The Medicare Part B deductible for 2020 is $198 – a $13 increase from 2019. This is an important amount for those who own Medicare supplements not covering the Part B deductible – like Plan G and Plan N.

Plans G and N continue to be some of our most popular policies because of the small Part B deductible. In many cases, the lower premiums with G and N more than make up for the deductible and/or office copay amounts.

Like most years, the Part A deductible (Inpatient Hospital Care) is only increasing slightly to $1,408 – a year over year increase of $44. Most Medicare supplements cover the Part A deductible, so this figure is not quite as important. The most popular policies, Plans F, G and N, all cover this gap.

What is the 2020 Plan G & Plan F High Deductible Amount?

High Deductible Plan F and G are also popular due to their low premiums and known out of pocket exposure. The deductible will only be increasing slightly to $2,340 in 2020. That’s a modest $40 increase from 2019.

Plan F, G and J are the only plans currently offered that come in a high deductible version. Plan J hasn’t been available for many years – and Plan F will only be available for those who were Medicare eligible before 2020.

High Deductible Plan G will be the only plan available for those who are new to Medicare in 2020 and beyond. In many states, HD Plan G will offer the lowest monthly premiums of any Medicare supplement for sale.

Medicare Supplement Plans K and L Maximums

Plans K and L were introduced in 2010 as part of the Medicare Modernization Act. In our minds, these plans most closely resemble Medicare Advantage policies. They have larger out of pocket exposure than more traditional plans like F, G and N. Unlike Medicare Advantage, Plans K and L do not have network restrictions, however.

CMS announced moderate increases for 2020 to the out of pocket maximums for these two unique plans. The out of pocket will be $5,880 for Plan K and $2,940 for Plan L. We don’t see a lot of interest in these two plans at out agent as others (including many Advantage plans) offer more value when comparing benefits and costs.

Contact Us For Quotes And Assistance

We are a full service, independent insurance agency. We license direct with all of our carriers and can help you enroll (at no additional cost) with the Medicare insurance plan the best fits your needs and budget.

We work with many, many carriers offering Medicare supplement, Medicare Advantage and Part D prescription drug coverage. Contact us today to compare your best options.

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Category: Medicare Advantage, Medicare Supplements

Medicare Open Enrollment for 2020 effective dates has begun. This window runs from October 15th through December 7th. All changes to your Medicare Advantage and/or Prescription Drug Part D coverage will take effect January 1, 2020.

Should you miss the Annual Election Period (AEP) open enrollment window, it may not be possible to make changes until this time next year. It’s important to review your coverage and make sure your benefits, costs, copays and network availability are still in-line with your needs.

What Are My Options During The Medicare Open Enrollment Window?

There are several changes you can make to your Medicare coverage during the AEP window. You can:

Switch to a new Part D prescription drug plan
Enroll in a new Medicare Advantage Plan
Disenroll from a Medicare Advantage Plan and return to Original Medicare
Compare and shop for Medicare Supplement Insurance

As you probably know, Medicare is full or rules and timelines. It’s usually a good idea to talk with a knowledgeable agent this time of year. Changing Medicare Advantage plans or enrolling into (or out of) an Advantage plan for the first time can be tricky. You’ll want to make sure you follow the Medicare guidelines so as not to incur penalties and/or delays.

Lowest Priced Part D Prescription Drug Plan For 2020

One of the most common changes this time of year is purchasing a new stand-alone Medicare Part D Drug plan. Medicare drug plans can change dramatically year over year and this year is no exception. You don’t want to assume your premiums, copays and deductibles will be the same. They won’t.

There are some significant changes for 2020 – more so than most years. WellCare has purchased Aetna’s book of business. Aetna has, in-turn, partnered with SilverScript. And Humana has introduced a new Walmart Drug plan. But if you have the old Humana Walmart plan, you will not automatically be mapped into the new one! In fact, you’ll be moved into a different plan with premiums that are twice as high. That change may not work well for a lot of consumers.

This year, more than ever, it’s important to check your options with several major changes happening. You may want to create an account at MyMedicare and plug-in your prescriptions. Or you may want to speak with an experienced agent if you’ve never shopped for a new Part D drug plan before.

