Original Medicare covers you in the United States of America, including the District of Columbia, Guam, U.S. Virgins Islands, Puerto Rico, Northern Mariana Islands, and America Samoa. If you are going outside of these lands and/or overseas, for a majority of the time Medicare will not pay for the health services or supplies. There are some rare occasions where Medicare will cover your service or supplies.  An example of the rare occasions where Medicare will cover your service or supplies is as the following: If your emergency happens in the United States of America but nearest hospital to treat you is in Canada or Mexico.

According to Medicare.gov “In some cases, Medicare may cover medically necessary health care services you get on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare won’t pay for health care services you get when a ship is more than 6 hours away from a U.S. port. “  As you can see, understanding the boundaries, the loop holes and the safety net created by Medicare is best left to an expert to fully understand.

Many experts advise their clients to invest in travel insurance as a “just to get home” safety net. when you have travel insurance you will have coverage for things that aren’t an emergency. It’s reasonably priced, and a great asset to have to in your back pocket if you are a frequent traveler, particularly an international traveler. If you have an emergency under $50,000, Medigap is a great option for you. With Medigap you can go anywhere in the U.S. that accepts Medicare . Also most Medigap plans include foreign travel emergency coverage up to  $50,000- but this coverage is meant to be reimbursed. For example, if you were hurt abroad, depending on the procedure needed you would either Medivac to the United States or receive treatment abroad. Either way, it would be your responsibility to pay for that procedure out of pocket, and then the insurance company will reimburse the claim. The Medigap covers 80% up to 50k, so you could still end up with a big bill.

So before setting sail, or boarding the plane, make sure you speak to your Medicare advisor and ask many questions. No one plans to have a medical emergency while on vacay, but it’s better to be proactive rather than reactive.

It’s that time of year again, the Annual Election Period (AEP) is upon us. If you’ve been a Medicare recipient prior to this year, then you are all too familiar with the implications of AEP. If this is your first enrollment season, then you’re about to experience what can be a frustrating and stressful time as a Medicare enrollee.

During the Medicare AEP, beneficiaries are able to alter their coverage under specific programs such as Medicare Advantage and Part D Prescription Drug plans. Often times, people make the mistake of thinking this is also the only time to change Medicare supplement plans, however those can be changed anytime throughout the year. The main things to focus on during AEP are switching from or to a Medicare Advantage plan, and entering into or changing your prescription drug plans.

You may be wondering why it is necessary to monitor these plans during the AEP, and the simple answer is that these plans change in coverage and price every year. If you don’t change or do anything to your existing plans, they will likely be much different in price and/or coverage as you enter into the next year. In many cases, the change can be significant. That’s why it’s always worth having your Medicare advisor analyze your existing plans and medications to ensure you’re still in the most cost-effective plan every year during AEP. Don’t wait, you could end up locked into a plan with a much higher premium or with holes in your coverage if you miss the AEP window (October 15^th through December 7^th).

In an effort to curb the stress and confusion that comes from Medicare AEP season, we’ve developed a list of 6 things that you should do to prepare.

1. Confirm your eligibility. This is pretty obvious, but you must be eligible to enroll in Medicare plans. If you’re unsure of your eligibility, consult this article from the US Department of Health & Human Services website: http://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html

2. Analyze your existing coverage thoroughly. Take some time to consider your past year of coverage. Weigh the pros and cons of the specific plan you’re in, the company/carrier of the plan, the total expenses (including prescription meds) of the year. Consider aspects like how quickly your claims were paid, if your doctor had any trouble with your insurance at any point, and if the out of pocket expenses were worth the healthcare you received.

3. Make note of any changes in medication or health that could impact your plans. After you’ve done a thorough self-analysis of your past coverage, make sure to note any looming changes that could be upcoming in your health. For example, if your doctor suggested a new medication or treatment that wasn’t previously needed when you set up your original plan. Write this all out and give your coverage an overall satisfaction rating for the year. This will help determine what the next move for you should be, and will make you aware of what you need most out of your healthcare coverage.

4. Compare prices of plan options for the coming year. There are MANY plans, programs, and carriers to choose from. When it comes time to select your coverage for the upcoming year, it’s essential to decide what type of Medicare beneficiary you are. Are you someone who would prefer to pay a little more on a monthly basis in exchange for peace of mind that you won’t have any unexpected expenses? Or would you rather pay a lower monthly premium and take the risk that your coverage may require high out-of-pocket expenses should you have a health issue? If you can answer this question for yourself, you’ll give a better starting point to determine what plan/program is a better fit and how much you will spend on said plan.

5. Make a list of your current medications, dosages, and frequency. After analyzing the entirety of your coverage, the next step would be to write down every medication you take, the dosage, frequency, and brand. This list is going to guide your Part D plan selection.

