Seniorstar Insurance Group

Tag: insurance

  • A Breath of Fresh Coverage: Navigating New Medications with an Independent Insurance Agency

    A Breath of Fresh Coverage: Navigating New Medications with an Independent Insurance Agency

    “Using his expertise, the advisor delved into researching insurance plans that would not only cover the new drugs but also enable Eve to maintain her relationship with her primary care provider.”

    For years, Eve, a 71-year-old woman, had been managing a medical condition with the help of her primary care provider, a compassionate doctor in the town’s local clinic. Recently, this doctor prescribed two new drugs to enhance Eve’s treatment. However, her current Medicare Advantage plan didn’t offer adequate coverage for these crucial medications.

    Eve cherished her visits to Dr. Reynolds, valuing the relationship they had built over time. As she faced the prospect of changing her medications and dealing with potential financial strain, Eve’s sense of frustration grew. Determined to find a solution that wouldn’t disrupt her healthcare routine, she began her search for alternatives.

    One day, while attending a wellness seminar at the town’s community center, Eve struck up a conversation with a fellow attendee named Alex. Alex had gone through a similar situation and shared his success story about overcoming coverage challenges with the help of an independent insurance agency.

    Intrigued and hopeful, Eve decided to visit the agency. Eve was greeted by an experienced insurance advisor who was committed to assisting her in navigating this intricate situation.

    Across a cozy desk, the insurance advisor attentively listened to Eve’s concerns about her medications and her desire to continue receiving care from Dr. Reynolds. Using his expertise, the advisor delved into researching insurance plans that would not only cover the new drugs but also enable Eve to maintain her relationship with her primary care provider.

    After a thorough analysis, the insurance advisor presented Eve with tailored insurance plan options. These options not only provided coverage for the medications but also ensured that Dr. Reynolds remained within the network. Over a cup of tea, the insurance advisor explained the benefits, costs, and seamless transition process associated with each plan. Eve was relieved to find a solution that aligned with her needs and values.

    With a newfound sense of confidence, Eve selected an insurance plan that offered comprehensive coverage for her new medications while allowing her to continue seeing Dr. Reynolds. The insurance advisor guided her through the enrollment process, ensuring a smooth transition from her previous plan.

    In the end, Eve’s journey exemplified the impact an independent insurance agency can have on an individual’s life. Through their commitment to personalized care and meticulous research, they not only resolved Eve’s insurance dilemma but also upheld her priorities – her health and her cherished relationship with her primary care provider, Dr. Reynolds.

  • From Group Plans to Medicare: Emily’s Journey to Comprehensive Coverage

    From Group Plans to Medicare: Emily’s Journey to Comprehensive Coverage

    “Tom and Emily were paying less for health insurance and getting considerably more coverage than they ever had before even while being covered under Tom’s group plan through work”

    Emily, a Seniorstar client, and recent Medicare beneficiary, found herself in a unique situation two years ago regarding her need for health insurance coverage. Prior to becoming eligible for Medicare, Emily’s husband, Tom, another Seniorstar client, had become ill and had to retire early. Ironically, that meant that both Tom and Emily would lose the group employer plan that Tom had and that both were covered by. For Tom, it was less of a problem because he was 67 years old and already eligible for Medicare, but what was Emily going to do?

    After getting Tom enrolled in original Medicare with a bundle that included a Medigap plan, a Part D prescription drug plan, and dental coverage, we turned our attention to Emily. We consulted with her about entering the individual marketplace to secure coverage while she waited to become eligible for Medicare.  Emily, like so many of our other clients, found it difficult to know what to do or where to look to find the most appropriate and comprehensive coverage at rates she could afford.   

    The challenge for Emily was now that her husband Tom had retired, and the household income was lower, so she had to keep a close watch on expenses.  We discovered that Emily was eligible for premium subsidies in the individual marketplace, which minimized her costs in the plans that were available to her. After realizing that, Emily still needed help finding the plan with the right mix of premiums, deductibles, and out-of-pocket expenses that best suited her needs, and we were right there to help her navigate through the process.

