Tag Archives: medicare and medicaid

How Much Will Your Health Expenses Be In Retirement?

Cost-of-careMy Comments: Having access to medical care is a big deal. Having access to medical care that you can afford is a big deal. And it becomes a bigger deal when you are no longer employed and attempting to live the rest of your life with some degree of financial freedom.

By Glenn Ruffenach July 15, 2016

Question: My wife and I are trying to set up a budget for retirement, and we’re wrestling, in particular, with health-care expenses. How can we estimate what our medical bills will look like in the future?

An important — and vexing — question. For instance, a healthy person will have fewer and/or smaller medical bills in later life, right? Well…maybe not. As a recent study, “An Apple a Day: The Impact of Health Conditions on the Required Savings” noted, “Excellent health, ironically, can actually raise an individual’s lifetime health spending needs because of the likelihood that healthy 65-year-olds will live much longer.”

A good starting point (and a study worth reading in full) is the “2015 Retirement Health Care Costs Data Report” from HealthView Services Inc., a provider of health-care planning tools in Danvers, Mass. According to HealthView, a healthy 65-year-old couple can expect to pay, on average, $266,589 for insurance premiums and $128,365 for related expenses (dental, vision, copays and out-of-pocket bills) over their lifetime.

Another good resource—one with an emphasis on prescription-drug costs—is “Amount of Savings Needed for Health Expenses for People Eligible for Medicare” from the Employee Benefit Research Institute in Washington. The study estimates that a couple, where both spouses have median drug expenses, would need $259,000 to have a 90% chance of having enough money to cover health-care bills in retirement.

Note: Neither report accounts for possible long-term-care expenses. For that piece of the puzzle, check out Genworth Financial’s GNW, +2.72% 2016 “Cost of Care Survey.”

I am due to begin required withdrawals from my retirement savings. What are the advantages and disadvantages of an annual lump-sum withdrawal as opposed to a monthly payout?

In most cases, a required minimum distribution, or RMD, in the form of a single annual payout causes fewer problems — if you have a good amount of self-discipline.

Yes, monthly withdrawals act like a regular paycheck. But, to take a worst-case scenario, if you die midyear, your family must withdraw the remaining RMD, says Carolyn McClanahan, founder of Life Planning Partners Inc. in Jacksonville, Fla. Figuring out how much has already been withdrawn and how much remains to be withdrawn can (at times) be a hassle.

With a single lump sum, you can deposit the funds in a savings account and then arrange for monthly transfers to your checking account, creating (in effect) a regular paycheck. And if you wait until November or December to take an RMD — when you have a clear picture of all your income for that year — you can calculate your tax withholding on the withdrawal more accurately.

The one cautionary note about a single annual withdrawal: willpower, or the lack thereof. “Some people spend it all at once if they take it as a lump sum,” McClanahan says.

I have a question about paying my grandchildren’s tuition. I understand that if I pay the institution directly there is no tax consequence for my grandchild or me. Does this apply only to tuition or does it include room and board?

The answer: just tuition. But you have some flexibility here.

To start, the “tax consequence,” in this case, is the federal gift tax. You can give as much as $14,000 in cash or other assets to as many people as you wish each year, and those gifts won’t count against your (the giver’s) lifetime exemption. (In all, you can give away $5.45 million before gift taxes kick in.) If you exceed the $14,000 ceiling in a given year, you have to file a gift-tax return. That said, there are exceptions to these rules.

Under section 2503(e)(2) of the Tax Code, “any amount paid on behalf of an individual as tuition to an educational organization” is exempt from gift taxes. Note the wording: “tuition.” Period. There’s no mention of associated costs, like books, room and board, etc.

This shouldn’t stop you, however, from paying the grandchild’s tuition — and then either gifting him $14,000 to pay room and board, or paying room and board up to $14,000 directly, says Barry Kaplan, chief investment officer at Cambridge Wealth Counsel in Atlanta. And if both grandparents are alive, each can gift $14,000, for a total of $28,000.