There are several new competitively priced Part D plans for 2020. Aetna, Envision, Humana and Wellcare all have plans with inexpensive premiums, robust formularies and low copays on most generic drugs. Your best option may depend on which pharmacy you prefer. Mail order will be a good option with many of these plans as well. Make sure to review your ANOC for (Annual Notice of Changes) and then research all of the new plans for 2020.

There will be other comprehensive low cost plans offered from SilverScript, Anthem BCBS and United Healthcare. But remember you don’t want to shop on premiums alone. Copays are one of the most important factors in determining your best option for 2020. It’s best to shop by lowest overall cost. This method factors in your premiums, copays and the deductible all at once.

Switching Medicare Advantage During Open Enrollment

Medicare Advantage plans can and will change year over year. Many will adjust their premiums, drug coverage costs, health benefits and networks. A plan can have a $0 premium one year and increase the next. It’s wise to review all of your options each year – especially if you experienced higher than expected out of pocket costs during 2019.

We help our clients shop for new Medicare Advantage coverage each year. If you are unhappy with your plan for any reason, then the Open Enrollment window is the best (and sometimes only) time to make changes.

It’s comforting to know that we see more competition and better coverage from Medicare Advantage plans almost every year. In some counties, you might have over 40 plans to choose from. It’s wise to compare them all with an agent to see if one has lower prescription costs and/or better access to the doctors and hospitals you prefer.

Additionally, the government has loosened the reins on many Advantage providers. Many companies are offering new ancillary benefits, like: dental, vision & hearing coverage as well as rider services, wellness visits, gym memberships, free meals during recovery, and much more. While these are not reason alone to buy an Advantage plan, they can put some policies ahead of another.

Leaving Your Medicare Advantage Plan

This change can be a little tricky. There are several factors that will help determine your best course of action. Most people who drop a Medicare Advantage plan will also want to purchase a Medicare supplement and/or a stand-alone Part D Drug plan.

In almost all cases, Medicare supplement carriers will require medical underwriting if you’ve been in an Advantage plan longer than 1 year. This means you can be turned down. Your acceptance depends on how long you’ve had your Medicare Advantage plan, what type of insurance you have previously, and your overall health. You don’t want to assume you’ll be automatically accepted for a Medicare supplement policy.

The good news is you should have no trouble enrolling in a Part D drug plan when making this change. In almost all cases, those can be purchased on a guaranteed acceptance basis with no underwriting. You just need to make your choice by December 7th. After that, the Open Enrollment window is closed until next year.

Our brokerage can help you understand your options when disenrolling from a Medicare Advantage plan and returning to Original Medicare. If you have some health issues, there may be some Medicare supplement providers who will accept you – and others who won’t. We can help find the companies that may make this transition possible.

What About Changing Medicare Supplement Insurance?

Unless you live in certain states like California and Missouri, there is no open enrollment window for Medicare supplement coverage. If you want to change Medigap plans, in most cases you will need to pass medical underwriting. This usually consists of answering yes/no questions on the application and a phone interview with a medical underwriter. You won’t need to see your doctor. At the end, you can be turned down for any number of health concerns.

In other words, you can try to change your Medicare supplement insurance any time you want so long as you are able to pass medical underwriting. A lot of consumers wait until AEP to shop for better rates on these policies, but this change can be done throughout the year. We encourage our clients to call us year round to see if they can qualify for lower rates.

Applying for a new Medicare supplement during Open Enrollment does not guarantee acceptance like it does with Medicare Advantage and Part D plans. It’s best to shop while you are in good health and/or when you get a rate increase during the year.

Our Independent Medicare Focused Insurance Agency

We offer Medicare supplement, Advantage and Part D insurance policies direct from several carriers all across the country. There are no fees whatsoever to use our services. Contact us today to discuss your best Medicare options for 2020.

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Category: Medicare Advantage, Medicare Supplements

Medical Savings Accounts for those on Medicare There are several policies designed to fill the gaps in Medicare. Medical Savings Accounts from Lasso are no exception. These innovative insurance plans offer a great way save toward future health care expenses.

First, you must be enrolled in both Medicare Parts A and B to qualify. You must also live in the plan’s service area and redside in the US for more than 183 days a year. These plans are in 35 states for 2021 with two different tiers available.

What’s a Medical Savings Account (MSA)?

