Seniorstar Insurance Group

Tag: 65 and older

A Clearer Vision: Navigating Medicare Choices for Ophthalmology Care During the AEP

“This case not only underscores the significance of the AEP in reshaping healthcare options but also exemplifies how agents, armed with expertise and compassion, can positively transform lives within the intricate Medicare landscape.”

In the bustling realm of Medicare insurance, the Annual Enrollment Period (AEP) stands as a critical juncture for beneficiaries seeking tailored coverage. This case study shines a light on an instance where an independent Medicare agent from SeniorStar Insurance Group brought meaningful change to a lady in need during the AEP. Faced with a challenging eye condition and an unsatisfactory network, the agent adeptly transformed the situation by orchestrating a switch in her Medicare Advantage Plan.

The lady in question, let’s call her Mrs. Thompson, was grappling with a concerning eye condition that demanded specialized care. However, her existing Medicare Advantage Plan’s network failed to provide convenient access to an ophthalmologist in close proximity. Understanding the urgency and importance of her predicament, the independent Medicare agent embarked on a mission to alleviate her distress.

Employing a blend of industry knowledge, empathy, and resourcefulness, the agent meticulously analyzed the available options. Keeping Mrs. Thompson’s primary care physician unchanged was a pivotal consideration, ensuring the continuity of her general healthcare. After comprehensive research and consultations, the agent proposed an alternative Medicare Advantage Plan that seamlessly accommodated her primary care physician while also featuring an extensive network of ophthalmologists.

With clarity and patience, the agent engaged Mrs. Thompson in a detailed discussion, highlighting the benefits of the new plan and elucidating how the transition would enhance her access to ophthalmology specialists. Empowered by the agent’s guidance, Mrs. Thompson embraced the change, and the agent deftly navigated the enrollment process on her behalf.

In the end, Mrs. Thompson’s experience stands as a testament to the invaluable role played by independent Medicare agents. The agent’s dedication to her well-being and their unwavering commitment to securing the most suitable coverage brought resounding success. This case not only underscores the significance of the AEP in reshaping healthcare options but also exemplifies how agents, armed with expertise and compassion, can positively transform lives within the intricate Medicare landscape.

September 6, 2023
How Does TRICARE Work with Medicare?

How Does TRICARE Work with Medicare?

TRICARE is a healthcare program that provides coverage to uniformed service members, retirees, and their families globally. On the other hand, Medicare is a government-run healthcare program that provides healthcare to US citizens aged 65 and above, citizens under 65 with certain disabilities, and citizens with end-stage renal disease. It is possible for some individuals to be eligible for both TRICARE and Medicare.

When you turn 65, you must enroll in Medicare to maintain your eligibility for TRICARE unless you meet certain criteria. Within 90 days of becoming Medicare-eligible, you must also change your TRICARE health plan. The health plan you choose will depend on your eligibility for Medicare, your active-duty status or that of your spouse, and your current TRICARE plan. To remain eligible for TRICARE, both parts of Original Medicare are required.

TRICARE for Life

TRICARE for Life is a secondary coverage plan that provides additional coverage to Medicare beneficiaries with both parts of Original Medicare. This coverage is automatic and available worldwide, with no enrollment fees required. TRICARE for Life becomes the primary insurance when you are outside of the US.

TRICARE for Life and Prescription Drug Plans

TRICARE for Life also offers prescription drug coverage, which is considered “creditable coverage”. This coverage is similar to Medicare Part D coverage. If you have a Medicare Part D prescription drug plan, you may still be eligible for TRICARE for Life, but it may be redundant.

TRICARE for Life, Medicare, and Health Care Costs

TRICARE for Life is always the secondary coverage plan to Medicare in the US, but it becomes the primary coverage plan when outside of the US. In the US, Medicare files a claim with the healthcare provider first. After Medicare has paid its portion, the remaining claim is sent to TRICARE for Life, which then pays its portion directly to the provider.

If you have any questions about your coverage, Seniorstar can help you with a free, no-obligation review of your Medicare needs. Contact us today for assistance.

April 12, 2023
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.
January 4, 2023
Is a Medigap Plan Right For You?

You’ve decided that you want to go into a Medigap plan, also known as Medicare supplement, and you’re concerned the preexisting conditions affect your coverage. Do they affect your costs? Well, it depends. It depends on whether you’re already in a Medigap plan, whether you have a Medicare Advantage plan and for how long, whether you’re coming into Medicare for the first time and you’re in your open enrollment period. I’ll give you a quick explanation. This is Jamie Sholom with Seniorstar Insurance Group. Welcome to the Seniorstar Minute.