6. After completing steps 1-5, set an appointment with a Medicare advisor. After you’ve done the previous five steps, you have painted yourself a pretty thorough picture of your healthcare needs. Now it’s time to take this information to your Medicare advisor, so they can analyze and help you select the best coverage at the best price. Completing steps 1-5 prior to your call or appointment will make the process go much faster and smoother for you. *Helpful Tip: Always work with a non-captive Medicare advisor. They have access to all the plans and companies, not just one of them. This ensures you are in the best plan at the best price.

Remember, in order to ease the confusion, contact a Medicare representative to help make this AEP much smoother. If you don’t have a dedicated agent or aren’t sure, our toll-free Medicare hotline is open for questions, comments, concerns for anyone in the United States who needs consult on their Medicare plans/coverage at (888)-404-5049.

We’ve said it before, and we’ll say it again, Medicare is confusing. Which is why we dedicate our lives to helping seniors PREPARE for Medicare before they enroll. Knowledge is power! So with that being said, here is a list of 10 things that you probably don’t know about Medicare, and some of them may surprise you!

1. Medicare covers more than just senior citizens. Medicare is designed for the aging population, but under certain circumstances, people under the age of 65 can be enrolled. If you have a qualifying disability or End Stage Renal Disease (ESRD), you can get covered under Medicare.
2. Baby boomers are aging into Medicare at a rate of 10,000 per day. Back when Medicare was first designed, people weren’t living nearly as long as they are today. Add that to the baby boomer generation who are rapidly aging into Medicare at a rate of 10,000 people PER DAY, and you can see how Medicare is quickly going to get into trouble.
3. Enrollment can happen outside of AEP. There is a common misconception surrounding Medicare that you can’t change your plans unless it’s during the Annual Election Period (AEP) from October 15-December 7. While this is true for Medicare Advantage (Part C) and Prescription Drug Plans (Part D), you can change from Medicare supplement plan to plan anytime you want. There are always “special election periods” and change of status that can warrant a change outside of AEP as well.
4. Each part of Medicare covers something different. While the parts of Medicare can be the most confusing part, it’s all for good reason. Each part of Medicare means something different and works differently. Part A is for your hospital care, Part B is for healthcare outside of the hospital such as routine doctors’ visits and preventive care, Part C is Medicare Advantage, and entirely different program from original Medicare altogether, and Part D is the prescription drug plan. Every part works differently to make one whole picture.
5. How much Medicare actually pays out. Medicare supplemental insurance was created to fill in the coverage gaps left behind by original Medicare. Did you know that traditional Medicare only covers 80% of the Medicare-APPROVED costs? That means, YOU as the enrollee are responsible for that other 20%. This is where Medicare supplement insurance comes in. It covers your 20% if you keep up with your monthly premiums, and can save you a ton.
6. A “non-participating” doctor still takes Medicare. Despite what the status title of “non-participating” doctors suggests, doctors under this status DO accept Medicare. They just don’t accept it at the amount that Medicare pays, meaning these doctors reserve the right to charge the patient additional money on top of what Medicare approves. While it seems confusing, don’t be too alarmed if your doctor becomes a “non-participator”- it just means that they reserve the right to charge you 15% more than Medicare approves. This is typically only found with specialty doctors/treatments.
7. Waiting to enroll in Part D can cost you FOR LIFE. Once you’ve reached Medicare enrollment time, you also have to enroll in your Part D drug plan. If you don’t, you have to wait until the following AEP, AND Medicare charges a fee every month for the rest of the time you’re on Medicare (aka, the rest of your LIFE!) While the fee is minor, it can add up depending on your lifespan. 1% of the national average in premiums in what you pay PER month, so 12% per year, lasting forever.
8. Medicare doesn’t cover everything. If you’ve been to your doctor for a physical and you WEREN’T charged for it, your doctor didn’t file it properly. Physicals and some other procedures aren’t covered under Medicare. While Medicare paired with a supplement covers almost everything, and mostly the big stuff, it doesn’t cover everything.
9. Medicare doesn’t work outside the USA. Getting ready for a big vacation to Europe? Make sure you understand before you go that your traditional Medicare coverage doesn’t apply out of the country. If you have a Medicare supplement, you’re covered. However, traditional Medicare without a supplement or Medicare Advantage does NOT work outside the United States.
10. On average, with Medicare you get WAY more than you pay for. While your Medicare premiums and co-pays do add up, compared to the average amount of usage, you are saving a TON. Medicare may not be perfect, but it is still possibly the greatest government healthcare coverage known to us. Take advantage of it by preparing yourself properly with a supplement so you don’t get stuck with huge bills, but rather a predictable monthly premium.

It’s true; Medicare is complex. But it’s one of the best working healthcare systems out there, and if used properly it can save enrollees a ton of money in their health care and keep them healthier, longer.

