Tag Archives: medicare and medicaid

10 Helpful Tips About Medicare

My Comments:retirement-exit-2 Medicare has been a life saver for me and my wife. It has allowed us to seek timely and appropriate medical care when problems surfaced.

An argument can be made that it serves to deprive hard working physicians with the compensation they deserve, but from a selfish perspective, that’s their problem.

Our problem was to find medical answers and find them NOW because the alternative was likely to be dramatic. Maybe not fatal, but… We are able to do this without leaving a financial pall hanging over us. Some people will take unfair advantage of this and perhaps abuse the system. But no one covered by Medicare should avoid timely advice from healthcare providers.

When you couple Medicare with a good supplemental, private health insurance plan designed to cover what Medicare will not cover, you are golden. And alive for a while longer, hopefully enjoying what life has to offer.

by Ann Marsh / AUG 13, 2014

SAN DIEGO — The average couple, at age 65, is likely to need $261,000 to cover all their health care costs for the balance of their lives — and those are just out-of-pocket costs, not those covered by Medicare. To make matters worse, health care costs overall are rising at about 5.8% a year.

Those details emerged during a presentation at LPL Focus in San Diego this week. Joe Moklebust, director of business development at Principal Financial Group, urges planners at the large independent broker-dealer’s annual conference to pay close attention to how and when their clients enroll for Medicare.

Failing to heed certain deadlines for enrollment and failing to evaluate plans can substantially affect clients’ financial lives, Moklebust says.

One audience member’s own experience illustrated the point. The advisor told the room that he has a medical condition and can’t buy generic versions of the medications he takes.

When it came time to sign up for Medicare Part D, which covers prescription drug medications, he says he and his insurance agent reviewed numerous plans to see how each one would handle his prescription drug needs. Some would not have covered them, he told Moklebust.

“If I were to buy my medications outside, it would be about $1,100 a month,” he said — adding that, with the plan he chose, “It costs me about $300.” That is a big issue for seniors, the planner said.

Moklebust concurs: “They do not investigate the plans,” he said. “It is costing them more money because they do not.” Moklebust offers advisors a series of tips for clients’ Medicare enrollment and usage.


• At 65, the mandatory age when Medicare starts (with exceptions), clients must enroll in the window that starts three months before their birthday month and ends three months afterward. If they don’t, penalties may apply. If those clients are still working and covered by their employers’ qualified group health insurance plans, they can delay. But some people who are laid off and get COBRA coverage make the mistake of thinking that they can wait to enroll in Medicare until after their COBRA period — sometimes as long as two years — has ended. That is not true. “If you don’t sign up within the prescribed enrollment period,” Moklebust says, “for each 12 months when you were eligible and not covered by a group plan, your Medicare part B premium is going to go up 10%. And it will stay up 10% for the rest of your life.” Planners should refer clients who are still working to their employer’s benefits administrator for more detailed information, Moklebust says.

• Clients who are 65 and older but working, with qualified medical plans through their work, may not be ready to enroll for Medicare — but in most cases they should still enroll in Medicare Part B.

• Medicare A and B plans are standardized at the federal level. But Medicare Advantage plans, also known as Medicare Part C, are localized. They can vary greatly in quality not only between states, but also within states — so it pays to shop around.

• If clients are enrolled in Medicare Parts A and B but want additional coverage — for deductibles and co-pays, or for travel abroad — they may wish to add a supplemental Medigap plan. The most common is Medigap Plan F.

• Medicare costs break down as follows: Medicare part A is free unless your client isn’t fully eligible; in that case it can cost as much as $441 a month. The base cost for Medicare part B is $104.90 monthly, although it can range up to $335.70 for wealthier clients. Medigap insurance varies in cost by carrier and by health status, but the average cost ranges from $60 to $200 a month, depending upon what type of plan a client wants. Medicare Part D costs about $40 a month and may carry additional costs for wealthier clients.

• Windfalls from the sale of a home or a large severance can push a client’s Medicare costs into an artificially high bracket. But those higher charges can be appealed and, in some cases, reduced.

