Frequently asked questions

What is Medicare Insurance

Three months prior and three months after you become 65 years old you eligible to file for Medicare benefits. Medicare consists of four parts as follows:

Part A: Covers your hospitalization

Part B: Covers your Medical Services

Part C: Is known as an advantage plan that includes 100% of your medical expenses plus it gives you prescription drugs. Private insurance companies administer these advantage plans. (Note that the benefits of this plan change by regions or area of service. Make sure that all the benefits of these plans are thoroughly explained to you as a beneficiary of Medicare.)

Part D: Medicare Part D, also called the Medicare prescription drug benefit, is a United States federal-government program that subsidizes the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. It was enacted as part of the Medicare Modernization Act of 2003 (which also made changes to the public Part C Medicare health plan program) and went into effect on January 1, 2006.

Individuals on Medicare are eligible for prescription drug coverage under a Part D plan if they are signed up for benefits under Medicare Part A and/or Part B. Beneficiaries obtain the Part D drug benefit through two types of plans administered by private insurance companies: the beneficiaries can join a standalone Prescription Drug Plan (PDP) for drug coverage only or they can join a public Part C health plan that jointly covers all hospital and medical services covered by Medicare Part A and Part B at a minimum cost.

(NOTE: Medicare beneficiaries need to be signed up for both Parts A and B to select Part C.) About two-thirds of all Medicare beneficiaries are enrolled directly in Part D or get Part-D-like benefits through a public Part C Medicare Advantage Health Plan.

Is Medicare Part of the Social Security Program?

Social Security and Medicare are two programs that have many similarities and can often get confused. Social Security is a government run program, that was established in 1935. This program offers income to those that have also worked and paid social security through their employment.

These two programs often become one in many people’s minds because the Social Security Administration (SSA) does handle enrollment and other aspects of both programs. Social Security Administration also determines who is eligible for the Medicare program and who will receive benefits. What separates these programs is that SSA offers income while Medicare provides health insurance and other benefits to Americans who have aged into the program and are able to enter this program due to disability.

What Is Advance Care Planning?

Advance Care Planning is the approach used for considering a person’s future and determining what health care will be needed as they continue to age. This is a difficult process and many families do not communicate about this issue and di not know how to confront the aging issue. One thing is certain, planning for your health needs will prevent unexpected misfortunes in health insurance coverage when it is most needed.

There are a few issues to consider when considering advance care planning. Always determine the individuals wishes and their current health status. Aligning the proper health care that the beneficiary desires for present and future needs is very important.

It is well advice that individuals document what they want done if they were to become disable and unable to communicate with family members and health providers. Advance care planning should involve physicians, patients, and family members to help ensure that the beneficiary receives the health care that he requested when he was able to communicate.

Can I Switch Between regular Medicare and Medicare Advantage?

Yes, you can change from one program to the other, but there are specific dates for this change. There are two dates in which you may do this, one date is the annual election period AEP which takes place from October 15th through December 7th. The second period takes place from January 1st and February 14th every year. The February 14th date is also the last day to enroll in a Part D plan that will cover you. This new plan will start the first day of the month after your enrollment date.

What are the Pros and Cons of Medicare Advantage Plans vs Original Medicare?

There are many advantages in utilizing a part C Advantage Plan. The main advantage in utilizing the advantage plans is that you get the most benefits included in the plan like 100% medical expenses and in many plans, you get other benefits such as prescription drugs, dental and vision benefits, over the counter non-prescription medicines and vitamins, silver sneakers and other benefits. Changes do exist between service areas make sure the plans in tour area of service is thoroughly explain to you.

The disadvantages of Medicare Advantage Plans are a few as follows;

1-In order to obtain services from a physician he or she must be in the physician’s network of the plan.

2- If you move out of the service area of the plan you are not able to continue visiting your doctors and must change to another plan offer in your new service area.

3-All services offer by the advantage plan are usually contracted out and they are also offered in the service area. Services such as dental, vision must be obtained from providers that have signed with the plan.

Advantages of having Original Medicare: The advantages of having Original Medicare is that you can visit any physician as long as they accept Medicare beneficiaries. It also allows you to go into any hospital in the nation that works with and accepts Medicare.

These are the main benefits that many beneficiaries of Medicare look for. This flexibility that many beneficiaries want in Medicare comes with a price. We know by now that Original Medicare only pays 80% of all your Medical Expenses. To obtain the remaining 20% of your medical expenses paid you must obtain a supplement plan from a private insurance company. These plans vary by prices depending on the benefits that you choose. These plans are lettered from A to F and the benefits are different.

My advice is that you get an agent who is experienced with all Medicare issues and your financial needs for you to obtain the right plan that fits your health and financial needs. On top of your supplement plan you must also sign up for a drug prescription plan that will add an additional cost to your budget. You must be careful in choosing your drug plan, the prices and the benefits do vary.

It is very important that your agent does an analysis of all the drugs that you take to arrive at the plan that will best fit your health needs. Always taking into consideration your financial needs.

Choosing your Medicare plan is confusing and a beneficiary always needs the consulting services of a licensed insurance agent who is knowledgeable and experienced with all the Medicare plans available to you in your service area.

What is a Health Saving Accounts (HSAs)?

A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. HSA funds roll over and accumulate year to year if they are not spent. The individual owns HSAs. HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty.

Over the counter medications cannot be paid with an HSA without a doctor's prescription. Withdrawals for non-medical expenses are treated very similarly to those in an individual retirement account (IRA) in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier. The accounts are a component of consumer-driven health care.

What is happening to my present Obama Care Health Plan?

I reserved this question for last since it is the most asked question from my customer base.

We really do not know at this time where we are going to end up at the end of the year and the plans that will be available in the market place through the government exchanges and private insurance policies.

The principal reason for this situation is that insurance carriers have withdrawn from offering their plans through the government exchanges that are offering the ACA plans aka Obamacare. I do plan to stay on this subject in the coming months and as soon as the new plans come out I will be letting you know the results. Everything is hanging with the new laws that Congress creates and hopefully approved by the Senate. This is a complicated situation for individuals like myself who have been selling health insurance throughout the years.

Presently due to the unaffordable price of an individual health insurance policy there are very few buyers in the market for these types of policies. I will continue working with my customer base with all their concerns about what is happening to their policies. Please feel free to contact me either by email or telephone call, I promise to answer all your questions and I will keep you informed on all coming changes to your health policy.