    And that’s exactly what we did for Emily again when she recently became eligible for Medicare.  After reviewing her many Medicare coverage options with us, Emily decided to go down the same path as her husband, Tom, and enrolled in original Medicare with a bundle that included a Medigap plan, Part D prescription drug plan, and a dental plan. Moreover, because she chose the same Medigap company as her husband they were both eligible for a household discount on the monthly rates and Tom’s premiums went down.  Now both Tom and Emily were paying less for health insurance and getting considerably more coverage than they ever had before, even while being covered under Tom’s group plan through work. Emily’s journey from the individual marketplace to Medicare highlights the intricacies and challenges that individuals may face during transitional periods in their healthcare coverage. Her journey underscores the importance of careful planning, informed decision-making, and a comprehensive understanding of the options available. Emily successfully navigated this transition with the educational and consultative support that Seniorstar Insurance Group gave her. We take the time to get a clear assessment of our client’s healthcare and financial needs along with their long-term objectives to give them solutions for peace of mind and security. Emily’s story is a reminder that proactive planning is essential for individuals approaching Medicare eligibility and can help fend off costly and potentially long-lasting mistakes. 

  • How Does TRICARE Work with Medicare?

    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.

  • How Does Medicare Determine My Premium?

    How Does Medicare Determine My Premium?

    Medicare Part A

    Most people don’t have to pay a premium for Medicare Part A. If you’ve paid Medicare taxes, generally, at least 10 years, or you enrolled in Medicare before 65, you won’t pay a premium for Medicare Part A. Buying Medicare Part A is an option if you don’t qualify for premium-free Medicare Part A. Your Medicare Part A premium will be determined by how long you or your spouse worked and paid Medicare taxes, you will pay either $278 or $506 as your monthly premium.

    Medicare Part B

    Your Medicare Part B premium is determined by your modified adjusted gross income (MAGI). Your MAGI is calculated using your adjusted gross income and several other income sources. The majority of people won’t have to add additional sources of income, so their modified adjusted gross income is the same as their adjustable gross income. This is what is used to determine your monthly premium. Unless you are a high-income earner, you will pay the 2023 standard Medicare Part B premium – $164.50.

    The chart below shows how the Medicare Part B monthly premium increases with your income.

    If you fall into one of these higher income tiers, the Social Security Administration will send a letter explaining their justification for this higher premium.

    If you have a special life event changes your income and puts you in a lower payment tier when it comes to your Medicare Part B premium. Contact the Social Security Administration to explain how this change affects your income.

    Medicare Part D Prescription Drug Plans

    Medicare Part D premiums are similar to Medicare Part B premiums in that the monthly premium can increase for those with higher incomes. The extra amount you pay is called an Income Related Monthly Adjustment Amount (IRMAA). Like Part B, you can let the Social Security Administration know if you’ve had a life-changing event that will change the income level used to determine your Medicare Part D.

    Below, you can see the IRMAA you will pay in addition to your plan premium depending on your income:

    If your filing status and yearly income in 2021 was
    File individual tax returnFile joint tax returnFile married & separate tax returnYou pay each month (in 2023)
    $97,000 or less$194,000 or less$97,000 or lessyour plan premium
    above $97,000 up to $123,000above $194,000 up to $246,000not applicable$12.20 + your plan premium
    above $123,000 up to $153,000above $246,000 up to $306,000not applicable$31.50 + your plan premium
    above $153,000 up to $183,000above $306,000 up to $366,000not applicable$50.70 + your plan premium
    above $183,000 and less than $500,000above $366,000 and less than $750,000above $97,000 and less than $403,000$70.00 + your plan premium
    $500,000 or above$750,000 or above$403,000 or above$76.40 + your plan premium

  • How to Enroll in Medicare if You Have Retiree Insurance

    How to Enroll in Medicare if You Have Retiree Insurance

    How to Enroll in Medicare if You Have Retiree Insurance

    Retiree insurance is employer-provided health insurance that some employers provide to former employees after retirement. This insurance usually pays second to Medicare so in order to be fully covered, you must be enrolled in Medicare. Depending on your policy, you may be required to sign up for Medicare Part A & Part B when you are Medicare-eligible.