When you’re enrolling in Medicare for the first time, when you’re turning 65, there will be no preexisting conditions that anybody can pay attention to, no matter what kind of Medicare plan you want to go into if you want to go into a supplement plan at that point. You can do it with any company or any plan that provides those policies in your area. Now, if you’re coming off of existing Medicare insurance, whether that be a different supplement plan, maybe you’re looking to lower your rate.

Maybe you’re looking to switch plans or companies. Or if you’re coming off a Medicare Advantage plan and you want to opt out of that. You may have to answer health questions now, these insurance companies can deny you coverage if you have certain criteria met, certain chronic conditions, certain combinations of conditions. If you’re on certain medications, they can say no, which will make your ability to lower your costs or save money much more difficult. Now, there are other situations where they would where insurance companies with Medigap plans would have to give you what’s called a guarantee issue, meaning they can ask your health questions, but under limited circumstances.

And you would have a limited option in terms of what type of Medigap plan and which company to go into. If you need any more information or if you have any questions about your specific situation, please give me a call. My phone number, my website there on the screen. It’s been a pleasure to talk to you. Hope to hear from you soon.

July 9, 2021
Medicare Myths You Must Know…

Hi everyone,

Time and again, I’m on the phone with a client of mine answering questions like “Am I automatically enrolled in Medicare when I turn 65?” or “Can I get a Medigap plan at anytime?”.

Let’s clear things up. Check out the most wide-spread Medicare Myths below.

Myth: All Medicare Options are Provided by the Government
No. Medicare is a federal health insurance program, and you can get original (aka, Traditional) Medicare, Parts A and B from the government, but that doesn’t cover all of your medical costs. You can also buy your own Medicare plan from a private company to supplement or replace original Medicare. In either case, most people start the enrollment process when Social Security kicks in.

Myth: The Government Pays for Medicare
Not really. Most people will be eligible for Part A (hospital coverage) without incurring a monthly premium, but Part B (outpatient coverage), has one. The amount of the Part B premium can vary depending on income level and it will be deducted from your Social Security check if you receive one. If you’re not on Social Security, you will receive a bill.

Myth: You’re Enrolled Automatically at 65
Not always true. Being eligible for Medicare upon turning 65 does not mean you are automatically enrolled. The automatic enrollment into Medicare only happens if you have Social Security when you turn 65. If not, you have to enroll through the Social Security Administration.

Myth: You Can’t Apply Until Your 65th Birthday
Incorrect. When you age into Medicare, your initial enrollment period includes a seven-month period that includes the three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday. If you enroll in the months before you turn 65, your coverage will begin the first day of the month you turn 65.

Myth: You Have to Be 65 Years Old to Receive Medicare
Not completely true. Some people under 65 who have certain disabilities and who have been eligible for Social Security Disability Insurance for at least 24 months as well as with permanent kidney failure, also qualify for Medicare benefits.

Myth: You Have to Wait Until You Retire
False. If you are still working past age 65, it may be beneficial and, in some cases, even required to sign up for Medicare. Even if you will be keeping your employer coverage until you retire, getting Medicare part A makes sense for additional hospital coverage. The decision to enroll in part B as well, depends on the size of your employer and whether you feel that your options in Medicare are better and less costly than your existing employer coverage.

Myth: Medicare Insurance Pays for Every Medical Cost
Not even close. Medical services are subject to copayments, coinsurance and/or deductibles, and original Medicare does not cover vision, dental, or hearing services. Original Medicare also does not have maximum out of pocket limit protection on potential costs, nor does it cover prescription medications. For that reason, it makes sense to consider either a Medigap plan with a stand-alone drug plan or a Medicare Advantage Prescription Drug plan, in order to limit your risk and to maximize your coverage.

Myth: You Don’t Need Drug Coverage
False. Even if you are not taking any prescription medications you should seriously consider enrolling in a Medicare prescription drug plan if you do not have a creditable drug plan already in place. Drug plans are not covered by original Medicare so you can either enroll in a stand-alone, (Part D) drug plan or enroll in a Medicare Advantage plan that includes drug coverage. If you are not enrolled in a Medicare prescription plan of one kind or another, when you are eligible to be on Medicare, without other creditable drug coverage, you will be charged a penalty. That penalty triggers when you do finally enroll in a Medicare drug plan, and it will grow bigger over the period of time you were eligible for it but did not enroll. What’s worse is that it will never go away. This is a permanent penalty that will last as long as you stay on a Medicare Part D prescription plan.