• Medicare Part D, the prescription drug coverage, comes with a “donut hole,” which is a gap in coverage. After clients satisfy their deductibles, they then pay a percentage of their prescription drug costs up to $2,850 a year. After that point, they must cover all these costs until they hit $4,550, after which point the insurance kicks in again. While in the “donut hole,” clients receive full credit for the cost of the medication but the actual cost is reduced by 28% for generics and 52.5% for name brands. Under the Affordable Care Act, however, that donut hole is shrinking. By 2020, it is expected to be closed.

• In some cases, clients will need to change their Medicare Advantage coverage if they move.

• Enrolling in a Medicare Advantage plan may require working with insurers’ PPOs or HMOs, which have their own doctors and hospitals. If your clients want to use their own doctors, advise clients to check to see whether those offices will accept original Medicare.

• If clients under age 65 are receiving Social Security disability insurance, they must have been disabled for two years before they can begin receiving Medicare.

Overall, Medicare covers about 51% of most older Americans’ annual health care costs, Moklebust says. To help clients get the most out of their coverage, he urged planners to go on the Medicare.gov website and get the Medicare & You handbook covering basic details of all Medicare plans.

3 Common Medicare Questions and Answers

health-is-wealthMy Comments: As someone who has been enrolled in Medicare for 7 plus years now, I can attest to its value for both my wife and I. At our age, things start to go wrong, and having the ability to seek medical advice and remedies without breaking the bank is critical to our peace of mind.

Along with millions of others across this country, we represent stability and a collective memory that can only help those coming behind us. Done the right way, it keeps those of you who intend to follow in our footsteps from making misteps, since the institutional memory we represent allows all of us to move forward without having to start from scratch every year.

These 3 points will prove helpful to you.

by: Jessica Ness / Thursday, March 20, 2014

One of the most confusing and stressful issues retirees face is the decision of when and how to file for Medicare. There’s a lot to know, but you don’t need to be an insurance expert to add value for clients. Simply knowing the answers to a few of the most common Medicare questions — and being able to point to deeper resources for more information — will help you equip clients to tackle this process.

Most advisors know that Medicare eligibility begins when a person turns 65 or has a qualifying disability. But not everyone understands when to begin the application process. And because some of your clients may apply for Part A and B at different times, it is important to understand when clients should apply for each.

For most clients, think in terms of the seven-month enrollment period for Part A: It includes the three months prior to a client’s 65th birthday, as well as that month and the three months after. One exception: Clients who are already receiving Social Security will be automatically enrolled.

Use your CRM system to help clients. Set up alerts to remind you when clients are approaching age 65 and then reach out to help them start the process. Remind clients that if they miss their initial enrollment period, their application may have to wait until the general enrollment period, which occurs each year between January 1 and March 31. That delay could cause a gap in coverage, since they will have to wait until July 1 for coverage to start.


My clients often ask if they should sign up for Part B at the same time as Part A. Naturally, they are concerned about paying premiums for Part B if they don’t need the coverage. But the timing for enrolling in Part B is a bit trickier and the stakes much higher, since late enrollment can cause a permanent premium increase.

One thing clients should consider: If they don’t have employer group coverage, then this is a no-brainer. They should apply during their seven-month initial enrollment period.

If your clients are covered under a group health plan based on current employment — whether their own employer or a spouse’s — they may qualify for a special enrollment period, often abbreviated as SEP. If so, they may delay enrolling in Part B until their group health coverage is terminated, and avoid the late enrollment penalty.

The eight-month special period starts the month after the end of either employment or the group health insurance coverage based on that employment — whichever happens first. Here, again, you can use your CRM system to remind you when to revisit a client’s Part B coverage.

Keep in mind that COBRA coverage does not qualify as employer coverage, and so won’t allow them to escape the penalty for delayed enrollment. Be sure to educate your clients so they don’t make this common mistake.

There are other considerations as well. Some smaller employers require Part B coverage to be integrated with their existing insurance plans, for instance, while larger employers may not. Have your clients talk to their human resources department or insurance specialist to know whether Part B coverage is necessary for them.


Do your clients understand the difference between a Medigap policy and an Advantage plan? Most don’t, so this is a great opportunity to educate them on the basics and provide resources to get them to the right coverage.

