Silver Insurance Solutions
Silver Insurance Solutions
Overview of Agents and Key Points you need to know about Medicare.
Most people don't know: If you are not eligible for Medicaid but make below 400% of the poverty level- you WILL get a tax credit to help pay the premium. There are also extra credits to help pay your co-pay and limits to what you will spend. I know how to help with this! I will put a chart below on how much you can make! We can look to se
Most people don't know: If you are not eligible for Medicaid but make below 400% of the poverty level- you WILL get a tax credit to help pay the premium. There are also extra credits to help pay your co-pay and limits to what you will spend. I know how to help with this! I will put a chart below on how much you can make! We can look to see what is new, do you qualify for extra help or just want to know the options?
Still need more options but have no idea what is out there? Ask! What about just stand alone policies?- read below.
*I include long term health and lump sum payments for sickness under Life*
Figuring out the Medicare plan that's most appropriate for your needs is not a great do-it-yourself activity. Once you understand the basics of Medicare, the decision is complicated and it is why we are here to help.
Working with a licensed insurance broker can show you both Medicare Supplement Plans and Advantage Plans from multiple companies. Each type has its positives. Since we are not tied down to any one company, it is our please to help you enroll in what suits your situation best. We cover questions you need to understand about the costs, doctor networks, coverage levels, and maximum out-of-pocket for each.
Beside all of that, we believe you are joining the Silver Insurance Team and are able to answer questions, call with your to your companies, help find the right doctors you need, and stand along side of you as you face difficult situations and advocate for your interests. We do try to keep in contact with our clients with classes, get together, games and more . To our clients further away, our team sends out coupons for your area and calls to see how you are doing.
Now in the next section, I am going to try to explain the basics of Medicare so you can gain a better understanding.
Medicare has four basic parts: A, B, C, and D. Taken together, Parts A (hospital care), B (doctors, medical procedures, equipment), and D (prescription drugs) provide basic coverage for Americans 65 and older. What's relevant for this article is what these parts don't cover, such as deductibles, co-pays, and other medical expenses that could wipe out your savings should you become seriously ill. That's where Part C comes in. Also known as Medicare Advantage, it's one of two ways to protect against the potentially high cost of an accident or illness. The other option is Medicare Supplement, also called Medigap coverage. Here's a look at the two options.
MEDIGAP (Or PART E)
Medicare Supplement Insurance, also called Medigap coverage, protects people who buy traditional Medicare against many of the additional costs a patient might pay. In return, Medigap charges a premium monthly in addition to what the person already pays for Medicare Parts A (many people get this free), B, and D.
Just to make life truly confusing, the various options offered by Medigap are also sorted by letter. The choices are Plans A, B, C, D, G, K, L, M, and N. What these plans include is standardized by Medicare. *Which means a plan G will have to cover the exact same thing any plan G covers REGARDLESS of what company you choose.
Also, the cost for them can vary, and each company will increase in cost year over year however, so it's worth shopping around. This is where knowing which companies raise rates at a high percentage would be worth knowing. These plans also do not generally cover dental, vision, hearing or your prescription drugs. You will have to buy extra policies to avoid the prescription drug penalty Social Security will charge you if you don't purchase this. Any other "extras" a company offers are not guaranteed.
These are great plans for people who travel constantly, do not want to have almost any out of pocket expenses in healthcare and no direct network of doctors. Medi-gap policies will cover you whenever you see ANY doctor or facility that takes Medicare. If the doctor or facility does not accept Medicare patients, Medi-gap won't cover any of those costs, even though it is a private insurance policy.
***IMPORTANT! There is a time limit to when anyone can sign up! You have a brief time frame when you first turn 65 and after that will face medical underwriting which can choose to charge extra or not cover you at all.****
MEDICARE ADVANTAGE (Or Part C)
A Medicare Advantage Health Plan (Medicare Part C) will provide more help at a lower cost or for zero $ than traditional Medicare plus Medigap. Instead of paying for Parts A, B, and D, a person would enroll through a private insurance company that, covers everything provided by Parts A, B, and D and may offer additional services. The beneficiary would pay the Medicare Advantage premium if there is one along with the Part B premium in most cases.