Myth: You Can Get a Medicare Supplement plan (Medigap) Anytime
Sort of true but with a BIG stipulation. Enrollment in Medigap plans is not limited enrollment periods such as the AEP so you can apply at any time throughout the year, but you run the risk of being denied coverage. Medigap carriers can ask medical questions when you are not in your initial enrollment period and they will take into effect any pre-existing medical conditions you have, in deciding whether to approve coverage. For this reason, the best time to enroll in a Medicare supplement plan is during your initial enrollment period (IEP), that runs three months before, the month of, and three months after your eligibility (often your 65th birthday). During that window you will get the best rate possible, and they cannot ask any health questions or take preexisting conditions into consideration. That does not mean you can’t get a Medigap plan outside of your IEP if your health allows for it. Many people regularly shop for a better rate in Medigap plans and they switch when and if they can.

Myth: You Are Allowed to Be Under Your Spouses Medicare Plan, Just Like an Employer Plan
Nope. Medicare is individual and if one partner loses health coverage because a spouse moves to Medicare from an employer plan, then that individual needs to secure their own coverage. Sometimes that may mean enrolling in their Medicare plan depending on age and eligibility and sometimes it requires another option altogether.

Myth: Preexisting Conditions Always Disqualify You From Medicare Plans
Mostly no. Original Medicare and Medicare Advantage plans do not restrict coverage for preexisting conditions and Medigap carriers cannot deny you coverage during your initial enrollment period, (IEP). However, if you want to enroll in a Medigap plan outside of your IEP, you will have to answer medical questions and may be denied coverage. If the Medigap carrier deems that your preexisting conditions will be too costly for them, they can either deny you coverage or charge you much higher rates.
Myth: You Only Get One Chance to Pick a Medicare Plan
Completely false. You can switch amongst or switch to a Medicare Advantage plan every year from Oct. 15 to Dec. 7, which is called the annual enrollment period, AEP. In addition, if you are already in a Medicare Advantage plan and you didn’t switch during the AEP for any reason, you can switch to a different Medicare Advantage or drop your plan and go to original Medicare or a Medigap plan, from Jan. 1 to March 31 every year. Moreover, you can apply for a Medigap plan at any point throughout the year but your acceptance may be dependent on your health.

Myth: You Don’t Qualify for Medicare If You Didn’t Work
That depends. If either you or your spouse paid federal payroll taxes for a minimum of 40 quarters (10 years), you are eligible for Part A with no monthly premium which means you can also enroll in Part B and the other coverage options. If you and/or your spouse paid federal payroll taxes for LESS THAN 40 quarters, are over age 65, and a citizen or permanent resident of the United States, you may be able to enroll in Medicare by paying a premium for part A.

Myth: Dental and/or Vision and/or Hearing (DVH) is Covered by Medicare
It’s all in the wording. Original Medicare (parts A and B) doesn’t cover DVH. That said, many Medicare Advantage plans provide this coverage at no additional cost and if you have original Medicare with a Medigap plan, you can always secure a stand-alone DVH plan with a private carrier to help complete your coverage package.

Myth: I Will Have to Deal with a Provider Network
Not always. Medicare supplement plans are secondary to original Medicare and having original Medicare as your primary insurance means that you can see ANY Medicare provider in the entire country. It’s not going out on a limb to say that most medical providers and facilities in the US take Medicare. Moreover, Medicare providers cannot refuse to accept your Medigap plan as your secondary insurance, no matter who the carrier is, even if they have never heard of the company or don’t take them in a network capacity. On the other hand, most Medicare Advantage plans are HMO’s or PPO’s and/or will otherwise require some adherence to local, regional, or national provider networks.

June 15, 2021
The Cost Of Cancer

Did you know that May is melanoma skin cancer detection and Prevention Month?

Now, of course, you didn’t, most people don’t, but it is and it had me thinking about cancer and the fact that we don’t talk about cancer when we discuss Medicare coverage enough, it’s a very important topic.

It’s one that can cost an enormous amount of money besides the medical toll it can take. It’s a subject I wanted to touch on. This is Jamie Sholom from SeniorStar Insurance Group.Welcome to the SeniorStar Minute.

