Seniorstar Insurance Group

Category: Financial

  • Medicare and Disabilities: What You Should Know

    Medicare and Disabilities: What You Should Know

    Medicare and Disabilities: What You Should Know

    For most beneficiaries, Medicare eligibility begins near. However, this is not the only qualifier for Medicare eligibility. Certain people with disabilities will qualify for Medicare enrollment before age 65. A few criteria must be met before one is eligible to receive Medicare before the age of 65.

    End Stage Renal Disease (ESRD) and Amyotrophic Lateral Sclerosis (ALS)

    Beneficiaries with either ESRD or ALS do not have to receive Social Security Disability benefits for 24 months to be eligible for Medicare.

    A person with ESRD must wait three months after a regular course of dialysis or three months after a kidney transplant to become eligible for Medicare. For ESRD, there are some criteria you must meet to receive benefits. You must have worked the required time and paid Social Security. You can also join the Railroad Retirement Board or have been a government employee. Getting Social Security or Railroad Retirement Board benefits will also qualify you. These two criteria can enable you to be covered if your spouse also meets these criteria.

    ALS is different because you are eligible for Medicare when collecting Social Security Disability benefits. There is typically a 5-month window between when a person is diagnosed with a disability and when they begin receiving Social Security Disability benefits.

    How Can I Enroll in Medicare If I Have a Disability?

    To enroll in Medicare with a disability, if you have been receiving Social Security Disability benefits for 24 months, you will automatically be enrolled. You will receive your Medicare card in the mail and a letter explaining that you are now enrolled in Medicare Part A and Part B. If you meet the standards but don’t qualify for Social Security Disability benefits, you can still purchase Medicare by paying a monthly premium for Part A and B.

    What Are the Medicare Benefits People with Disabilities Receive?

    The benefits people with disabilities receive through Original Medicare are the same as other beneficiaries who enroll in Original Medicare. This includes Medicare Part A coverage (inpatient care at a hospital, care in a skilled nursing facility, care in a nursing home, hospice care, and home health care) and Medicare Part B coverage (clinical research, ambulance services, durable medical equipment, and mental health care). These services don’t have to relate to a person’s disability.  Dual Special Needs Plans are a type of Medicare Advantage (Part C) plan that can offer personal care services and nursing home care that Original Medicare doesn’t cover for beneficiaries with certain conditions.

    Are There Other Conditions that Can Disqualify Me from Medicare Enrollment?

    Technically, no disabilities, illnesses, or underlying conditions disqualify someone from ever being enrolled in Original Medicare. Once someone meets the criteria for becoming Medicare eligible, they can enroll in Original Medicare. Beneficiaries can’t be denied coverage because of a timetable related to their condition or improvement of that condition. This means that people with mental illness, dementia, and other long-term chronic conditions could still possibly enroll in Medicare.

    However, it is crucial to understand the eligibility requirements for Medicare and that not all conditions make an individual eligible for Medicare. If someone does not have conditions or disabilities making them eligible for Medicare before turning 65, they will still become eligible when they are turning 65.

    Can Medicare Deny “Maintenance Only” Services?

    Even if a service is considered “maintenance only,” meaning it is only expected to maintain a condition or slow deterioration, it can still be covered by Original Medicare. Examples of “maintenance-only services” include physical therapy, which may be critical to maintaining a livable variant of a condition. Some conditions are more at risk of being unfairly denied coverage for services than others.

    Beneficiaries with conditions such as Alzheimer’s Disease, mental illness, Multiple Sclerosis, Parkinson’s Disease, and other long-term conditions are entitled to coverage if their provider order care that meets Medicare criteria. Consult with your doctor if you feel coverage has been wrongfully denied.

    If I Have a Disability, Can I Still Work and Receive Medicare Coverage?

    You can still work and receive Medicare coverage because of your disability. However, one must follow many guidelines while needing Medicare coverage while working with a disability. The Social Security Administration breaks this eligibility down into three time frames: Trial Work Period (TWP), Extended Period of Eligibility (EPE), and indefinite access to Medicare.

    Trial Work Period (TWP)

    If a disabled individual wants to try and work, they can do so and still receive Medicare during their Trial Work Period. The Trial Work Period consists of 9 months within any rolling 5-year period. A month is considered a month of service for a trial work period if it exceeds 2023’s amount of $1050 a month or if they work over 80 hours of self-employment monthly. It’s important to note that these nine months need not be consecutive. The beneficiary’s ability to perform their job cannot be used to disqualify them from receiving Medicare benefits – during the 9-month Trial Work Period. However, the work may be considered in determining the individual’s disability status and Medicare eligibility once the 9-month period has ended.  

    Extended Period of Eligibility (EPE)

    Beneficiaries whose disability is still active but who’ve earned income meeting or surpassing that of the “Substantial Gainful Activity” level can still receive Medicare coverage after their trial work period is over.