My husband started taking Social Security at his full retirement age, but continued to work. He is now 75 and still working full time. Over the past 10 years, his benefit has gradually increased because of cost-of-living adjustments and his continuing contributions (via his paychecks) to Social Security. I am nearing full retirement age and am trying to figure out how much I would receive as a spousal benefit. I know that — at my full retirement age — I can qualify for half of my husband’s benefit. But do I get half of what he started receiving 10 years ago, or half of what he is receiving now, including the adjustments to his benefit?

Your spousal benefit would be based on your husband’s current payout, including the cost-of-living adjustments and any increases tied to his continued wages. To get a better idea of how much the spousal benefit will be, says Darren Lutz, a public affairs specialist with the Social Security Administration, your husband can create a “my Social Security” account at socialsecurity.gov/myaccount to see what his full benefit is, before deductions for Medicare premiums, etc. Then you can visit the agency’s retirement planner for spouses to learn more about potential benefits.

Glenn Ruffenach is a former reporter and editor for The Wall Street Journal, and co-author of “The Wall Street Journal Complete Retirement Guidebook.” Email your questions and comments to askencore@wsj.com.

11 Medicare Mistakes to Avoid

healthcare reformMy Comments: If you are 65 and older, Medicare is fantastic. Okay, it has its limitations, but coupled with what is known as a MediGap or MedSup plan, it’s fantastic.

You can argue all you want about how this country is slowly sinking into a socialist morass, but when you reach my age, health issues surface almost weekly, not annually. Being able to seek advice from medical professionals without first thinking how it might break the bank, is a huge component of financial freedom. HUGE, I say.

July 18, 2016 By Ginger Szala

First, let’s generally define the Parts of Medicare. Part A, referred to as original Medicare, focuses on hospital coverage. Part B is medical coverage. Part C (also called Medicare Advantage) is a different way of putting Parts A and B into one plan, offered by private companies. Part D is prescription drug coverage.

The rules of Medicare are complicated and laden with deadlines that are costly to miss. Via Kiplinger, here are 11 common Medicare mistakes to avoid:

1. Not reviewing your Part D Plan annually
Medicare Part D is a headache for many to keep on top of. But remember these key points:
• Open enrollment runs from Oct. 15 to Dec. 7 every year.
• During open enrollment it’s essential to review options because there might be changes to your current plan, meaning your cost and coverage would vary. Be leery of plans that increase premiums, increase your percentage of cost for drugs, or other requirements, like having to use a specific pharmacy, to be covered.
• Make sure you check if any drugs you’re on have gone generic, as you might get a nice price reduction.
• Medicare also helps you to compare plans. Check out the various links on Medicare.gov or AARP.org for more information, guidance and price comparison tools.

2. Picking the same Part D plan as your spouse
Not all Part D plans are alike, and just because a plan works for you it might not be the same for your spouse, who may be taking different prescriptions. Use the Medicare Plan Finder to determine your out-of-pocket costs on each plan. Also keep in mind that some plans require the use of specific pharmacies.

3. Going out of network on private Medicare Advantage plans
If using private Medicare Advantage plans, similar to PPOs or HMOs, you’ll need to utilize the network of doctors and hospitals within the plan to get the lowest co-payments. Be wary that if you go out of network, there may be no coverage at all.

4. Not knowing how to switch Medicare Advantage plans anytime if needed
Even outside the annual open enrollment period, it’s possible to switch plans for life-changing events, like moving to a place that isn’t in your current plan’s geographical coverage. And if you’re in the five-star plan, you can make a switch any time during the year. Also, from Jan. 1 to Feb. 15, you may be able to switch from Medicare Advantage to traditional Medicare plus Part D prescription-drug plan.

5. Not considering Medigap within 6 months
Once enrolling in Medicare Part B, you have six months to buy any Medicare supplement plan in your area even if you have pre-existing conditions (and at age 65, who doesn’t?). But after six months, insurers can reject you or charge more depending on your health. It depends on your state rules and insurer’s policies. Check at Medicare.gov for your options.