Everybody knows somebody personally that’s been affected by cancer.In fact, according to the CDC and the American Cancer Society, it’s the second leading cause of death in the United States right behind heart disease.

What’s worse for my population that I serve the seniors is that eighty seven percent of all diagnosis of cancer in the US are from 50 year olds are older. Forty one percent of all males and thirty eight percent of all females will have a diagnosis of cancer at some point in their lives. Now, the good news is that cancer survival rate is thirty one percent higher than it used to be, but along with those higher survival rates are the costs.

The treatments are better and the costs are going higher. Now, why am I telling you this? If you’re covered by Medicare, if you have a great Medicare coverage package or even an average Medicare coverage package, it’s going to cover cancer, isn’t it? Well, yes and no cancer has two open holes that affect a lot of people that didn’t think they were going to be affected by it financially. The first is the enormous cost of cancer, prescription drugs.

The second are the untold costs that are indirect with cancer treatments. I’m going to talk about them both a little bit. The drug costs were studied by the Kaiser Family Foundation recently.

They did a study of 13 popular, for lack of a better word, drugs that were for various forms of cancer. These were Medicare recipients that had Medicare drug coverage. What they determined was that the average cost for these drugs, the out-of-pocket costs for Medicare beneficiaries, was between eight thousand and sixteen and a half thousand dollars. You heard that right. Medicare beneficiaries with a Medicare drug plan had to spend an additional eighty one hundred dollars to sixteen and a half thousand dollars out of their own pockets each year because of that cancer drug that they were on unplanned for.

And it’s enormous. There are studies that come out every year that talk about how people can’t afford their cancer medications.

They also go through their retirement funds and deplete them at a much higher rate than they thought they were going to. There are also studies that show how indirect costs of cancer affect people in ways that they didn’t expect. Downtime from work counseling, getting family help for the family members that you took care of. Home health aides travel and lodging for cancer treatments, all of these add up to forty two percent of cancer costs. That’s right. Indirect costs are costing you forty two percent of your overall cancer costs.

Now, the reason I’m letting you know this, there is a solution.

There are cancer protection and critical care policies out there that can give you coverage and protection from a diagnosis of cancer. These plans are fairly low monthly premium plans that will give you a lump sum payment, typically between fifteen thousand dollars and seventy five thousand dollars, with which you can do whatever you want. If you get a diagnosis of cancer, you get a lump sum of an amount that you can afford the premiums for and you can choose if you need to use them on cancer drugs, on some of the indirect costs or in any other way that you choose.

If you’re interested in getting more information about this very important product, please contact me Jamie Sholom at SeniorStar Insurance Group. My contact information is on the screen. I hope to speak to you soon. Thank you for listening.

May 8, 2021
Do You Have to Sign Up for Medicare?

Do You Have to Sign Up for Medicare?

Many people look forward to the day when they finally can sign up for Medicare but not everyone feels that way. This is an important question for anyone approaching 65 but it really breaks down into two smaller questions: Are you eligible for Medicare and, are you required to enroll in Medicare if you are?

Eligibility:
You are eligible for premium-free Part A (hospital coverage) and Part B (outpatient coverage usually with a premium attached) if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can also get Medicare at 65 if you are receiving retirement benefits from Social Security or the Railroad Retirement Board, you are eligible to receive Social Security or Railroad benefits but you have not yet filed for them or you or your spouse had Medicare-covered government employment. If you are under age 65, you can get Medicare if you have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months or you are a kidney dialysis or kidney transplant patient. But if you’re turning 65 and you are eligible, Medicare often provides the least expensive and most comprehensive protection available.

Requirements:
You are not required by law to enroll in Medicare but if you do not enroll when you become eligible, without having other “creditable” insurance, you will likely be penalized for the delay when it comes times for you to eventually enroll in Medicare. Creditable coverage includes many retirement health and many employer group plans but COBRA and the ACA individual plans are not considered creditable by Medicare standards. The late enrollment penalty, (LEP) imposes a higher monthly premium for Part B benefits and/or Part D (Medicare prescription drug plan) benefits. The longer the delay in enrollment in Medicare without other creditable coverage, the higher the penalty will be and it never goes away. For that reason, it is very important to find out if the coverage you have now is considered “creditable”, by Medicare standards to help guide your decision. If you are receiving social security benefits when you turn 65, you will be enrolled in Medicare automatically and your Medicare card will be mailed to you around three months prior to the month of your 65th birthday.