Medicare Advantage Health Plans are similar to private health insurance plans. With most plans, services such as office visits, lab work, surgery, and many others are covered after a small co-pay. They also always have a max out of pocket amount. Depending on what’s available regionally, plans could offer HMO or PPO network plans and will ALWAYS place a yearly limit on total out-of-pocket expenses.
Also, like private plans, each has different benefits and rules. Most provide prescription drug coverage; some may require a referral to see a specialist while others won’t. Some may pay some portion of out-of-network care, while others will only cover doctors and facilities that are in the HMO or PPO network.
These plans are funded by taking over the management of your part A, B and generally D as well. That is why most of them do not charge you much or anything. To be clear: Medicare hands over your Part A and Part B payments to that company to "manage". They are already getting 600+ a month for you. This is how those plans are funded.
The government doesn't allow more than an allotted profit so the companies have to give the money back with perks. That is how they fund the gym memberships, glasses, dental etc. That also means that all payments to any facility will come from that plan. That is why they normally include extra benefits that can change yearly such as dental, vision, hearing, rides to doctors, gym memberships and more.
Some are made just for VA veterans and some will even pay you part of your part B back monthly. Some plans are made only for those with Medicaid and Medicare, or certain chronic illnesses. These plan usually operate within a certain region so it is worth it to check that out. However- you are always covered by Emergency care if you travel.
Let's say a patient only has Parts A, B, and D. Here are what the holes or “gaps” in coverage would cost if the patient were admitted to the hospital for, say, heart surgery, and complications required a long hospital stay followed by needing regular medication after it:
At the hospital: Because of the Part A deductible, the patient would pay the first $1,364. After 60 days, they would start paying a portion of each day's cost.
For doctors and medical procedures (Part B) at the hospital and at home: The patient would pay 20 percent of all costs AFTER meeting the $185 deductible. Unlike many other health insurance policies, with medicare alone- there is no cap or maximum out-of-pocket amount on what a person could owe.
The American Heart Association says that the minimum cost of bypass heart surgery is $85,891, in which case, the Part B copay would be over $17,000.
Chemotherapy drugs are covered in Part B and would require 20 percent every single treatment.
These coverage gaps mean that a particularly bad health year could leave a patient with tens of thousands of dollars in hospital bills. That's why most people purchase Medicare supplement insurance, or enroll in Part C, a Medicare Advantage Health Plan.
Then there is Prescription drug coverage or Part D. Without an advantage plan or stand alone plan a patient could pay between 35 percent and 85 percent of the cost of some of their prescription drugs. You have to enroll in a private company plan or you pay a penalty. Once in a plan there is an initial coverage stage, to donut hole or catastrophic coverage. This category is complicated and needs pages to explain.
It is illegal for an insurance company to sell you both a Medicare Advantage and a Medigap policy.
Key Take aways:
I hope my explanations will help you and also give you confidence in choosing our group to help you navigate everything when it comes to this.
In order to buy a marketplace health insurance plan, you must:
We make it our mission to know the plans in the area that are easier to deal with, and offer our full support of you! Agents are allowed to help you navigate all of the confusing questions and help getting the subsidies you deserve.
Having a person in your corner helping you navigate this confusing world of health insurance can not be underestimated!
It turns out that over 88% of Americans choose the wrong plan and end up wasting more than $500 a year. Before you sign up for a plan, it’s important to understand your options, understand the health insurance market and read the fine print.
That is what we are here for!
There are several ways to purchase health insurance. When you shop at Healthcare.gov, you’re only seeing “on-exchange” plans. However, insurance companies only make a fraction of their plans available “on exchange.”
If you see an agent, we can also look at off exchange plans. This right here can save you money!
There are also private exchanges, or Faith- based sharing plans and short term health plans.
