Category Archives: HealthCare

Medicare Open Enrollment Runs from October 15th to December 7th

My Comments: Medicare is an absolutely critical component if you expect to have a joyful and happy retirement.

As someone who benefits monthly from it, I can attest to its value in contributing to my peace of mind.  Don’t vote for any politician who in any way threatens is viability.

Each year, there is an open enrollment period when you can get your name into the system if you are not already age 65, and if you are already signed in, evaluate some options that might benefit you.

This image is what appeared in my email inbox a few days ago. The links shown are not live; instead simply click on the image itself and you’ll find where you need to start.

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How to Prepare for Costs Medicare Won’t Cover

My Comments: Health issues in retirement are a given for those of us not already passed. Whether they end up costing an arm and a leg depends to some extent on how prepared we are before they happen.

Both my wife and I are covered by Medicare and each of us has a ‘medigap’ insurance policy, designed to cover most of what Medicare does not cover. But make no mistake, between the Medicare Part B premiums and the ‘medigap’ policy, it still represents a significant monthly outlay if you don’t think of yourself as financially comfortable.

And then there is Medicare Part D which covers prescription drugs. My wife is a diabetic, and that too can be very expensive. She and I both elected to purchase a Part D plan. All this assumes you have the resources to pay the extra premiums.

As for Medicare Part C coverage, or Advantage Plans, I have a bias against them so we didn’t go that route. But that’s a personal preference.

The real benefit to me for having what we have is that when we decide we need to speak to one of our many physicians, the out-of-pocket expense is not a deterrant. Being able to deal with health issues as they surface provides real peace of mind as the years flow by.

Katie Brockman Aug 19, 2018

When you think about how you’ll spend your retirement savings, you probably imagine traveling the world, getting more involved in your hobbies, or spoiling your grandchildren. What you probably don’t envision is spending every spare dime on healthcare expenses.

Unfortunately, that’s the ugly reality some retirees face.

The average 65-year-old couple retiring today can expect to spend roughly $280,000 on healthcare during retirement, according to a recent report from Fidelity Investments. That includes costs like premiums, deductibles, and other out-of-pocket expenses.

This may come as a shock to some, as many people mistakenly believe that Medicare will cover all their healthcare expenses during retirement. The truth is that while Medicare can offer significant financial assistance, it doesn’t cover everything. And some of the costs it doesn’t cover can put a serious crack in your nest egg.

What Medicare does (and doesn’t) cover

First, it’s important to understand what Medicare does cover and how much you’re paying for it. Original Medicare consists of Part A and Part B. Part A covers hospital visits, visits to skilled-nursing facilities, and in-home healthcare services. As long as you’ve been working and paying taxes for at least 10 years, you generally don’t need to pay a premium for Part A coverage. You do have a deductible for each benefit period, though, and for 2018, that deductible is $1,340. Also, if you have to spend an extended period of time in a hospital or skilled-nursing facility (typically longer than 60 days for hospital stays and 20 days for visits to a skilled-nursing facility), you may have to make coinsurance payments, which range from $167 to $670 per day — or Medicare may not cover your stay at all.

Part B covers more routine care, like doctor visits and flu shots, and the amount each person pays varies based on their income. Those earning less than $85,000 per year (or $170,000 for married couples filing jointly) pay $134 per month for Part B premiums. You also have to pay a yearly deductible, which for 2018 is $183. After you meet that deductible, you pay 20% of the remaining expenses.

You also have the option of enrolling in Part D, which covers prescription drugs. This coverage is provided by private insurance companies, though, so the amount you pay will vary widely depending on which plan you have.

Even considering all that Medicare Part A and Part B cover, there’s a variety of expenses that basic Medicare won’t touch. For example, you still need to pay for all copayments, deductibles, and coinsurance out of pocket, and those costs can add up quickly. You’re also not even eligible to enroll in Medicare until you turn 65, so if you retire before that and lose your health insurance when you leave your job, you’ll need to find coverage outside of Medicare.

Then there are healthcare expenses that most people don’t realize aren’t covered. Most dental care, for example, isn’t covered by Medicare, and neither are eye exams, hearing aids and exams, dentures, or long-term care.

These aren’t necessarily hard rules, because there are always exceptions. Expenses that are considered medically necessary are often covered by Medicare, while routine care is not. So if, for example, you have a dental emergency, then Medicare may pick up the tab, but if you simply get your teeth cleaned or have a cavity filled, then you’ll likely need to pay for that out of pocket. And even routine care can cost hundreds of dollars per visit. If you’re not prepared for those expenses, they can drain your savings quickly.