MSAs fall into the category of Medicare Advantage plans. They combine a high deductible health plan with an IRS approved custodial savings account. They are approved and regulated by Centers for Medicare & Medicaid services – our federal government.

By CMS rules, these policies must be offered at no cost to the consumer – they have no premiums. You still pay your Medicare Part B premiums to the government, but MSA plans cost $0.

There are two moving parts: Your deductible and the insurance company’s contribution to your account. Deductibles and contributions will vary by state and region. For example, one option for 2021 has a $5,000 deductible and a $2,000 deposit. Subtracting one from the other makes the member’s responsibility $3,000 for the year. That’s less than many HMOS and PPOs offered today.

At the beginning of each year the insurance company deposits funds into your MSA account. If you enroll in the middle of the year, then those funds (and the deductible) would be prorated based on the month of enrollment. The deposits belong to you – not the insurance company. The funds are in a no-fee, interest crediting account with Optum Bank.

Once you’ve met the deductible, there is nothing more to pay. Like most Medicare Advantage (MA) plans, it would take a hospital stay or big health event to meet the deductible. But unlike other Advantage plans, you get a large upfront deposit each year. You can apply that amount toward your deductible and other Qualified Expenses.

It’s important to note that these are not Medicare Supplement insurance plans. They are similar in that they have no network restrictions, however. With a MSA qualified policy you can see any doctor or hospital that accepts Medicare. They are not HMO or PPO type plans. You benefit most by using doctors who accept Medicare assignment – which most do.

What Should I Expect From a MSA?

Preparation for future and financial concept. Coins in glass jar with HEALTH label. Malaysia coins. The first thing to know is the insurance company’s contributions to your savings account are NOT use it or lose it. The funds belong to you – it’s more a matter of how you choose to spend them. In this way, they work very much like a Health Savings Account.

Your funds roll over year to year and can be spent on a number of Qualified Medicare Expenses (QMEs) as defined by the I.R.S. You can spend your money on physician services, labs, scans & x-rays, hospitalization and a host of other Part A and Part B services.

All of these items would count toward your deductible.

You can also use them tax-free toward eye glasses, dental work, hearing aids, over-the-counter and prescription drugs. You can see a long list of QMEs here.

You should be aware that if you choose to spend your deposits on non-QMEs, then there can be a penalty and the funds would be taxed as ordinary income. So it’s wise to know your options. These funds are not designed to be spent on a vacation or new car.

The yearly contributions made on your behalf are always yours. You cannot contribute additional funds to your account, however. Yearly contributions only come from the insurance company, but you are in control of how they’re spent.

Why Might I Enroll & What If I Leave the Plan?

Lasso Medical Savings Account Medicare Advantage plans are most popular with our well-organized clients who are familiar with HSA type policies. These consumers also tend to be in above average health. Those who might be planning a joint replacement – or something of that nature – might benefit more from a different type of Medigap plan.

And if you leave the plan, your remaining deposits stay with you. They do no belong to the insurance company. Should you leave mid-year, they can recoup a prorated amount. And should you have any funds in your account at passing, then those go to your named beneficiaries – much like a HSA or IRA account would.

Learn More About Medicare MSA Policies

For 2021, our brokerage is working with Lasso to provide MSA policies in several states, including Ohio! There is more to know, so we’ll be happy to explain the details of this exciting new coverage.

You want to keep in mind that MSA plans, by rule, do not include Part D drug coverage, so that will be a separate expense. And if you’re concerned about the gap between the deductible and their contribution in the first year or so, then you might consider an inexpensive hospital indemnity plan as a stopgap measure.

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Category: Medicare Advantage

Medicare Advantage Plan Insurance Medicare doesn’t cover everything so it’s wise to enroll in additional coverage. In our second part series, we discuss three reasons why you may want to choose a Medicare Advantage plan over a Supplement. (View Part One Here.)

There’s not always a right or wrong way to fill in the gaps, but in this post we’ll make an argument for Advantage plans. Many of our clients choose this option for a variety of reasons, but we’ll discuss the most common reasons below. We’ll also explain what to watch out for.

Background On Medicare Advantage

What are they? These are private insurance plans that, to some extent, replace government provided Original Medicare. In other words, you’re turning your Medicare A & B coverage over to a private insurance company like, Aetna, Humana, Cigna or United Healthcare. There are also many smaller regional companies across the country offering Advantage policies as well.