    The Substantial Gainful Activity levels are levels of income an individual cannot pass and still receive Medicare benefits. For statutorily blind individuals in 2023, the monthly amount is $2460; for non-blind individuals, the monthly amount is $1470. Read more here.

    The Extended Period of Eligibility lasts much longer than the trial work period; it can be extended as long as 93 months after it has ended. The beneficiary will pay no premiums for Medicare Part A; however, they are still responsible for their Medicare Part B premium. An individual’s Social Security Disability (SSDI) cash benefits may also end during this period.

    Indefinite Access to Medicare

    Suppose an individual remains medically disabled after the Extended Period of Eligibility (8.5 years) is up. In that case, they can still receive access to Medicare benefits if they are still considered medically disabled. They will however be required to pay both the Medicare Part A premium and the Medicare Part B premium. Original Medicare Part A’s premium will be determined by how many quarters you or your spouse worked and paid into Social Security. There is a helpful state-run buy-in program that can help low-income individuals pay these premiums.

    Seniorstar Insurance Group can help with any Medicare questions you may have. Contact us today for a free, no-obligation review of your coverage.

  • Will Medicare cover help for back pain?

    Will Medicare cover help for back pain?

    Will Medicare Cover Help for Back Pain?

    Back pain is a common problem among older adults in the United States. Because of this, the Centers for Medicare and Medicaid Services (CMS) has added more coverage in recent years that assists with covering back pain treatments.

    What kind of back pain treatments are covered by Medicare?

    Medicare will cover a list of non-surgical or minimally invasive treatments and even some required surgeries. Each part of Medicare will cover their respective treatments for back pain, and the costs have many factors that go into them. Even though Medicare has expanded its coverage of back pain, some more invasive treatments can still be difficult to get. Medicare may require treatments to be medically necessary before it is covered. This means they may require your pain to be at a certain level for a while. It could also mean they might make you try less invasive treatments first; if they fail, they will cover further treatment.

    What Are the Non-Surgical Treatments Medicare Covers?

    Medicare covers most common treatments and has even expanded the coverage in recent years. Below is a chart showing which common back pain treatments are covered by the different parts of Medicare.                                             

    What Are the Surgical Treatments Medicare Covers?

    Medicare may cover surgeries for back pain but often require less invasive treatment to be tried and unsuccessful first. When it comes to surgery, Medicare looks at it as a last resort and wants it to be medically necessary to cover it.

    Always speak with your physicians and surgeons if you suspect you may need surgery to ensure your back pain treatments are covered. Seniorstar Insurance Group can help you get the right Medicare coverage for your needs. Call us for a free, no-obligation review of your coverage today!

  • What Isn’t Covered by Original Medicare?

    What Isn’t Covered by Original Medicare?

    What Isn’t Covered by Original Medicare?

    If you choose to enroll in Original Medicare, it covers most of your healthcare needs after you turn 65 or if you qualify earlier due to certain disabilities or End Stage Renal Disease (ESRD). Original Medicare Part A covers inpatient hospital stays, surgeries, skilled nursing facilities, and some hospice and home care. Original Medicare Part B covers doctor visits, preventative services, durable medical equipment and supplies, and outpatient care. With all that coverage, Original Medicare still leaves you are responsible for some out-of-pocket costs, and there are still services left uncovered. If you choose to keep your Original Medicare coverage, enrolling in a Medicare Supplement, aka Medigap, plan can help fill in some of these gaps. You also have the option to opt for a Medicare Advantage (Part C) plan; these plans offer at least as much coverage as Original Medicare Parts A & B. They also may include additional benefits as well as prescription drug coverage.

    Here are a few things Original Medicare Parts A & B don’t cover.

    Prescription Drugs

    Original Medicare Part A & Part B do not cover prescription drugs. You will need to enroll in a standalone Medicare Part D Prescription Drug Plan to receive prescription drug coverage (and avoid penalties ) if you plan on enrolling in Original Medicare. You can enroll in Medicare Part D during your initial enrollment period. If you choose to enroll in a Medicare Advantage (Part C) Plan, prescription drug coverage may be included.

    Long-Term-Care

    Original Medicare Parts A & B do not cover long-term care. While some of the care in a skilled nursing facility may be covered, not all is. The average cost of a nursing home is upwards of $100,000 without any form of insurance. There is long-term care insurance to help individuals cover these costs.

    Co-pays and Deductibles

    Although Original Medicare covers trips to the doctor’s office, hospital stays, or any outpatient care, you still have to pay co-pays or deductibles. Original Medicare Part A will require a deductible before coverage begins, and you must pay a portion of the cost of a long hospital stay starting at day 61. Original Medicare Part B will also require a deductible, but you also must pay 20% of the costs of doctors’ services with Part B. Medicare Supplements can help ease the burden of some of these costs.