Statistically, over 75% of your costs in the next year are predictable based on your known needs. What really drives costs, and your plan choice, are the things you know about: prescriptions, doctor visits, therapy, medical equipment, etc. If you’re healthy, maybe you don’t plan on using any of these things–which is just as important to know.
One way to pay too much for health insurance is to leave money on the table. Many individuals assume they’re not eligible for tax credits when they actually are. Depending on where you live, a family of 3 or 4 that makes $90,000 a year will likely qualify for a tax credit.
If you do make too much money for a credit, then you should probably consider using a Health Savings Account (HSA), HSAs allow you to pay for your care with tax-free dollars. For high-earners in a higher tax bracket, that’s like a 30 to 35% discount on health costs!
Another relatively recent tax-advantaged strategy if you work at or own a small business is a OSEHRA (Qualified Small Employer Health Reimbursement Arrangement). Efficient, flexible, and predictable, this allows a small business employer to reimburse for premiums and medical expenses tax-free while the employees choose their own individual plans. It’s not surprising this strategy is gaining so much popularity across the country!
Keeping your favorite doctors “in network” is critical to saving money. If you try to see a doctor that is out of network, your health plan won’t help very much or may not pay anything at all. Many people are familiar with “PPOs” and “HMOs” but there are actually several options in between that are worth considering.
While PPOs provide the most flexibility, they are also the most expensive. If your doctors happen to be in an HMO or if you don’t have preferred doctors yet, the HMO can be a great money saving choice. These aren’t the HMOs of the past with long lines and long wait times. You can get referrals online (check with your provider), and going to see some specialists (like an OBGYN) no longer requires a referral.
It’s tempting to want to stick with one plan out of convenience, and the thought of trying something new can be intimidating. Unfortunately, health insurance isn’t something that should be put on auto-pilot. Plans, doctor networks, prescription coverage and your family’s health needs are changing every year. Not to mention, the market is changing significantly due to several emerging trends: narrowing provider networks, rising premiums, insurers leaving the exchange and offering off-exchange only plans. What was great for one year may be terrible the next, and insurance companies are frequently shifting things around to maximize their earnings—not necessarily your health. Here are a few things to keep in mind:
I can not tell you names but I have researched each and every one. These companies differ so much we would need to go over each one. Some of the same highlights are:
I can not tell you names but I have researched each and every one. These companies differ so much we would need to go over each one. Some of the same highlights are:
These plans are selling like hot cakes right now but be careful. These plans have out of pocket max that can start over every 3 months!
These plans are also allowed to cover a surgery but then if you end up needed a lot of aftercare, they can non-renew. No guarantees made.
They also will not cover pre-exsisting conditions ever and have been
These plans are selling like hot cakes right now but be careful. These plans have out of pocket max that can start over every 3 months!
These plans are also allowed to cover a surgery but then if you end up needed a lot of aftercare, they can non-renew. No guarantees made.
They also will not cover pre-exsisting conditions ever and have been known to fight about other issues you might have coming from a pre-exsisting condition.
A lot of the time, they only cover a few doctor visits and it is cheaper just to work out a price with the DR. then to pay for a plan.
Who can benefit :
children who are healthy and you don't want to pay the ACA price for a few doctor visits.
If you are also really young, healthy and make to much $ for a tax break on ACA, this might be a great option for you.
These 3 speak for themselves.
Most dental plans are costly and don't cover much but there are a few good ones out there. Meaning cheap monthly and give you a tons of discounts.
If you are looking for only braces or implant help- most private plans will only pay a portion or help cover a specific percentage only.
There are a few vision plans
These 3 speak for themselves.
Most dental plans are costly and don't cover much but there are a few good ones out there. Meaning cheap monthly and give you a tons of discounts.
If you are looking for only braces or implant help- most private plans will only pay a portion or help cover a specific percentage only.
There are a few vision plans to consider as well.
There are some plans that will cover all three of these and grow with time on coverage.
There are no stand alone hearing plans out there at this time that are worth anything so the only way to get this is to buy it in a group issue (such as a Dental/Vision/Hearing plan)
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