Most plans are HMOs and PPOs, but you will also see PFFS, MSA and Cost plans available too. Usually these plans have networks of doctors and hospitals you’ll want to use for routine care in order to keep your costs lower. Going out of network can cost you more – ore in some cases – not be covered at all.

You can’t have both a Medicare Supplement and an Advantage plan. It’s one or the other. Either you keep your Original A & B benefits from the government and pair it with a Supplement – or turn your coverage over to a private insurance company who will insure your government benefits and more.

1) Most MAPD Plans Offer All In One Coverage

Many of our clients like the convenience of Medicare Advantage Prescription Drug plans. These all-in-one policies privately cover everything provided by Original Medicare (Parts A & B) while also including Part D Drug coverage. They close all gaps in Medicare so you know exactly what your maximum out-of-pocket exposure will be for the year.

You’ll typically have copays, coinsurance and deductibles, but so long as you don’t have a significant health event, your out-of-pocket costs should be minimal each year. And the network of providers with Advantage plans are fairly robust in most areas. Many policies provide concierge services when you travel and will help you find doctors and hospitals in your area if needed. This is helpful for those who travel extensively and/or own multiple homes.

2) Extra Benefits At No Additional Cost

Medicare Advantage plans have more flexibility in the benefits they can offer. We have to be a little careful as Medicare does not want consumers to buy these plans for the extras alone. They are nice to have, but not usually the best reason to choose an Advantage plan over a Supplement.

That being said, many policies will include basic dental and vision coverage at no additional cost. Oftentimes, you can buy-up if you want more comprehensive dental and vision coverage – some benefits available without waiting periods. Other plans will include transportation services to and from doctor’s appointments – and free home meal delivery if you’re recovering from an ailment or procedure. Still others can provide quarterly funds toward over-the-counter items that monitor or improve health.

But the benefit we’re asked about most often is Silver Sneakers. The good news is almost all Medicare Advantage plans include a free Silver Sneakers gym membership with your policy. That’s a big help for those who enjoy going to the gym, but don’t want to pay a monthly membership fee.

3) Low To No Cost $0 Medicare Advantage Plans

The cost of the insurance policy itself is a very important factor for most of our clients. Medicare Advantage plans are popular because they can be found for under $50 a month in a lot of areas. In fact, you’ll see many HMO, PPO and MSA plans offered for $0 a month.

Having no monthly premiums does not necessarily make Advantage plans inferior, but there are some risks. Zero cost plans can have more out-of-pocket exposure to the insured, smaller provider networks, and/or less comprehensive drug coverage. You’ll want to review all of these items with your broker. We have many clients who get along just fine with $0 policies, however.

The bigger risk is if you have a significant medical event. Most Advantage policies will have somewhere in the neighborhood of $3,500-$10,000 in out-of-pocket exposure depending on whether you are in – or out of network. This would be for something like a major surgery or prolonged hospital stay. Otherwise it would be hard to reach those maximums.

And remember, you still have to pay your Medicare Part B premiums to the government no matter what. So even though your Medicare Advantage plan is free, you still pay the government. Your Part B premiums are unavoidable, but some plans offer Part B premium reductions to those who qualify.

Are Medical Savings Accounts A Good Option?

Preparation for future and financial concept. Coins in glass jar with HEALTH label. Malaysia coins. Okay we said only three reasons to consider Advantage plans, but Medical Savings Accounts (MSA) deserve a subheading here. These innovative Medicare Advantage plans offer a great way to save money while also accounting for future health expenses.

MSAs are $0 high deductible health plans that contribute approximately $3,200 each year into the owner’s account. The deposit can be used to pay the deductible which will range be in the range of $7,500 to $9,500 depending on where you live. If you’re in good health, you can cover your deductible after a two or three years of deposits.

There are no networks to worry about with Medical Savings Accounts and your balance rolls over each year. It always belongs to you. MSAs do not cover Part D drug insurance, however. Medicare Drug plans will need to be purchased separately when enrolling in an MSA.

Contact Us To Learn More About Your Insurance Options

We are a full-service, independent insurance brokerage specializing in Medicare Advantage, Supplements and Part D Drug policies. We’re licensed direct with dozens of providers across the country and can help you compare the options that best meet your needs and budget. Contact us today!