• Medicare supplemental insurance policies, also known as Medigap policies, provide additional benefits and can reduce out-of-pocket costs when combined with parts A and B. They’re provided by private insurance companies and require additional premium payments. And because they usually exclude prescription drug coverage, clients may need to layer Part D coverage on top. That means clients could end up with three different monthly insurance premiums to pay and coverage plans to manage. There’s a vast marketplace for these types of policies, though, so you should be able to help them target and virtually customize coverage for a client’s exact situation.
• Advantage plans, on the other hand, combine Medicare parts A, B and sometimes D. In essence, these policies bundle coverage into a single Medicare-approved health plan offered by a private insurance company. The level of coverage varies depending on the plan chosen; again, there are numerous options available.

When a client still has employer health plan coverage, it can sometimes act as a Medigap plan, so usually additional coverage is not necessary. Otherwise, I’ve found that traditional Medicare with a Medigap plan is a great option for clients who have a special health consideration, don’t mind shopping around and/or have a tendency to be thrifty. Advantage plans tend to feel more like traditional employer health plans; they are great if the client is willing to pay a little more for the convenience.

While either Medigap or Advantage plans could make sense for a client now, circumstances change — and both the plans and your clients’ needs may require a recalibration in the future.

Encourage clients to shop around at least every three years. The Medicare website is a great resource; among other information, it shows what plans are available in each state. There is also a customized search option that lets enrollees filter plans based on the coverage they want, with an estimate of the health care costs associated with each specific plan.

Your clients can also get personalized health insurance counseling at no cost from their local State Health Insurance Assistance Program. In fact, you may want to send clients a reminder each year during open enrollment — from Oct. 15 through Dec. 7 each year — suggesting that they review their plan. They’ll appreciate that you are thinking of them.

Jessica Ness, CFP, is a client advisor and the director of financial planning at Glassman Wealth Services, a wealth management firm in McLean, Va.

10 Things You Must Know About Medicare

My Comments: The people at Kiplinger have created another great blog post for me to borrow. And if you insist, you have “my permission” to click on their links and get more good information from them.

At the end of the day, however, you may need someone local, a dedicated, knowledgable professional whose experience over the past 40 years counts for something. I like to think I’m that person. At least my hand is raised in the air to let you know I want to talk with you and possibly help you find the right answers.

Here is an image of what you see when you go to the Kiplinger page about the Ten Things to Know. Be aware it is a slide show and to get to the next slide, note there is a red arrow at the top right which navigates you to the first of the 10 Things to Know. Just click on this image and you’ll be there. 10-Medicare-things

Health vs. Wealth: What’s More Important?

health-is-wealthMy Comments: When I took economics courses in college in the early sixties, there was a common adage when talking about politics and business that you could not, at the same, have both guns and butter. This meant that at our industrial heart, we could either produce weapons of war, or we could produce products for general consumption, but not both at the same time.

Then came Lyndon Johnson, and his Great Society. He was somehow able to fight the war in VietNam and at the same time, cause many social changes that served to improve the standard of living for those of us not fighting the war.

When I saw this headline, my first reaction was “Why can’t we have both?”. What logic dictates that it is one or the other? Then a re-read of the headline reminds me that it is only asking which is most important. I believe they are equally important, as having one most often leads to the other, regarless of their order.

By Christine DiGangi / February 6, 2014 9:00 AM

As far as self-improvement goes, personal finance and health are important to Americans — just think about how many people have New Year’s resolutions like losing weight, getting out of debt or making more homemade meals (a potential two-in-one resolution).

But if you had to choose one or the other (financial health or physical health), what would you prioritize? In an informal, online poll conducted by American Consumer Credit Counseling, nearly 59% of those surveyed said they were more concerned about the state of their finances than that of their physical fitness. A lot of people are looking at both, though: About the same portion, 60%, said their resolutions include money and health goals.

Which Comes First?

It’s not a scientific study — the Health and Wealth poll reached 243 adults — but the results might hint at what people prioritize when it comes to well-being. Money and health have an interesting relationship, because issues in one area could adversely affect the other, like the costs associated with weight-related health issues and the sometimes-expensive aspects of maintaining good health.

Fewer than 4% of respondents said they would go into debt if it would make them more physically fit, and nearly 30% said they would trade their physical fitness for a better financial situation.