    Should I Keep My Retiree Insurance?

    There are some instances where keeping your retiree insurance along with your Medicare coverage may be beneficial if you can afford the premium. Some Retiree insurance plans cover things like Medicare deductibles, copayments, and coinsurances. The Retiree plan may also include prescription drug coverage. If you are satisfied with that coverage, call your plan to see if you can delay your Medicare Part D enrollment.

    It is also important to know that your spouse or family members are not eligible to enroll in your Medicare coverage. If you choose to drop your retiree insurance, keep in mind they may need coverage of their own.

    How Do Medicare and Retiree Insurance Interact?

    Medicare and Retiree insurance are intermingled because if you have retiree insurance you must be enrolled in Medicare to be fully covered. There are differences, however, in how Medicare interacts depending on the type of plan you have.

    Fee for Service (FFS) Plans

    Fee for Service plans act almost like a supplemental insurance policy and cover Medicare cost-sharing. They can pay for healthcare from any hospital or healthcare professional.

    HMO or PPO (Managed Care) Plans

    Managed care plans, known as HMO or PPO plans, require you and rely on you seeing healthcare providers and getting care from facilities in your network. Most of the time, your costs will be lowest when getting care from providers in your network who accept retiree insurance and Medicare. If you see out-of-network providers, you will pay full Medicare cost-sharing & your retiree coverage may not pay anything at all.

    Employer-Sponsored Medicare Advantage (Part C)

    There are some employers that require you to enroll in a Medicare Advantage (Part C) plan to continue getting your retiree insurance once you are eligible for Medicare. If you choose not to enroll in your employer’s Medicare Advantage (Part C) coverage, you may have difficulty getting retiree coverage back. With this in mind, you are also free to enroll in Original Medicare or another Medicare Advantage (Part C) plan of your choosing.

    Employer-Sponsored Medicare Supplements

    Another employer insurance plan option is employer-sponsored Medigap, or Medicare Supplement, policies. Just like employer-sponsored Medicare Advantage (Part C) plans, you do not have to enroll in employer-sponsored Medigap plans but it may be harder to get your retiree insurance back later.

    Retiree Insurance and Medicare Part D Prescription Drug Plans

    Retiree insurance can offer prescription drug coverage as well. If the prescription drug coverage offered with your retiree insurance is creditable drug coverage (as good or better than basic Medicare Part D) you are eligible to delay Part D enrollment. It may be beneficial to keep your retiree insurance even if it doesn’t provide creditable drug coverage. This is because some plans keep you covered when you are in the coverage gap. Remember that some plans don’t allow you to drop prescription drug coverage without losing your retiree insurance.

  • 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 Medicare cover Dental Implants?

    Does Medicare cover Dental Implants?

    Does Medicare cover Dental Implants?

    Dental implants are devices implanted into the gums that help restore a person’s ability to chew or restore a smile or appearance. They can also be used as an alternative to dentures. These are great solutions for lost teeth from injury or periodontal disease.

    Without coverage, these implants can cost as much as $25,000 out of pocket, depending on your needs.

    For many people, dental problems can become more common with age and can profoundly impact their health. This may leave you wondering if Medicare covers dental implants. Although dental implants are not covered by Original Medicare [SH1] (as is the case with most dental care under Original Medicare), that does not mean that you do not have options to find the coverage you need.

    How Can I Get Coverage for Dental Implants?

    Medicare Advantage (Part C) Plans

    If you are looking for comprehensive coverage that will help you get coverage for dental implants, one option is to look at Medicare Advantage (Part C) [SH2] plans. Some Medicare Advantage (Part C) plans include dental coverage that covers dental implants. Be sure you fully understand your plan’s coverage when you enroll, as some Medicare Advantage (Part C) plans only include routine dental services. Also, it is essential to note most of these plans also have a maximum dental benefit. This means that after you reach the limits of the maximum dental benefit, you will be responsible for 100% of any additional costs. When choosing a Medicare Advantage plan, these things are essential to consider, especially if you know you will need dental work.