Ever wondered what all the different parts of Medicare actually mean? There are many terms and ideas associated with Medicare that are constantly thrown around, but do you truly know what they mean? Our blog is aiming to answer some of the common and consistent Medicare questions so that you can better understand the industry, and furthermore, your coverage.

So let’s dive in today with the basics: defining the two primary parts of original Medicare, Part A and Part B. We’ll get into Part C & D on another day.

Okay, so let’s start with the more basic Medicare Part A.

Medicare Part A

This is your hospital insurance. Any inpatient hospital stays, care received in a skilled nursing facility, hospice care, and some health care are covered under Medicare Part A. This is pretty straight forward; however, it can be more complex depending on your healthcare status and provider. Often times “under observation” can be a troublesome status for a patient covered under Medicare to have, because it can cause trouble with coverage. That’s a story for another day though, so for now, just remember that “Medicare Part A covers your stay” (in most cases).

Medicare Part B

Okay, so this is your actual health insurance coverage. This covers two types of medical services:

• Preventive medical services such as flu shots, illness screenings, and the like, are considered preventive services. The lines here can become a bit blurred, but essentially, any sort of screenings or lab work that is done in an attempt to prevent major illness is considered preventive. Additionally, coverage can extend to necessary durable equipment like walkers or wheelchairs, when a diagnosis requires that.
• Necessary treatment is covered when patients require treatment and care to treat conditions or illnesses. Included in this category are x-rays, lab work, outpatient services, and doctors visits that are necessary per your condition.

For part B, just remember it either helps prevent illness with preventive care coverage or treats an illness or condition.

If you don’t have a Medicare supplement plan in addition to your original Medicare coverage, then you are responsible for paying a deductible annually, as well as 20% of the Medicare-approved amount with participating providers. This 20% can really add up quickly, especially if you are being treated for a serious illness. This is why in most cases it makes sense to have a Medicare supplement plan to back up your original Medicare.

Well that in a nutshell is Medicare Part A and B. Stay tuned for more Medicare news, tips, and facts by following our blog or social channels.

Add to that the growing number of insurance agents pounding on your door or filling your inbox, the pile of confusing mail awaiting you, and the government “experts” constantly modifying plans and procedures- now, you’re in trouble.

If you take ownership of Medicare knowledge, these pitfalls won’t affect you. In order to be the most educated Medicare buyer, you just have to stop doing these 3 things right now. What happens if you don’t? You waste money and time.

1. Stop buying insurance from agents.

Despite any claims otherwise, most insurance sales people tend to play favorites with carriers and products. In many cases the commission rates, incentive trips, and sales leads provided to the agent all contribute to the favoritism. On top of that bias, the Medicare landscape changes indefinitely; carriers in the Medicare realm usually enter the market at a great price, then are followed by substantial increases. Agents aren’t always giving the best advice, and you should really seek an advisor over an agent any day.

• Make sure that the agent you are working with has access to a multitude of carriers (they’re called many names like “non-captive”, “independent” or “non-exclusive”) and definitely avoid “captive” agents, who work exclusively for one carrier.

• Always ask, “What other carriers offer the same plan in my area?” We have literally seen scenarios where one carrier pays close to $300 more commission than another…for the same exact plan! In most cases, carriers who pay less commission to the agent have had more stable rates with smaller increases.

2. Don’t take the “easy” way out.

Most agents love to sell Medigap plan “F”, but it’s usually not the best plan for you. The honest truth is that because commission is a percentage of the premium you pay, plan F pays the agent the most. Plus, it’s the only plan that pays both Medicare part A and B deductibles, and all Part B co-insurance, which makes it very attractive. If you are in “open enrollment”, or can qualify for coverage, plan G is almost always the way to go.

Here’s why: Plan G requires you to pay the Part B deductible of $140 per year, but pays everything else the same as plan F. Most plan F premiums are far more than its friend plan G, but only for the convenience factor. Would you pay $300 more per year just to have a $140 deductible paid on the insurance companies’ behalf?

Here’s the other big secret about plan F: It has larger and more frequent rate increases than the other plans. Because Plan F is used for the “Guaranteed Issue” privilege, (for those who have lost coverage from somewhere else), Plan F almost always has more claims due to the absence of medical underwriting. The sicker the pool of people, the more the rates go up. When you apply for a plan G…you’ll know that everyone, except those who just turned 65, had to qualify based on their health. Healthier people=lower rates.

3. Stop buying into marketing tactics and sales clichés.

Here’s a short list of some of the most popular sales pitches used to convince a person to enroll, followed by the real interpretation:

• “The customer service is great and they pay claims really fast.” Tell us something we don’t know. Every sneaky agent uses this line, and they usually know darn well it’s out of their control. A good Medigap plan pays everything automatically that Medicare approves, and most clients will NEVER have to work with the carrier except for premium payment changes or a billing address change, etc. What’s more…it’s not as if the Medigap carrier is paying you, they are paying the doctor or the hospital. So whether they pay the claim in 2 days or 2 weeks is completely irrelevant to you. Don’t fall for this one!

