Seniorstar Insurance Group

Tag: medigap

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.

September 1, 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
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