    Standalone Dental Plans

    If you prefer to stay enrolled in Original Medicare, you are not out of luck – you can always enroll in a standalone dental insurance plan. If you are not concerned about the cost of another premium, you can always add a separate dental insurance plan. These plans are through private insurance companies, or carriers, and provide similar dental coverage you may have had through an employer. These plans typically come with coinsurances, deductibles, and annual maximums.

    Working with a licensed insurance agent can help you decide what coverage makes sense for you. At Seniorstar Insurance Group, we can help you sift through and evaluate the options that meet your needs and fit your budget. Call 844-779-5010 today to get a no-cost, no-obligation coverage evaluation.

  • Does Medicare Provide Dental Coverage?

    Does Medicare Provide Dental Coverage?

    Does Medicare Provide Dental Coverage?

    Dental health is an essential aspect of one’s overall health. Poor dental health can become very costly without proper insurance coverage, making it hard for many to get the care they need. Uncared for dental issues can even create new health problems in other parts of the body.

    If you’re new to Medicare, you may have some questions when it comes to Medicare and dental coverage. This is important to consider when you are evaluating your Medicare options as well. In short, Original Medicare does not provide dental coverage, but that does not mean you do not have options.

    Does Original Medicare Provide Dental Coverage?

    Original Medicare Part A and Part B do not cover dental care. The only exception in which Original Medicare will cover dental care is if you have a traumatic injury affecting your jaw, mouth, or teeth and are hospitalized. Only then might Original Medicare cover some dental care.

    Will Medicare Advantage (Part C) Plans Cover Dental Care?

    There are some Medicare Advantage plans that include dental coverage. Each plan can be different in the services and care they provide; however, this dental coverage typically includes extractions, fillings, teeth cleaning, and routine X-rays. Medicare Advantage plans are also similar to traditional health plans regarding cost and coverage. This means they can include coinsurance, copays, and deductibles for dental just as it does medical, prescription, etc.

    Are there any Medicare Supplement plans that cover Dental Care?

    Medicare Supplements (Medigap) do not cover dental care; however, they can offer help with out-of-pocket costs, which can be used to help lessen the cost of an out-of-pocket dentist bill.

    How Can I Get Dental Coverage Without Changing my Medicare Coverage?

    Even if you are enrolled in Medicare coverage that meets all your needs except dental – don’t worry. You have options!

    In this case, you can purchase a separate dental insurance plan from a private insurance company. These plans can offer basic preventive care or a more premium plan for more coverage, with a higher premium. These options will be similar to those you may have seen if you ever chose dental coverage through an employer-sponsored plan.

    If you are not interested in enrolling in another line of coverage, walk-in dental clinics or local dental schools may provide free or low-cost care. These are good for beneficiaries paying out-of-pocket for care because the prices are more affordable. Your local Health Department can help lead you to walk-in clinics near you or other resources offering affordable dental care.

  • What Does Original Medicare Cost in 2023?

    What Does Original Medicare Cost in 2023?

    2023 Medicare Part A and B Deductibles, Premiums, and Medicare Part D Income-Related Monthly Adjustments Amounts

    In late 2022, the Centers for Medicare & Medicaid Services (CMS) delivered the dollar amounts for the 2023 Original Medicare Part A & Part B co-insurance, premiums, and deductibles. This article will give you what you need to know about these amounts, how these amounts are calculated, and how these amounts affect Medicare beneficiaries.