“This carrier hasn’t had a rate increase in years!” Bad sign. A carrier who hasn’t taken a rate increase in more than 2 years is probably long overdue for one, and you’ll be along for the ride when it happens. It is far smarter to enroll in a plan that has just recently adjusted its rate, as the chances of you experiencing a large bump in price are far less. Little increases are fine, and necessary based on the claims activity. But huge ones are usually the result of a carrier trying to “buy” the business by maintaining a lower rate until it hits the number of clients it wants; then treating those “lucky” recipients to a whopping increase.

“This company also offers the Part D benefit, so you can have both plans with same carrier.” Run away from this line-giver as fast as you can. It makes no sense to even consider a Medicare supplement plan based on the Part D benefit. Any responsible agent would offer to run a complete prescription drug analysis before recommending a part D. The best one for you is the one that has the least out of pocket costs for that year, and it rarely ends up being the same company as your Medigap policy. You could end up overpaying WILDLY. A reputable, good company would offer a Part D analysis to determine what medicines you actually take, before trying to determine prescription coverage.

Non-captive agents help you get the best coverage at the best price, always. 

Okay, so we know insurance is a source of stress and angst for people everywhere. Am I in the right plan? Am I overpaying? Will our coverage be enough if something terrible happens?

If you’ve asked yourself these questions about your health insurance plan, then you are definitely not alone. It’s extremely difficult to navigate the sea of insurance options, plans, prices, and companies- it can be almost impossible to go it alone.

But even if you have someone to help you, how can you be sure that they have your best interest at heart? If you are working with a captive agent, we’d be willing to bet that they usually don’t.
So, what is a captive agent? A captive agent is an insurance salesperson who works for one insurance carrier and, therefore, can only offer products from said carrier, nowhere else. These are your typical big-name insurance companies like Blue Cross Blue Shield, HAP, or Humana. If you’re working with one of these companies, don’t worry, they all offer good products that meet health insurance needs. However, the agents representing these brands can only give you the price and coverage quotes of the products they have access to- which means only one carrier option. Aside from that, sometimes there are incentives given to agents for selling a certain product. This product might not be the best option for you, but if it gets your captive agent on a trip to the Bahamas they won’t tell you that.

This is why we ALWAYS recommend that you select your health insurance plan with the guidance and help of a non-captive advisor. Non-captive providers can select the best coverage for you at the best price from an infinite list of carriers. Not only that, but they can explain thoroughly the details of your plan and stay with you for years to come.

Try calling into find your captive insurance agent at their home office and we can almost guarantee you’ll be pushed through an automated phone system. Select a non-captive provider and you can access them directly anytime you want for questions or help regarding your plan.

Having a non-captive provider not only saves you money, but it saves you time and worry. A non-captive agent is not tied down to one carrier or persuaded by incentives to sell products like captive agents are. They only select the best plan at the best price to suit each client’s individual needs.

Okay, so let’s recap the primary differences between captive and non-captive insurance advisors:

• Flexibility– Non-captive agents have the flexibility to select from a wide variety of carriers and plans, not just one. This means they have a much higher chance of finding the perfect coverage/price for you.

• Accessibility- Instead of calling into a major corporation and going through the run-around, you can more quickly and easily access your non-captive advisor year round. Get a bill that doesn’t make sense? Give your non-captive advisor a call and they’ll be sure to help.

• Dedicated Resource- Even if you aren’t sure you’re ready to buy yet, a non-captive provider will give you information about the plans, health care laws, and policies whenever you need help. Think of your non-captive advisor as a dedicated resource for all insurance questions.

• Fluidity- Whereas many captive providers want you to think you’re stuck in your plan, there can sometimes be a way out if rates get to high (especially with Medicare supplement insurance). The ability you have to move if your plan doesn’t work out as well as you thought, is a benefit only offered by non-captive providers.

• Freedom- The freedom to live your life without stressing about your health insurance plan and how it affects your bank account, is something that can only be reached with non-captive agents.

For these reasons, we highly recommend you seek a non-captive provider to be your health insurance guide. Your wallet will thank you.

The annual enrollment period for medicare is between October 15th and December 7th each year.
During this time you’re going to be able to do a few special things.

• Change your Medicare Part D Plan.
• Change from and to medicare advantage programs.
• Change from a medicare advantage program to a medicare supplement.

This a time where medicare is crazy busy and agents are very active.

Keep in mind, if you have a medicare supplement you are going to be able to change your medicare at any day and time.

If you have any questions, ask an agent at http://www.omegabenefit.org/