6. Not opting for Medicare when you turn 65 (most of the time)

Forever young, so who needs Medicare? Well, you’re smart to take advantage of what the government is giving you, often for free. If you are getting Social Security already when you turn 65, you’ll automatically be enrolled in Medicare Part A and Part B. But if you aren’t receiving Social Security benefits, you’ll have to act on your own to sign up. There are reasons to delay: for example, you or your spouse have a full-time job and already get health care coverage as a part of that. Be aware that if you aren’t collecting Social Security benefits, there’s a seven-month period to sign up for Medicare, which runs from three months before the month you turn 65 to three months after.

7. Not signing up for Part B if you have retiree or COBRA coverage
Again, there are many tricky steps in the Medicare signup game. Unless you or your spouse are receiving insurance through a current employer (who has 20 or more employees), Medicare is considered your main health insurance coverage. Retiree coverage, COBRA or severance benefits are NOT primary, and if you don’t sign up for Medicare, you might have gaps in coverage and be late on your Part B premium. So pay attention.

8. Missing the Part B enrollment deadline after leaving your job

It’s an alphabet jungle out there, but this one is easy: if you still have insurance through a job when you turn 65, that’s fine. You don’t need to worry about Part B premiums. But within eight months of leaving your job, you need to sign up or you might have to wait for the next enrollment period, meaning a gap in coverage. Then there is also the possibility of a 10% lifetime late-enrollment penalty.

9. Ignoring income thresholds
Most people pay the minimum of $140.90 a month for Part B premiums and $12.30 per month for Part D. This goes higher depending on your adjusted gross income. So if you are bringing in more than $85,000, that Part B premium could more than double per month, where as Part D could jump fivefold. Be mindful when you are withdrawing from tax-deferred accounts that you don’t go over the income threshold if possible.

10. Not fighting surcharge changes for the year you retire
The Social Security Administration uses your tax returns from the most recent two years to determine if you are subject to an income surcharge, that is you are making more than $85,000 a year. But you can protest it if you prove life-changing events, such as divorce, death of a spouse or retirement.

11. Not minding your HSA contributions

You can’t contribute to HSAs if you are getting Medicare, but if you or your spouse have health insurance through a job (with 20 or more employees) and haven’t applied for Medicare or Social Security benefits, you still can continue to add to your HSA. That said, be careful about contributions in the year you leave your job and sign up for Medicare, as your HSA must be prorated by number of months on Medicare.

Social Security: When to Claim at 66

SSA-image-2My Comments: Many of my close friends, clients and associates have long since started taking their Social Security benefits. For those of you who have not, there are probably some issues you need to explore before you sign on the dotted line.

A generation ago, 65 was the automatic full retirement age. Rembember the phrase Full Retirement Age or FRA; it’s that point in time when it first all comes together for you. Based on your past contributions to the system, the FRA represents the base line number to determine how much you’ll receive for the rest of your life.

Start at age 62 and you get considerably less; wait until age 70 and you’ll get a lot more. But there’s a catch. You have to remain alive to get more since the SSA is not going to intentionally send a monthly amount if you’re dead.

I have access to software that will help you explore the various options, and there are more than you think, that will help you make the best timing decision less confusing. Here are a few to start you thinking.

by Donald Jay Korn JUL 6, 2015

“It’s most common for our clients to begin Social Security benefits at age 66,” says Brandon Jones, a senior wealth manager at Accredited Investors, a fee-only planning firm in Edina, Minn.

If sexagenarian clients still have substantial earned income, starting earlier would trigger an earnings penalty. When they reach 66, seniors now reach “full retirement age (FRA),” for Social Security purposes. (Any reduction in cash flow from the earnings penalty may be temporary, as seniors subsequently will get makeup benefits.)

“At 66, someone can earn any employment amount and still receive the full Social Security benefit,” says Marilyn Capelli Dimitroff, director of wealth management and principal at Bloomfield Hills, Mich.-based Planning Alternatives, a wealth advisory firm.