Don’t let healthcare costs catch you off guard

The best way to avoid paying tens (or hundreds) of thousands of dollars in healthcare costs is to do your research, understand what Medicare does and doesn’t cover, and figure out how to pay for uncovered medical care before you retire.

One option is to enroll in a Medicare Advantage Plan (also known as Medicare Part C). A Medicare Advantage Plan is a health plan offered through private insurance companies that includes all the benefits of Medicare Part A and Part B, as well as some additional coverage for vision, hearing, and dental. Advantage Plans are similar to the insurance plans you likely enrolled in while you were working: You have to visit a doctor within your plan’s network or risk not being covered, and the premiums and deductibles vary by plan and provider.

Although prices vary, you typically get more coverage with an Advantage Plan. Depending on the type of care you need, it could be worth it to pay more for an Advantage Plan in order to pay much less out of pocket for routine care.

Another option is to use a health savings account (HSA) to cover some of your medical expenses. An HSA is essentially a retirement savings account just for healthcare costs. You’re eligible for an HSA if you have a high-deductible health insurance plan, and for 2018, that means you have a deductible of $1,350 for an individual or $2,700 for a family, as well as maximum out-of-pocket costs of $6,650 or $13,300 for an individual or family, respectively.

If you’re eligible to open an HSA, you can contribute up to $3,450 per year (or $6,850 for family health plans) in pre-tax dollars. Those aged 50 and over can contribute an extra $1,000 per year. When you withdraw the funds, so long as you spend them on qualified medical expenses, you don’t need to pay taxes on withdrawals either.

Regardless of which route you choose, it’s crucial to have a plan in place. If you go into retirement assuming you won’t need to pay a dime more in medical expenses than you used to, you’ll be in for a rude awakening. But if you prepare yourself and come up with a plan before you make the leap into retirement, your wallet will thank you.

Source: https://www.fool.com/retirement/2018/08/19/how-to-prepare-for-costs-medicare-wont-cover.aspx

Here’s what you need to know about Medicare if you’re still working

My Comments: Despite the appeal of retirement, no one is ready to admit that the transition from “working for money” to “money working for you” will be easy.

The cost of health care as you get older has the potential to cause your retirement plans to come unglued. To keep that from happening, Medicare is an enormous benefit, especially when coupled with what is known as a ‘medicare supplement’ insurance policy.

Many of us choose to keep working well beyond the age when we become eligible for Medicare and that alone presents some interesting challenges. Here’s a good summary of what you can expect if you are still employed.

by Joe Baker on 9/11/2018

If you’re 65 or older, working and have an employer group health plan based on your current work, you may have questions about how your job-based insurance coordinates with Medicare. On our Medicare Rights Center National Consumer Helpline, such questions are among the most frequent ones we get.

Here’s what you need to know:
For people who work and have job-based insurance, knowing when to enroll in Medicare falls on them. There is no formal notification from the Social Security Administration or Medicare. Some people are misinformed by employers or don’t have reliable information about Medicare enrollment, leading them to delay enrollment in Medicare Part B and then incur penalties and high medical costs.

The rules on coordinating Medicare and employer coverage

Having job-based insurance does allow you to delay Medicare enrollment without penalty and delay paying the Medicare Part B premium (the standard Medicare Part B premium is expected to be $134 a month in 2019). However, it’s important to know whether your job-based insurance will pay primary or secondary to Medicare.

In most cases, you should only delay enrollment in Medicare if your job-based insurance is the primary payer (meaning it pays first for your medical bills) and Medicare is secondary. There are additional enrollment considerations if you have a Health Savings Account (HSA); if you enroll in Medicare Part A and/or B, you can no longer contribute pretax dollars to your HSA.

Job-based insurance is primary if it is from an employer with 20 or more employees. Medicare is secondary in this case, and some people in this situation choose not to enroll in Medicare Part B so that they do not have to pay the monthly premium.

Job-based insurance is secondary if it is from an employer with fewer than 20 employees; Medicare is primary in this case. If you work at an employer this small and delay Medicare enrollment, your job-based insurance may provide little or no coverage. That’s why you should enroll in Medicare Part B to avoid incurring high costs for your care. The rules are different, however, if you are Medicare-eligible due to a disability or because you have End-Stage Renal Disease (ESRD).

The Medicare special enrollment period

If you are eligible for Medicare because you are 65 or older and are covered by your job-based insurance or your spouse’s, you have a Special Enrollment Period (SEP) to enroll in Medicare Part B while you are covered by job-based insurance and up to eight months after you no longer have that coverage. This means you aren’t required to take Part B during your Initial Enrollment Period (IEP), or the seven months surrounding your 65th birthday, when you become Medicare eligible.