    Dental and Vision Care

    Most routine dental care is not covered by Original Medicare. Routine visits, cleanings, fillings, extractions, and dentures will have to be covered by a separate insurance plan if you choose to enroll in Original Medicare. Some Medicare Advantage (Part C) Plans can cover these basic cleanings and X-rays, but these plans have an annual coverage cap (as may some standalone dental plans). Routine vision care is also not covered by Original Medicare. There are exceptions to this, such as if you have diabetes or must have cataract surgery; you may get an annual eye exam through this exception. Some Medicare Advantage (Part C) Plans include routine vision care. For those choosing to enroll in Original Medicare, you may want to consider a standalone vision insurance plan.

    Hearing Care

    Hearing aids are another essential healthcare item for many. However, unfortunately, Original Medicare does not cover hearing aids or routine hearing exams. Just like vision or dental, some  Medicare Advantage (Part C) plans may be able to cover hearing care costs. Standalone hearing care plans are also an option.

    Traveling Abroad

    Any care you receive while abroad will not be covered by Original Medicare. However, some Medicare Supplements offer emergency care coverage when traveling abroad.

    Choosing the Best Coverage for Your Needs

    It’s important to fully understand the coverage you will receive, regardless of which type of plan you choose to enroll in when the time comes. For some people, Original Medicare and a Medicare Supplement provide the most effective mix of coverage, along with a Medicare Part D Prescription Drug Plan. Others may find the best option for their needs & budget is to enroll in a Medicare Advantage (Part C) plan. If you have questions about evaluating your Medicare options, give us a call for a no-cost, no-obligation coverage review.

  • What is the Medicare Part B IRMAA?

    What is the Medicare Part B IRMAA?

    What is the Medicare Part B IRMAA?

    Original Medicare Part B, sometimes referred to as medical insurance, helps to cover the cost of outpatient care, ambulance services, mental health services, durable medical equipment, and other medically necessary doctor’s services.

    For those enrolled in Original Medicare, the monthly premium for Original Medicare Part B is standardized. The standard premium (which most beneficiaries will pay) in 2023 is $164.90.

    For individuals with a higher income, a charge called the IRMAA (Medicare Income-Related Monthly Adjustment Amount) is added to the Medicare Part B premium.

    The IRMAA is determined annually by the Social Security Administration. They calculate whether or not you have to pay the IRMAA based on your annual income reported on your taxes from 2 years prior.

    In 2023, those who filed single and made more than $97,000 annually or those married, filing jointly making more than $194,000 annually will have to pay the IRMAA. IRMAA is a different amount based on your income from there, and individuals can pay up to $560.60 monthly for Original Medicare Part B. The chart below shows how IRMAA increases across the income brackets.

    If you feel the Social Security Administration’s tax amounts may need to be updated or corrected, you can file an appeal to have your IRMAA charge reduced or eliminated. Also, if you have a sudden life change affecting your annual income, this is another reason for filing an appeal. After receiving your notice of the change, you have 60 days to file an appeal.

    Seniorstar Insurance Group can assist in understanding these charges or answer any of your Medicare questions. Don’t hesitate to call us and reach out at 844-779-5010 or visit seniorstargroup.com for a no-cost, no-obligation coverage review.

  • What is a Qualified Medical Expense?

    What is a Qualified Medical Expense?

    What is a Qualified Medical Expense?

    If you have a Medicare Savings Account (MSA) plan, this money is intended to be used for Qualified Medical Expenses. When you spend the money on Qualified Medical Expenses, it is not taxed; however, it is taxed if you spend it on anything else.

    All qualified medical expenses are tax deductible, but they are not all eligible to count toward your deductible. This is important to consider, as you need to meet your deductible before your plan starts to cover expenses. If you use your MSA to cover the costs, not counting towards your deductible, you may pay more out of pocket overall.

    Examples of expenses that count toward your deductible

    • Hospital stays
    • Provider visits
    • Durable medical equipment (DME)
    • Home health care
    • Skilled nursing care

    Note: follow your plan’s coverage rules to ensure these expenses count towards your deductible

    Examples of expenses that do not count toward your deductible

    • Dental care
    • Vision care
    • Prescription drug premiums
    • Prescription drug deductibles
    • Prescription drug copays
    • Prescription drug coinsurance

    Can I use my MSA account for other expenses?

    You can use the money in your MSA account for non-medical expenses, but it is essential to know that it becomes taxable income. Keep this in mind when using the MSA money to cover rent, bills, groceries, etc., and ensure you have planned appropriately.

  • Does My Doctor Accept Medicare?

    Does My Doctor Accept Medicare?