“Therefore, the 66-year-old who waited receives a significantly higher monthly check than the 66-year-old with the same earnings record who began payments at 62, the earliest starting date. The differential continues for life.”
Starting at 66 avoids the 25% benefit reduction imposed at age 62, so the early bird with a $1,800 monthly check could have received $2,400 a month by waiting until 66.

“For the majority of people, postponing the receipt of Social Security to at least FRA is a smart move,” says Dimitroff. “Most seniors will need to work to 66 or later to maintain financial security in very old age.”

Waiting even longer, until as late as age 70, would increase benefits even more, yet many clients start at 66 anyway. “We human beings value a ‘bird in the hand,'” says Dimitroff, so some people want to collect from Social Security as soon as practical.

In addition, Dimitroff notes, monthly Medicare premiums are due for many people, starting at age 65, and it’s easier to have the payments subtracted from Social Security direct deposits rather than writing checks periodically. “A third reason for starting at 66,” she says, “is that most people underestimate how long they are likely to live.” Some people just invest their unneeded Social Security checks, she adds, hoping to exceed the 8% annualized increase they would have received for waiting beyond age 66.

Moreover, 66 can be a key milepost for spousal claiming strategies. For married couples, says Dimitroff, delaying the benefit start from 62 to 66 increases the spousal benefit as well as the worker’s benefit.

“For a one-earner couple,” says Jones, “we may recommend that the earning spouse file at FRA and immediately suspend the benefit, allowing the other spouse to begin claiming a spousal benefit. Meanwhile, the earning spouse’s benefit continues to grow, with the intent of beginning benefits at age 70.”

Jones adds that a similar strategy can work if one spouse has considerably more lifetime earnings than the other spouse.

Insurers Backed Obamacare, Then Undermined It; Now They’re Profiting From It

healthcare reformMy Comments: Remember those frantic days right after the PPACA was passed? How soon would we see death panels? Could Grandma survive? The world would end very soon.

In my writings, I’ve argued there are five primary stakeholders in the health delivery system here in these United States. 1. Insurance companies; 2. pharmaceutical companies; 3. the hospital industry; 4. physicians; and 5. patients (you and I). I argued that the alternative to acceptance of the PPACA was to cede the future of healthcare to the two of these five that would most likely prevail in making the rules for the rest of us to live by if the PPACA didn’t survive. God help us if the two winners turned out to be insurance companies and big pharma. Or insurance companies and hospitals. Talk about death panels.

Last week the Supreme Court once again upheld key elements of the PPACA. Today, in the Gainesville Sun is a letter from a health care attorney suggesting that with the consolidation of insurance companies, we are inexorably moving toward a Medicare for all system, run and administered by ultimately perhaps three major insurance companies, subject to the framework imposed by the PPACA.

I still fail to understand why the GOP considers this a threat to the survival of the Republic. Health care for everyone, with corporate America intimately involved with the whole system, with help for those who cannot afford it from the government. A healthier workforce, better health outcomes, more opportunities for economic growth (and profits) and less stress for people like you and me. How is this different from the interstate highway system, brought to you by the Republican Party back in the 1950’s? Built by private companies, and maintained by the government.

Saturday, 23 May 2015 by Wendell Potter, Center for Public Integrity

Anyone who still thinks the Affordable Care Act was a “government takeover of health care” should consider this headline from the news pages of last Thursday’s Investor’s Business Daily: UnitedHealth Profit Soars On Obamacare, Optum—April 16, 2015

That’s from a Wall Street publication whose editorial writers have rarely missed an opportunity to bash the health care reform law. Here are a few other headlines, these from IBD’s editorial page, just since the first of this year.
More Phony ObamaCare Numbers From The White House—March 16, 2015
Shock Poll: Half The Uninsured Want Obamacare Repealed—March 3, 2015
Democrats Keep Running Away From ObamaCare—February 2015
CBO Now Says 10 Mil Will Lose Employer Health Plans Under ObamaCare—January 27, 2015

It wouldn’t surprise me if UnitedHealth Group executives helped shape the opinions of those editorial writers during the reform debate. One of the things I did in my old job as head of PR for one of the country’s other big for profit-insurers was arranging for my CEO to have “desk side chats” with bigwigs at important publications like Investor’s Business Daily. We would often leave those meetings with an invitation to submit an op-ed, as was the case several years ago when Ed Hanway, Cigna’s CEO at the time, and I visited with then Dow Jones CEO Peter Kann and Daniel Henninger, deputy editor of The Wall Street Journal editorial page.