Using the Part B Special Enrollment Period means you will not have to pay a Part B late enrollment penalty (LEP). Normally, for every 12 months that people who are Medicare-eligible and not covered by employer insurance delay enrollment, they accrue a 10% penalty, which is then added to their monthly Part B premium amount. In most cases, the penalty lasts for as long as someone has Medicare.

Retiree coverage, COBRA, Affordable Care Act and Medicare

Many Medicare-eligible individuals do not know that employer-offered retiree coverage is almost always secondary to Medicare.

Similarly, health insurance coverage through COBRA (employer-sponsored coverage you can pay to keep after you leave your job, usually for up to 18 months) is also always secondary to Medicare coverage. If you have employer-offered retiree coverage or COBRA, you should enroll in Medicare when first eligible to avoid possible penalties, higher medical costs and gaps in coverage.

You should also make sure you understand how to make Medicare Part B enrollment decisions if you are enrolled in a Marketplace plan under the Affordable Care Act.
If you have an insurance plan certified by the Marketplace, known as a Qualified Health Plan, deciding what to do as you approach Medicare eligibility depends on your circumstances. If you delayed enrolling in Medicare so you could stay in your Marketplace plan, you may be eligible to request time-limited equitable relief. That will let you enroll in Medicare Part B without penalty or eliminate or reduce your late-enrollment penalty under certain circumstances. The opportunity to request time-limited equitable relief lasts until September 30, 2018.

For more information on how Medicare works with other types of health care coverage, visit Medicare Interactive, the Medicare Rights Center’s free, online resource packed with hundreds of answers to Medicare questions.

Joe Baker is president of the Medicare Rights Center, a national nonprofit consumer organization that works to ensure access to affordable health care for older adults and people with disabilities. He is also an adjunct professor at the New York University School of Law. Previously, he was deputy secretary for health and human services for New York state.

Click HERE to read the source article

10 things I’ve learned 10 years after I finished medical school

Friday’s Random Thoughts: I’ve long argued that the health care system in America is a mess. (How Did Health Care Get to Be Such a Mess?)

These next words from Kevin Tolliver, a physician with a strong exposure to economics and finance, is a welcome addition to the debate. It’s taken a long time to reach the mess we have and it’s going to take a long time and an attitude adjustment among the citizenry if it’s going to get better.

I was once very hopeful that the ABA (ObamaCare) was going to turn the tide toward a better national outcome. But unless the Democrats take over the House of Representatives in 2 months, we’re going to lose any gains we’ve made. There will be an effort in the lame duck session to abolish it entirely. Be prepared to start shouting from the rooftops.

Kevin Tolliver, MD, MBA/Aug 30, 2018

1. Our health care system is broken, and there isn’t going to be an easy way out. Costs are too high and our outcomes too poor. There’s a lot of finger-pointing in how we got to this point, but one thing is for certain — physicians must lead the way to a better system. The heart of health care is still the doctor-patient relationship and that needs to be protected at all costs. Historically speaking, physicians have tended to shy away from the business side of medicine in lieu of caring for patients, but that’s no longer a realistic option. Physician leadership is a must.

2. Nurses are underpaid and underappreciated. Physicians diagnose and develop treatment plans, but the nurses are the ones who carry things out. They’re present for the good, the bad, the embarrassing and whatever else becomes necessary. They spend substantially more time with patients and families than the physician. A competent, compassionate nurse is an invaluable benefit for a physician and shouldn’t be taken for granted. I feel this more strongly with each passing year I work alongside them.

Here’s What the Average Retiree Spends on Healthcare Each Year Hint: It’s not a small number.

My Comments: As you approach phase two of your adult life, please understand that the economic and financial dynamics can change dramatically.

Retirement is when you have effectively turned off the ‘work for money’ switch and have turned on the ‘money works for you’ switch. That implies you have money and credits in place to pay your bills.

Unless you’re OK with wandering off into the woods to die, health care costs are going to continue and potentially become a noose around your neck. Just know that if you are alive and well today, the day will arrive when you’re not, and in the interim, you’re likely to have a few medical care visits from time to time, and those people do not work for free. Those that do may not provide you with good care.

Maurie Backman Jul 22, 2018

It’s natural to assume that our living costs will mostly go down in retirement, but if there’s one expense that’s likely to rise during your golden years, it’s healthcare. From deductibles to copays to Medicare premiums, healthcare can easily grow to become your single greatest monthly expense — but planning for it can help alleviate some of the stress it causes so many seniors.