Health & Credit
At times, these goals could be at odds (i.e. forgoing a gym membership to save money or being forced to go into debt to pay medical bills), but they can also work together. Like so many things, improving financial and physical health requires balancing priorities, even when life throws you for a loop.

No matter how much work you do on your finances, an unexpected or major illness can still put your financial health in peril. For example, we hear from readers all the time about how an unexpected medical bill went to collections and ruined their credit because they hadn’t budgeted for a major health expense or they didn’t see the bill coming.

The best thing you can do to prevent this from happening is to get informed about medical billing, make sure you’ve saved for a rainy day and monitor your credit. You can do this for free with the Credit Report Card, a tool that updates you two of your credit scores every month for free. Any sudden, unexpected drop in your credit scores could signal a missed medical bill, but you’d need to pull your credit reports to confirm this (you can get free copies of your credit reports once a year from each of the major credit bureaus).

Restricted Application for Social Security Benefits

Social Security 2My Comments: Years ago, it was simply a matter of waiting to reach 65, showing up at the Social Security office and then waiting for a check to appear in the mail. Today, that idea is quaint and naive.

As the baby boomers reach age 62 and beyond, it’s become a chore to figure out when to apply. For one thing, there are a possible 97 months to choose from. If you have a spouse, there are 9 different options for each one of those 97 months. Between the best month and the worse month for you, there is often a $100,000 difference over time. Increasingly, financial planners such as myself are being asked to help.

Which is why I’ve become knowledgable and aligned myself with a team that provides a personalized Social Security Report that quantifies the best options. The flaw in this system is you cannot know ahead of time when you are going to die, but that’s probably a good thing. So you have to play the odds and hope for the best.

If you aren’t confused yet, you will be by the time you finish reading this.

By Dana Anspach

In many cases to get the most out of your Social Security benefits you will need to use something called a restricted application.

As there are different types of Social Security benefits you may be eligible for, a restricted application, sometimes referred to as “restricting the scope” of your application, specifies to the Social Security office that you are not simultaneously applying for all benefits you are eligible for.

To understand why you would do this first take a look at some of the types of Social Security benefits you may be eligible for:
• A benefit based on your own earnings record, referred to as a Retirement Insurance Benefit (RIB)
• A benefit based on a spouse or ex-spouse’s earnings record, referred to as a spouse’s insurance benefit (SIB)
• A benefit based on a deceased spouse’s or deceased ex-spouse’s earnings record, referred to as a Widow/Widower’s Insurance Benefit (WIB)
• A benefit if you are disabled referred to as disability insurance benefits (DIB)

How might you use these rules to boost your benefits?

If married, or eligible for a benefit on an ex-spouse’s record, once you reach full retirement age, you can use a restricted application to claim a spousal benefit, while letting your own benefit continue to grow. You would then switch to your own higher benefit amount when you reached age 70.

In Social Security’s online Programs Operations Manual System (POMS) their Scope of the Application section says:
“A claimant may choose to limit or restrict the scope of the application to exclude a class of benefits he/she may be eligible to on one or more SSNs for any reason (except where deemed filing applies). The reason may be to receive higher current benefits or to maximize the amount of benefits over a period of time, including the effect of delayed retirement credits (DRCs).”

Here are a few key points to note about the restricted application rules:
1. A spouse must be full retirement age to file a restricted application for spousal benefit only
2. A widow/widower, or survivor of a deceased ex-spouse, may file a restricted application even if they have not yet reached full retirement age.
3. A claimant who is caring for child (under age 16 or disabled adult child) who is entitled to child’s benefits may have the option to restrict the application to spouse’s benefits only even if they have not yet reached their full retirement age.

Regarding item number one above POMS says (GN 00204.020D.1):
“In fact, a spouse claimant at or past Full Retirement Age (FRA) has the right to restrict the application to exclude RIB. However, always take a RIB application in a reduced benefit situation when the spouse is insured for RIB as the “deemed filing” provision applies.”

A “reduced benefit situation” means if you are filing before you reach full retirement age. When you file before you reach full retirement age if your spouse has already filed for their benefits (in the cases of an ex-spouse they have to have reached age 62, but do not have to have filed yet) you are deemed to be filing for spousal benefits at the same time you file for your own retirement benefits. Doing this prevents you from using claiming strategies that might otherwise allow you to later switch between benefits.