The CEOs of the largest for-profit health insurance corporations were very wary of Obamacare as it was being drafted on Capitol Hill. They didn’t really say so publicly—in fact they had their chief lobbyist, America’s Health Insurance Plans’ Karen Ignagni—claim to support reform.

“You have our commitment to play, to contribute, and to help pass health care reform this year,” Ignagni told President Obama during a March 5, 2009, meeting at the White House.

But insurers were playing a duplicitous game. Later that year, Ignagni’s group began secretly funneling tens of millions of dollars to allies like the U.S. Chamber of Commerce to finance anti-Obamacare PR and ad campaigns. The big for-profit insurers, which gave AHIP the lion’s share of the secret money, arguably are more responsible than any other special interest in turning the public’s attitudes against reform.

Although the insurers stood to gain financially from a law that would require Americans to buy coverage from them, many Wall Street financial analysts and investors worried that some provisions of the law might cut into insurers’ profit margins.

Analysts and investors in particular didn’t like the section of the law that would require insurers to spend at least 80 percent of their premium revenues on health care. Before the law, many insurers routinely spent 60 percent or less of their revenues on patient care. The less spent on care, the more available to reward shareholders.

Wall Street also didn’t like the provision that would have created a government-run public option to compete with commercial insurers, and they didn’t think the penalties on Americans who refused to buy coverage were harsh enough.

Partly because of the anti-reform advertising blitz insurers financed in late 2009 and early 2010, Congress capitulated and gave up on the public option. And lawmakers agreed to make the penalty for not buying insurance more painful with every passing year.

But despite the worry, it turns out that the law the insurance industry’s shills demonized has been awfully good to insurance company investors.

Here’s how IBD’s Vance Cariage reported UnitedHealth Group’s first quarter 2015 earnings report last Thursday: “UnitedHealth Group delivered its best quarter in years Thursday as it benefited from new Obamacare customers, another strong Optum-platform showing and tame medical expenses. The nation’s No. 1 health insurer also raised its full-year 2015 sales and earnings guidance.” (Optum is a fast-growing division of the company that provides data and other services to its health plan division as well as to employers and other insurers.)

UnitedHealth Group’s revenues grew an eye-popping 13 percent, from $31.7 billion in the first quarter of 2014 to $35.8 billion in the first quarter of 2015. Net earnings on a per share basis were even more impressive, growing 33 percent, from $1.10 to $1.46 per share.

One reasons for the glowing results was the fact that UnitedHealth added 570,000 new customers during the first quarter of 2015 from the Obamacare exchanges. And contrary to conventional wisdom, that the formerly uninsured Obamacare customers would overuse medical services, UnitedHealth executives said that wasn’t the case.

In fact, the company’s CEO, Stephen J. Hemsley, said that even with the new Obamacare enrollees, the company “improved” its medical loss ratio, which measures the percent of revenues spent on medical care, from 82.5 to 81.1 percent. He used the word “improved” because, as I noted, Wall Street loves it when insurers spend less on medical care.

That decrease was viewed as a very positive development by investors. By the end of Thursday, they had bid up the company’s share price by 3.6 percent, to $121.60, just shy of the all-time high of $123.76 set on March 30.

I can’t wait to see how IBD’s editorial writers spin UnitedHealth’s Obamacare success. I’ll let you know if and when they weigh in. But don’t hold your breath.

This piece was reprinted by Truthout with permission or license (and appears here without anyone’s permission or license). It may not be reproduced in any form without permission or license from the source. (Oh, well. So sue me. And good luck with that.)

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