So how much money should you expect to allocate to medical costs? The average retiree spends $4,300 on out-of-pocket healthcare expenses each year, according to the Center for Retirement Research at Boston College. Given that the average Social Security recipient collects just under $17,000 a year in benefits, that’s a large chunk of that income to be spending.

Now the good news is that you can take steps to save money on healthcare in retirement. But while you’re optimizing those strategies, be sure to work on boosting your income as well so that you have the means of paying for whatever costs do inevitably come your way.

Make sure you’re financially prepared for retirement

It stands to reason that the more money you have available in retirement, the less worrisome the notion of covering your medical costs will be. And in that regard, padding your nest egg during your working years is really your best bet.

Currently, workers under 50 can save up to $18,500 per year in a 401(k) and $5,500 in an IRA. For workers 50 and over, these limits increase to $24,500 and $6,500, respectively. If you’re 55 years old and are able to max out a 401(k) for the next decade, you’ll add $338,000 to your nest egg, assuming your investments grow at an average rate of 7% a year during that time.

While you’re working on boosting your retirement savings, start thinking about other income streams you might set yourself up to optimize during your golden years. Maybe you have a home you’re willing to rent out or a hobby you can monetize to drum up extra cash. The key is to get a little creative, especially if you’re nearing retirement and don’t have a lot of time to pad your savings the way you’d like.

But don’t forget about Social Security, either. There are ways you can grow your benefits and get more money out of the program to cover your various living expenses, healthcare included.

If you delay filing for benefits past what’s considered full retirement age, those benefits will go up by 8% a year until you reach age 70. This means that if your full retirement age is 67 and you wait a full three years, you’ll boost your benefits by 24%, and that increase will remain in effect for the rest of your life. Fighting for more money at work will also help your benefits go up, since they’re calculated based on your earnings record.

Take good care of your health

While going into retirement with the highest level of savings possible will help make your medical costs more manageable, another important step to take is keeping tabs on your health as you age. All too often, we neglect medical issues because we don’t want to be bothered with waiting at the doctor’s office or don’t want to dish out a pesky copay. But when you let medical problems linger, they tend to escalate, and once that happens, they can become costlier to treat.

Case in point: A nasty cut on your leg might cost you a $25 doctor visit and a $10 bottle of antibiotics. But if you ignore that cut and it gets infected, you could wind up with a $1,200 ER bill. Of course, this applies whether you’re mid-career or on the verge of retirement, but since our health tends to decline as we age, it pays to be even more vigilant when you’re older.

There’s no question about it: Healthcare is a whopping expense that’s pretty much unavoidable for retirees. But there’s no need to let it ruin your golden years. Read up on how Medicare works so you know what to expect from it, save aggressively, and be vigilant about health problems that inevitably arise. With any luck, you’ll be well prepared to tackle those medical bills once your career comes to a close.

Source: https://www.fool.com/retirement/2018/07/22/heres-what-the-average-retiree-spends-on-healthcar.aspx

Medicare open enrollment begins Sunday – and not just for those age 65 and up…

My Comments: Have you noticed a flurry of ads on TV recently talking about Medicare and all the benefits you are entitled to for one easy price per month? I have.

The ads promote the use of Medicare Plan C, also known as Medicare Advantage plans. They are a sop to the insurance industry, giving companies a way to make more money by selling you stuff you may or may not need.

Years ago I decided those extras had little value to me and only lined the pockets of agents and companies at my expense. That’s not to say you might find value with them but as a financial professional, I refused to play the game.

Last year during the open enrollment period, I checked my coverage for Part D, the prescription drug coverage plan. I went to https://www.medicare.gov/, found the spot where you can compare alternatives, and entered the drugs I’m taking for a price analysis. The result was signing up for a different provider and it saved me $85 per month. Not bad.

That being said, if you are already on Medicare or your 65th birthday is around the corner, I encourage you to visit the official Medicare web site. It has good information. Go here: https://www.medicare.gov/

Normally when I write one of these posts it’s to share an article written by someone else. This time I’m simply going to give you two active links to follow if you think any of this is important to you.

Link #1: https://goo.gl/p8nRiF

Link #2: http://flip.it/fg6foM

Remember, there’s also a link just to the right on this page where you can schedule a conversation with me as you wrestle with all this…

How to choose a health insurance policy

My Comments: Having health insurance is critical to maintain your financial well being, much less your long term health. Health care costs in this country are the highest in the world, and the long term outcomes are among the worst.