If your spouse has not already filed for benefits, you would not be deemed to be applying for a spousal benefit, however, if they subsequently file for their own benefits before you reach your full retirement age, the deemed filing rules would kick in, and your future choices would be limited if you had filed before your own full retirement age.
Regarding item number two above, POMS says (section GN 00204.020E.4.a):

“A widow(er) or surviving divorced spouse may wish to exclude a reduced RIB from the scope of the application and defer filing for an unreduced RIB because of the increasingly greater amount payable after FRA because of DRCs,” and that in order to do so the Social Security office needs to take get a statement such as “I do not wish this application to be considered an application for reduced benefits on my own record.”

This means if your spouse or ex-spouse is deceased, and you are eligible for a widow/widower’s benefit on their earnings record, you have greater leeway to restrict the scope of your application, even if you have not yet reached full retirement age.

Regarding item three above POMS says (GN 00204.020F.2.a):
“A claimant who is between the age of 62 and FRA, has in his/her care a child (under age 16 or a disabled adult child) of the NH (number holder) who is entitled to child’s benefits, and is filing for spouse’s benefits is not deemed to have filed for reduced RIB. He/she may exclude RIB from the scope of the application for spouse’s benefits by a clear declination.”

In addition to item three above there are also special provisions when you are eligible for a disability insurance benefit that may allow you to file for spousal benefits, while not yet applying for your own retirement benefits. It is beyond the scope of this article to go into details about such disability or child benefit strategies.
Because the rules are complex, some couples seek the advice of an attorney to advise them on their best claiming options.

If you are married, or a widow/widower, a Social Security calculator (online software) can often provide you the needed Social Security strategy.

If you have dependents, multiple ex-spouses, may be eligible for disability benefits, or have other complexities, the services of an attorney may be appropriate.

Court Rules in Favor of IRS on Obamacare Tax Credits

healthcare reformMy Comments: The plainfiff in this case at least acknowleges that Congress passed the PPACA.

This is at least a small victory for those of us who believe the PPACA is a good thing. If you are an American, you should be able to participate in the bounty offered by this country, one feature of which is now health insurance for almost ALL OF US.

Since Governor Scott chose to not establish an exchange for the citizens of Florida, it reaffirms the ability of Floridians to purchase coverage on the federal exchange, and if qualified, get tax credits, which will help. Since I’ve been paying for my coverage and that of another family for about 40 years anyway, I’m OK with this.

by: Michael Cohn | January 15, 2014

A federal district court judge has ruled in favor of the federal government in a lawsuit that claimed the Internal Revenue Service did not have the authority under the Affordable Care Act to write rules providing tax credits to individuals purchasing health insurance on the health insurance exchange set up by the federal government.

The IRS issued a final rule in May 2012 implementing the premium tax credit provision of the Affordable Care Act, in which it interpreted the ACA as authorizing the agency to grant tax credits to individuals who purchase insurance on either a state-run health insurance exchange or a federal exchange such as the one that has been available on the problem-prone HealthCare.gov site for people in states that have not set up state exchanges.

The plaintiffs in the lawsuit, who include the conservative advocacy organization, the Competitive Enterprise Institute, contended that the IRS’s interpretation was contrary to the statute, which, they asserted, authorizes tax credits only for individuals who purchase insurance on state-run exchanges, but not on federal exchanges. The plaintiffs in the case, known as Jacqueline Halbig, et al v. Kathleen Sebelius, et al, claimed that the rule promulgated by the IRS exceeded the agency’s statutory authority and was arbitrary, capricious and contrary to law, in violation of the Administrative Procedure Act.

The U.S. District Court for the District of Columbia heard oral arguments in the case last month and a judge on the court tossed out the lawsuit Wednesday, agreeing with the federal government that the law made clear that the tax credits should be available on both state-run and federally run health insurance exchanges.

“In sum, the Court finds that the plain text of the statute, the statutory structure, and the statutory purpose make clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated exchanges,” wrote U.S. District Judge Paul Friedman. “What little relevant legislative history exists further supports this conclusion and certainly—despite plaintiffs’ best efforts to suggest otherwise—it does not undermine it.”