Penalties:
Part B has a monthly premium which for most people in 2021, is $148.50 but it can be higher depending on income. The LEP for Part B is 10% of the standard premium for each 12-month period that you could have had Part B but didn’t and you’ll have to pay this penalty on top of your premiums for life or disenrollment. For example, if you delay enrolling in Part B for 2 full years you will have an additional 20% to pay on top of the $148.50, which equals $29.70.
For Part D, Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($33.06 in 2021) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D premium. In this case, the same 2 year delay would result in a an additional $8.00 per month above the premium you pay for your drug plan.

There is no penalty for not enrolling in a Medigap plan or a Medicare Advantage plan but not doing so when you are first eligible for Medicare could also have negative implications for you. For example, preexisting health conditions may be considered, or you might have to wait for the annual enrollment period to obtain coverage if you do not obtain coverage during your initial election period.
So, should you sign up? Well, if you don’t have a qualified employer group plan or you’re not covered under a spouse’s plan, then it makes a lot of sense to get on Medicare. Health insurance is a great idea at any age, but it is vital for seniors who may have fixed incomes and have ever increasing medical needs.

Bottom line?
Navigating your entry into Medicare can be tricky and confusing but making the wrong decisions could cost you money and limit your coverage at a time when you can least afford either. For a FREE one-on-one review from a Medicare expert call (732) 658-5100, email jamie@seniorstarig.com or go to our website at www.seniorstargroup.com.

May 3, 2021
Is the Lowest Costing Option Always the Best One?

With Medigap Plans, Is the Lowest Costing Option Always the Best One?

Medicare Supplement plans (also known as Medigap plans) are offered by private insurers and fill many of the coverage gaps in Original Medicare. There are several plan types, all identified by a letter, but the most popular are Plans G and N. These two plans compromise the vast majority of new Medicare eligibles who elected to enroll in a Medigap plan since January of 2020.

Medicare Supplement plans of the same type which are offered by different insurers, may have significantly varying rates while providing the same basic benefits and levels of coverage. For example, a plan G that costs $140 per month with a lesser-known carrier is the same coverage as a Plan G for $172 per month with a widely-known carrier. Premiums can vary so dramatically between carriers for the same plan, because of market conditions, risk tolerance, claims ratio, management and marketing decisions, etc…

As such, wouldn’t it seem to reason that it’s always best to choose the company with the lowest rate available? NOT SO FAST…. Medicare supplement plans have rate increases every year and some insurers raise their rates higher and faster than others. That means that a carrier with the lowest costing Plan G for 65 year old’s today might be on the high side at age 71.

Although it is possible to shop for different carriers for lower rates as often as one wants, (in fact most my time is spent on helping clients find lower rates for the same coverage), there is a risk that a medical condition will arise which “locks” the beneficiary into their current plan. That’s because after the short initial enrollment period ends, Medigap applicants will have to answer health questions on the application and certain preexisting conditions may become a disqualifier for coverage.

For that reason, it makes sense for someone considering a Medigap policy, to factor in a carrier’s history of rate stability, their financial strength and their customer service record as well as their rates. Finding that balance is what we help our clients do. Please contact me for more information.

April 26, 2021
Medicare! What is it, and what does it cover?

Medicare! What is it, and what does it cover?

Medicare is a public healthcare program, funded by the government, workers and employers, and available to people at age 65 or who have qualifying disabilities. But contrary to popular belief, the program was not intended to cover all services at no cost. Generally, it provides a core set of basic medical benefits to cover inpatient and about 80% of outpatient care. Medicare beneficiaries face out-of-pocket expenses, such as deductibles copayments and/or coinsurance.

When you initially become eligible for Medicare, you can pick any plan available in the zip code of your primary residence and are not asked about preexisting health conditions. Once that initial enrollment period (IEP) ends, there are certain times during the year when you can make changes depending on the plan type you choose.

Seniorstar Insurance Group is a licensed, independent Medicare agency working with more than 20 highly rated insurance carriers in Medicare supplement, Medicare Advantage, Medicare prescription drug, dental, vision, hearing, critical care, hospital indemnity, final expense and long term care plans. Our services are completely FREE. Why not let Jamie Sholom and the team at Seniorstar become your ongoing resource for your senior benefits.

April 26, 2021