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Category: Medicare Advantage

Choosing A Medicare Supplement Policy When you’re Medicare eligible, you’re likely deciding how to best supplement your coverage. Should you choose a Medicare Supplement or a Medicare Advantage plan?

A good argument can be made for both, but for the purposes of this article we’ll explain why many of our clients choose a traditional Medicare supplement plan. Also referred to as Medigap policies, these plans (like F, G, & N) work with Original Medicare as oppose to replacing it.

1) No Network Restrictions With Supplements

The primary reason many of our clients enroll in a Medicare supplement is to avoid the hassle of network restrictions. When you choose a supplement, you can see any doctor or hospital that accepts Medicare. Your supplement will not in any way determine who you can see – or where you can receive care.

Medicare Advantage plans work differently. Most of these policies are HMOs and PPOs. In other words, they have networks you need to use in order to keep your medical costs down. If you go out of network, you’ll pay more. And in some cases, out of network care may not be covered at all. Additionally, some Advantage plans require a referral from your Primary Care Physician to see a specialist.

Since Medicare Supplements have no networks to worry about (they simply start paying after Medicare stops), they’re convenient for those who travel frequently within the U.S. They can also be more suitable for those who have second homes in other states. With a supplement, you never need preapproval to go see any doctor or hospital that accepts Original Medicare.

2) You Have Limited Out Of Pocket Exposure

The other nice feature Medicare supplements provide is predictability. With almost all of these plans, you’ll know exactly what your out-of-pocket exposure is for the year. The most commonly purchased policies (like Plans G, N and F) only have a couple of hundred dollars that you are responsible for each year – if that. Then your supplement covers the rest of any Medicare approved expenses you might encounter.

Medicare Advantage plans have much higher out-of-pocket exposure for the insured. It’s not uncommon to see yearly out-of-pocket maximums in the $5,000 – $10,000 range. Your exposure will depend on what plan you choose (HMO, PPO, or PFFS) and whether you are in (or out of) network for your care. It’s much harder to predict, but the cost-sharing is much higher with most Advantage plans.

3) You’re Tailoring Your Coverage To Fit Your Needs

You’ll here many insurance companies refer to Medicare Advantage plans as, “All in One” policies. That’s because they privately insure you for what Medicare Parts A and B cover – while also filling in some of the gaps in A and B. On top of that, many of the policies include Part D drug coverage and some dental and vision insurance.

But some of our clients like to tailor their Medicare insurance coverage to their needs. This means selecting the Medicare Supplement that’s best for them, choosing a separate Part D drug plan that best covers their specific prescriptions, then choosing a comprehensive dental and vision plan that their providers accept.

Sometimes an Advantage plan can work well for some of these part, but not all of them. Maybe they don’t have a favorable copay on a particular prescription – or one of your doctors is not in the plan’s network. While you usually pay more when purchasing each piece separately, you have the peace of mind knowing that all parts should be a better fit overall.

And there are a handful of plans available that offer a free Silver Sneakers gym membership. This is a great way to stay healthy and in shape while not needing to spend more money on memberships.

Contact Us To Compare All Of Your Medicare Options

Still not sure? Read our article on the top three reasons to choose a Medicare Advantage plan and then contact us with questions. Hyers and Associates is an independent insurance brokerage specializing in Supplements, Advantage, and Part D Drug plans.

We can help you compare all of your options so you can find the insurance coverage that best suits your needs and budget!

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Category: Medicare Advantage, Medicare Supplements

Medicare Supplements with Silver Sneakers Many of our clients ask about the free Silver Sneakers gym membership and how to qualify when shopping for supplemental insurance plans. It can save members a lot of money.

Some insurance companies offer this valuable benefit, but many do not. And availability will depend on where you live. We help our clients compare the Medicare insurance policies offering this perk while crunching the numbers to make sure they aren’t overpaying for their coverage.

What Is Silver Sneakers & Why Should I Be Interested?

Silver Sneakers is a gym and fitness membership organization for those age 65 and older. It partners with several health insurance plans in order to offer unlimited gym access to over 13,000 locations across the country. This program also offers free fitness classes (both in and out of the gym) to accommodate all levels of experience.