    Medicare Part B: Premium and Deductible Information and Amounts

    Original Medicare Part B is the part of Medicare that covers outpatient hospital services, physician services, some home health services, medical equipment, and other services not covered by Medicare Part A. The prices of the deductibles, coinsurance rates, and premiums for Medicare Part B are settled by the Social Security Act. For 2023, the standard monthly premium for Medicare Part B enrollees is $164.90. All Medicare Part B beneficiaries will also pay $226 for 2023’s annual deductible. These costs are lower than in 2022, primarily because of a larger reserve in the Medicare Part B sliver of the Supplementary Medical Insurance Trust Fund. There is also a small stipulation for Medicare enrollees that are 36 months post kidney transplant, making them no longer eligible for full Medicare coverage. Starting this year, they can pay a premium of $97.10 for coverage of immunosuppressive drugs.

    Medicare Part B: Income-Related Monthly Adjustment Amounts

    The Medicare Part B monthly premium each beneficiary pays is based on their income. The standard price of $164.90 for 2023 is the price most beneficiaries will pay. Depending on their adjusted gross income, the premium may increase as shown in the chart below.

    Medicare Part B Premium Chart

    The same levels of adjusted gross income affect the premium the 36-month-out kidney transplant beneficiaries pay for their immunosuppressive drug coverage. The amounts are shown in the chart below.

    How you file your yearly tax returns can affect these prices as well. Below are two charts respectively showing the two different Medicare Part B premiums discussed above for married beneficiaries who lived with their spouse for any period during the last year but filed a separate tax return.

    Medicare Part A Deductibles and Premiums

    Original Medicare Part A is the part of Medicare that covers skilled nursing facilities, inpatient hospital stays, hospice, inpatient rehabilitation, and several home healthcare services. Beneficiaries with at least 40 quarters of Medicare-covered employment don’t have to pay an Original Medicare Part A premium which amounts to around 99% of all beneficiaries.

    In 2023, the inpatient hospital deductible that Original Medicare Part A beneficiaries will pay if admitted will be $1,600. This deductible covers the beneficiary’s costs for the first 60 days of inpatient hospital care in a benefit period. If any more inpatient hospitalization is necessary in a benefit period, the beneficiary is required to pay a coinsurance amount per day. For days 61-90, the beneficiary will pay a coinsurance amount of $400 per day. If the beneficiary uses any of their lifetime reserve days, they will pay $800 daily. In skilled nursing facilities, days 21-100 of extended care services in a benefit period will require beneficiaries to pay a $200 daily co-insurance.

    A monthly premium for Original Medicare Part A is required to enroll in Original Medicare Part A under certain circumstances voluntarily. These circumstances include being age 65 and over and having fewer than 40 quarters of coverage, and certain people with disabilities. If an individual had fewer than 30 quarters of coverage or was married to someone with at least 30 quarters of coverage, they may buy into Medicare Part at a discounted monthly premium rate. This discounted rate in 2023 is $278 per month. Some uninsured aged persons who have less than 30 quarters of coverage will pay the entire premium, which is $506 a month in 2023. If certain individuals with disabilities have drained other entitlement, they will also pay this premium for Medicare Part A.

    Medicare Part D Prescription Drug Plan Income-Related Monthly Adjustment Amounts

    Medicare Part D Prescription Drug Plan premiums depend vary based on the individual plan, but there are income-based adjustments for beneficiaries with a higher income. The income-related monthly adjustment amounts can follow these same payment routes. These amounts are as follows:

    Again, just like Original Medicare Part B, tax returns affect these amounts. Individuals who are married and lived with their spouse for any period of the taxable year but file a separate return will pay different amounts, which are listed below:

    Medicare Savings Programs

    These deductibles and premiums can add up for extensive hospitalization, specialized care, nursing facilities, etc. For low-income beneficiaries or those on a fixed income, this can be extremely frustrating and difficult to handle financially. However, there is help in the way of the Medicare Savings Programs for some of these individuals. These programs can help reduce the costs of the high-quality care a beneficiary may need. They help pay Medicare premiums and possibly cover co-insurance, deductibles, and co-payments for those who meet eligibility.

    For any additional information on Original Medicare Part A & Part B or Medicare Part D Prescription Drug Plan premiums, co-insurance, co-payments, deductibles, or Medicare Savings Programs, contact Seniorstar Insurance Group at 844.779.5010.

    Medicare Savings Programs List

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  • 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.