    Does My Doctor Accept Medicare?

    When you are enrolling in Medicare for the first time or changing your Medicare coverage, it is advisable to check and ensure that any providers you wish to continue seeing will still be covered. How do you find out if your doctor accepts your Medicare coverage? The answer is quite simple. However, it does depend on the type of Medicare coverage you are enrolled in.

    Are you enrolled in Original Medicare (with or without a Medicare Supplement)? If so, you will need to find out if your provider takes Original Medicare. Your Medicare Supplement will also cover any provider who takes Medicare. If you are enrolled in a Medicare Advantage plan, you will need to find out which providers are in your plan’s specific network.

    How Do I Know if My Doctor Accepts Original Medicare?

    Finding out if a doctor or provider takes Original Medicare is simple. You can visit medicare.gov and use their easy-to-use, free tool to find and compare providers and facilities that accept Original Medicare.

    Along with finding providers, you can also use this tool to compare providers and facilities with information including:

    • Cost estimates for doctors
    • Dialysis facilities and hospitals in your area
    • Contact information for local inpatient rehabilitation centers
    • Quality ratings for home health agencies and nursing homes

    You can also easily create a list of your favorite providers with this tool once you are logged in to Medicare.gov.

     How Do I Know if My Doctor Accepts My Medicare Advantage Plan?

    All Medicare Advantage plans, whether HMO, PPO, or SNP, will have a provider network. This process may be familiar to you if you have ever had job-based coverage through a spouse, parent, or partner.

    To find out which providers are in your plan’s network, you can go to your Medicare Advantage (Part C) plan’s website or contact your provider to request a provider directory. For some plans, you may need a referral from your primary care provider in order to have care from a specialist or specific hospital. It’s important to know that with some plans, choosing your primary care provider can also mean you are choosing a network of hospitals and specialists associated with them. These are all things to keep in mind when choosing a Medicare Advantage plan.

    At any time during the year, Medicare Advantage plans can add or remove providers from their network.

    If you have any questions, feel free to reach out to the team at Seniorstar Insurance Group at 732 658 5100.

  • Medicare Savings Programs for Beneficiaries in New Jersey

    Medicare Savings Programs for Beneficiaries in New Jersey

    Medicare Savings Programs for Beneficiaries in New Jersey

    There are programs across the United States, both state-specific & national available to help Medicare beneficiaries on a fixed income and low incomes afford the health insurance coverage they need.

    In New Jersey, multiple Medicare Savings Programs are available for beneficiaries who meet the requirements. Two of the main eligibility requirements are the Medicare beneficiary must be a New Jersey resident & they are not financially eligible for the New Jersey Care program under NJ Medicaid.

    Here, you can find brief details about each program and how to apply for financial assistance from the NJ Medicare Savings Programs.

    Qualified Medicare Beneficiary (QMB)

    The Qualified Medicare Beneficiary program helps Medicare beneficiaries pay for Part A Premiums, Part B Premiums, coinsurance, & copayments for services and products covered by Medicare. To be eligible for this savings program, the Medicare beneficiary must be within the income and asset limits. You can find this year’s information on the State of New Jersey’s Department of Human Services website.

    Specified Low-Income Medicare Beneficiary (SLMB)

    The Specified Low-Income Medicare Beneficiary program helps eligible Medicare Beneficiaries pay for their Medicare Part B premium. To qualify for this savings program, the Medicare beneficiary must be within the income and asset limits; you can find this year’s information on the State of New Jersey’s Department of Human Services website.

    Qualifying Individual (QI)

    The Qualifying Individual program helps eligible Medicare beneficiaries pay their Medicare Part B premiums. To qualify for this savings program, the Medicare beneficiary must be within the income and asset limits. You can find this year’s information on the State of New Jersey’s Department of Human Services website.

    NJSave

    To apply for the above Medicare Savings Programs in New Jersey, you apply NJSave. NJSave is an online application that helps those with disabilities and seniors apply to save money on Medicare premiums, prescription drug costs, and living expenses. Below we have linked some resources to help Medicare beneficiaries or caretakers easily access NJSave.

    NJSave Video Tutorial

    NJSave Instructions

    For more assistance, contact your county’s Area Agency on Ageing or State Health Insurance Assistance Program (SHIP).

    How NJSave Helps Beneficiaries

    NJSave helps streamline the application process for Medicare Savings Programs or other savings programs for individuals with disabilities and seniors by submitting their application to multiple financial assistance programs, including:

    If a beneficiary meets the eligibility requirements, their information can also be forwarded to:

    We know that navigating the ins and outs of Medicare & Medicare Savings Programs can be stressful and a heavy lift. If you have any questions or would like any assistance, please feel free to reach out to the team at Seniorstar Insurance Group by calling 732 658 5100.