More than 60 health plans nationwide have partnered with Silver Sneakers to include this valuable benefit. Some of these include AARP Silver Sneakers (also known as United Healthcare), but they have discontinued this relationship in several states.

Many Medicare supplement and Medicare Advantage insurance plans include this benefit at no extra cost.

Medicare Supplements With Silver Sneakers Membership

As a rule of thumb, more Medicare Advantage plans offer Silver Sneakers than do Medicare supplement policies. Membership availability will depend on the State where you live. It’s more common to see larger insurance Medicare supplement providers offering this benefit. Many smaller companies will not.

Popular insurance companies like Anthem Blue Cross and Blue Shield, Humana, United Healthcare (AARP), and Medical Mutual of Ohio offer this program in many states. This benefit does not cost extra. It is included as part of your overall monthly premiums.

Taking it a step further, Silver Sneakers is one of the very few benefits that Medicare supplement insurance companies are allowed to include at no additional cost. Unlike Medicare Advantage plans, supplemental policies cannot (by rule) include many ancillary benefits. Gym memberships are one of the few free service available.

Medicare Advantage Plans Including Silver Sneakers

There are many, many Medicare Advantage plans affiliated with Silver Sneakers. Your options will depend on where you purchase your insurance. If you would like to see which insurance companies in your state include this plan, view the participating health plans here.

It’s not uncommon to see both large and small insurance companies include this popular benefit. Large carriers like Aetna, Anthem Blue Cross & Blue Shield, Coventry, Gateway, Humana, United Healthcare and WellCare (to name a few) participate in most states.

Which is Better – Medicare Advantage or Supplements?

It’s important to know that Medicare Advantage plans are much different than Medicare supplement plans and you cannot have both at the same time. While Silver Sneakers is a nice perk, it may not be reason enough to choose one policy over the other. It’s a good idea to discuss the differences with an independent agent before enrolling.

Getting The Most Out Of Your Medicare Insurance

Too often Medicare insurance policies are purchased and stashed away. Whether you purchase a Supplement or Advantage plan, it’s important to know about extra benefits. Medicare Advantage plans are allowed to offer ancillary benefits like dental, vision and hearing. Conversely, Supplements, by rule, cannot usually offer as many added benefits.

How do I Get Silver Sneakers?

If you aren’t sure, just ask your agent while considering your options. Sometimes we cannot disclose all perks offered by an insurance company so as not to inadvertently steer clients one way or the other.

Of course, Silver Sneakers is one of the biggest perks and some of our clients will choose a carrier based on this benefit alone. It’s important to crunch the numbers, however. If you frequently use the gym and a membership will save you $60 a month, then it might be an easy decision. But if you don’t use the gym often you might benefit from a lower cost Medicare plan that does not offer this benefit. We can help compare your best options.

Here are a few FAQ’s that will help you:

What Insurance Plans Include Silver Sneakers?

The best way to find the participating plans is to check out the Silver Sneakers eligibility page and look there. The website will tell you exactly which health insurance plans cover it.

What’s the Silver Sneakers Minimum Age?

In order to qualify for this program, you have to be at least 65. Generally it is given in conjunction with the age for Medicare.

How do I Get My Membership Card?

You’ll receive a 16 digit code or card from your health insurance company. Once you have that, you can access any participating gym or center. You will also receive a card you can use at any participating gym or fitness location.

What Does it Include?

You get access to over 15,000 gyms across the nation. Not only can you get into the gym, you are able to take classes that promote a healthy lifestyle. Also, many gyms offer programs and social opportunities for their members. As a note that you don’t have to got a gym to take the classes. Many community centers and other places are available to you. And there are additional programs that allow you to save toward a family member’s college scholarship!

Contact Us For Quotes, Coverage & Enrollment

Hyers and Associates is an independent insurance agency specializing in Supplements, Advantage plans and Part D coverage. We help our clients compare and contrast all of their options. We’ll tell you which plans offer Silver Sneakers and discuss whether or not this value-added benefit puts one plan on top of another. Contact us today!

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Category: Medicare Advantage, Medicare Supplements

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1) No Network Restrictions With Supplements

2) You Have Limited Out Of Pocket Exposure

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Contact Us To Compare All Of Your Medicare Options

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Medicare Advantage Plans Including Silver Sneakers

Which is Better – Medicare Advantage or Supplements?