The budget passed by the House of Representatives includes a significant cut to Medicare, if the media is correct. Why do we keep electing people to Congress who fail to understand their reason for being there in the first place?

Oh, I guess I forgot. They’re there to make money, and the drug companies, the insurance companies, the hospital industry make sure they are properly prioritized.

P.S. – there’s a short window open to get coverage under the ACA. There’s also a short window open to buy a better Medicare Plan D (subscription drug coverage).

Wendy Connick, The Motley Fool Sept. 29, 2017

Given the high cost of major medical treatments, health insurance is a must for just about everyone. But health insurance policies vary wildly in cost, coverage, and other features, so it’s important to choose your plan with your individual needs, resources, and medical history in mind.

Identify your source

If you’re fortunate enough to have employer-provided health insurance, that narrows your options down to the plans that your employer offers. If you don’t have coverage through your job, perhaps an organization or association that you belong to will allow you to buy health insurance through them at a group rate.

Another option is to check your local Obamacare health insurance marketplace to see if you qualify for an upfront premium credit, which would get you reduced premium costs. Even if you don’t qualify for the credit right away, buying your health insurance through the marketplace means you may qualify for it when you file your tax return for the year.

If you can’t, or won’t, get health insurance from any of these sources, you’ll have to fall back on buying a private plan. It will give you the widest range of options, but likely will be far more expensive.

Decide which type of policy to buy

Health insurance policies come in a variety of basic types, although you may not have access to all of these options through your preferred source. Health Maintenance Organizations (HMOs) are a very common type of health insurance policy. With an HMO, you’re required to use healthcare providers within the policy’s network, and you have to get a referral from your primary care physician in order to see a specialist.

Preferred Provider Organizations (PPOs) are also quite common. A PPO health insurance policy has a network, but you’re not limited to in-network care — although using network providers is cheaper — and you don’t need referrals to see specialists.

Exclusive Provider Organizations (EPOs) are a hybrid between HMOs and PPOs. You’re required to stick to the plan’s network, but don’t need referrals for specialists. Finally, Point of Service (POS) plans are a less common option that are essentially the opposite of an EPO. You’re not limited to the POS plan’s network, but do need a referral to see a specialist.

Of the four common types of plans, an HMO or EPO tends to be cheaper than a PPO or POS with the same level of coverage. However, if network coverage is poor in your area, or you’re uncomfortable limiting yourself to network providers, it may be worth paying a little more to get a PPO or POS policy.

High deductible versus low deductible

All things being equal, the higher a plan’s deductible is, the lower the monthly premiums will be. A high deductible means that you’ll have to pay a lot of healthcare expenses yourself before the insurance policy kicks in, but if you have few or no medical expenses in a given year, these plans can be a bargain. Very low medical expenses means that you probably won’t surpass the deductible, even of a low-deductible plan, so getting a high-deductible plan keeps your insurance costs as low as possible while still protecting you in case something catastrophic happens.

If you decide to go the high-deductible route, getting a Health Savings Account (HSA)-enabled plan, and funding it with at least the equivalent of a year’s deductible, is your best option. An HSA plan neatly covers the biggest weakness of a high-deductible health insurance policy — namely, that you’d have to shell out a great deal of money on a major medical expense before the insurance would take over. If you have a full-year’s deductible tucked away in your HSA, you can just use that money to finance your share of the expenses, while simultaneously enjoying the triple tax advantage that an HSA offers.

Comparing coverage

There are two major factors that affect how well a particular plan will cover your medical expenses: the plan’s network and its coverage policies. Even if you choose a plan with out-of-network options, like a PPO, you’re still better off using in-network health providers as much as possible because doing so will reduce your costs. And the rules that a given health insurance policy uses to decide what’s covered and what’s not — and how much the co-pays will be — can make a huge difference in how helpful a particular policy really is for you.

For example, if there’s a rather pricey medication that you take every day, you’ll definitely want to get a health insurance policy that lists that medication on its formulary. If you travel a lot, stick to plans that offer good out-of-area treatment options. And if you already have a primary care physician, you’ll definitely want to pick a plan that includes your doctor in its network.

Finding the best deal

If you’re stuck between two or three different policies and can’t decide which one to choose, try this exercise. Multiply the monthly premium by 12 to get your annual cost for a plan, then add in the plan’s out-of-pocket maximum. The result is the most you would end up spending on health care if you had one or more major medical expenses during the year. Do this calculation for each plan you’re considering, then compare the results. The plan with the lowest total is likely the best deal for you.