Sam Kazman, general counsel for the Competitive Enterprise Institute, said he planned to appeal the judge’s ruling.

“The court’s ruling today delivers a major blow to the states that chose not to participate in the Obamacare insurance exchange program,” Kazman said in a statement Wednesday. “It is also a blow to the small businesses, employees and individuals who live in those states as well. In upholding this IRS regulation that is contrary to the law enacted by Congress, this decision guts the choice made by a majority of the states to stay out of the exchange program. It imposes Obamacare penalties on employers and on many individuals in those states, penalties that Congress never authorized, putting their livelihoods and the jobs of their employees at risk.

Worst of all, it gives a stamp of approval to the Administration’s attempt to substitute its version of Obamacare for the law that Congress enacted.”

The case is Halbig v. Sebelius, 13-cv-00623, U.S District Court, District of Columbia (Washington).


My Comments: I’ve been a licensed insurance agent since sometime in 1976, or was it 1975? I have helped place hundreds, if not thousands, of insurance contracts over these many years, some of which I know are still in force.

This article is directed toward those who are dealing with elderly parents, some of whom are not as mentally alert or as strong as they once were. Time has a way of getting away from us and for those of you in middle age, this part of your future has a lot of challenges.

So I encourage you to approach your time with your parents, aunts and uncles, with the following circumstances in mind. You’ll be doing yourself a favor, not to mention minimizing stress for those afflicted.

By Kevin Sypniewski | March 20, 2013

When we hear something once, we might pay attention but when we hear the same thing from totally unrelated people, we begin to suspect there is a trend.

Some of the most enlightening and interesting professional conversations I’ve had recently have been with long-term care (LTC) claim departments. Okay, perhaps I should get out more!

Two different claim departments from two different leading LTC carriers tell me that they regularly get LTC claims submitted 12 or even 24 months after the claim event.

Why on earth would someone wait that long to receive the money for which they are entitled? Because the family just found the LTC policy!

The insured was ADL dependent but not communicative, and the family just “happened” to find the policy in a shoebox or file cabinet in the basement.

Have you ever been into the basement of the house that someone has lived in for 30 years and tried to find a specific file? It is wonderful that this policy got found and even more wonderful that the carriers are paying “late” claims, some of which they are no longer contractually obligated to pay.

What about the other LTC policies on other insureds that never get found?

If some get found, others surely do not get found!

We’ve had employees in our caregiving education and LTC sessions tell us about finding policies and others tell us about “knowing” mom bought one, but they never could find it once mom needed it.

We were hoping these were somewhat isolated incidences; however, after talking with leading LTC carriers, we know these are not isolated. If someone lapses their policy and takes the carrier “off the hook,” I’m okay with that.

That is their decision and certainly the carriers don’t mind. But knowing that families are paying premiums for the duration and the carrier gets a bye on the payment…That just stinks!

You as an insurance professional did your job selling the policy. The claimant did a smart thing buying the policy, but in the end the family loses a lifetime of assets and now the family home has a lien and the insured is on Medicaid in a Medicaid facility.

That is just not right! Sure, the policies that get found eventually get paid, but by then the assets might be gone, mom is in a Medicaid facility, and now the family gets the $200,000 check.

Better than nothing, but not for Mom.

I can hear the family discussion now. “I sure wish Mom had bought long-term care insurance because she really wants to remain at home in her house of 30 years.” She did buy the policy but just never told anyone, which is exactly like not buying a policy… just more expensive.

The carriers and regulators require we designate a third-party in case we don’t pay our premium. What about a third party to make sure we file our claim?

I think we have an obligation to communicate this story to each and every person we help with LTC insurance.

Perhaps we create our own third party notification memo that at the time of purchase the new policyholder is able to designate several people who get notified about the policy purchase.
Sure, those people may or may not be around 25 years later at claim time, but I certainly like the odds of that effort versus the strategy of hope.

Source: http://www.lifehealthpro.com/2013/03/20/lost?eNL=514a2b29150ba0161b0002ff&utm_source=LifeHealthProDaily&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=1044219161