Monday, May 23, 2016

Question: What is a Medicare Advantage HMO?

HMO stands for Health Maintenance Organization. Medicare Advantage HMO plans are the part C of Medicare and are a popular option all over the United States including Texas.  According to the Kaiser Family Foundation, approximately 30% of Medicare beneficiaries are enrolled in some type of Medicare Advantage plan and Medicare Advantage HMOs are common because of the lower premiums and other benefits they often offer.

A Medicare HMO is an organizations through which Medicare beneficiaries can access their Medicare services. This organization handles all of your claims and is compensated by Medicare. The insurance company contracts with certain hospitals, urgent care facilities, durable medical equipment providers, physicians and specialists in your local area to form a network. The medical providers agree to provide your care as instructed by the plan for negotiated rates. In return, one of the benefits to the doctor or hospital is that the plan directs people to them for care by listing the provider in its official network directory.

When you enroll in a Medicare HMO, you agree to obtain your care only through the plan’s network, except in certain circumstances, such as an emergency. Some of the common features of Medicare HMO plan are:

Premiums may be lower or zero as compared to Medigap plans in your area. You must continue to pay your Medicare Part B premium too. Remember, Medicare Advantage HMOs have certain limitations and restrictions by which you must abide.

You must use the organizations local network of healthcare providers and hospitals from which you must seek your care, except in emergencies. Many plans will have you choose a primary care physician and that doctor can coordinate your care by referral to send you to a specialist as needed.

A creditable Medicare Part D drug insurance plan is included in many Medicare Advantage HMO plans. This could save you the cost of purchasing a separate Part D prescription drug insurance plan like when you have a Medicare Supplement.

Unlike a Medicare supplement, in which you pay your monthly premium whether you use it or not,  with Medicare Advantage you pay as you go in the form of co-pays or coinsurance. Each plan has a benefit summary which will tell you how much the provider is allowed to charge for certain services, such as inpatient hospital care, doctor’s visits and lab-work.

Annual Notice of Changes – The benefits formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must remember to review the annual notice of change letter/book that the insurance company will send you so that you can decide if you need to make any changes in your coverage.

Medicare Advantage HMO’s usually have a built in safety net by having a yearly out of pocket maximum, which is the maximum amount you would pay for your healthcare for the year. Keep in mind this does not apply to your Part D prescription insurance plan portion.

Reviewing each and every Medicare Advantage HMO insurance plan is a tedious job Get help from a licensed independant insurance agency like Ashford Insurance Services that specializes in Medicare products and can guide you with important information such as a plan’s network size, service area, star rating, and history in the marketplace, and, tell you whether or not your physicians participate in the plan.

Experienced independent agents can also can help you find the right plan  and will consider factors specific to you, such as whether the plan has a built-in Part D drug formulary that includes the medications you need.

I’d love to be your agent so contact me for help today!













Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.

Thursday, May 19, 2016

Question: Is a Yearly Review of your Medicare Supplement Plan Essential?

In short, yes. You could be paying too much for your Medicare Supplement Insurance Plan. Medicare supplement insurance plans are regulated by federal and state law. What this means is every Medicare Supplement Plan is the same. Meaning Medicare Supplement Plan F with company A is exactly the same as the same plan with company B. The only variance between different Medicare Supplement plans can be price and a few include health and wellness programs. This is outlined in your Medicare and You Handbook that Medicare sends out to you every year. It is on page 100 for 2016 if you want to take a quick look. So what does this mean to you?

This means that you should review your plan at least once every 1-2 years to make sure you are still in the RightFit plan for you. Not keeping up with current Medicare Supplement rates could mean hundreds of dollars lost in insurance premiums. If your hospital, doctor and specialists take Medicare, then you can continue to see those providers regardless of which supplement plan you have. Remember, the supplement plan benefits are regulated so why pay more to be with company A if company B can save you a lot of money?
Your local independent insurance agent can run cost comparison for you and tell you which rates you may qualify for. Then, all you need to get these savings is a quick application that your agent can help you complete. These savings can mean a world of difference especially for seniors on a fixed income.

Keep in mind you may have to go through “underwriting.” This means you may have to answer some health questions and certain health issues may hinder you from changing plans. Some carriers underwriting health questions can be harder to get through than others. Your independent insurance agent can help you with this.

Wouldn’t the best plan for you when you turned 65 still be the best plan for you now? Not necessarily. Every year there are different price increases so what might be a very competitively priced plan one year may not be a great priced plan down the road. The other variance you have to consider is if your agent is an independent or a captive agent. There are some agents that can only sell one company’s supplement plan because they are captive to that particular carrier. So even if there was a better priced plan on the market, if they did not have access to it, they may have put you in a plan that costs too much. Do not forget, if your agent does not specialize in Medicare Supplements, they may be limited on the different plans they have available to you.

It is important to find an agent that has your best interest in mind. This agent should specialize in senior health insurance and have many companies available to offer you. They should also be checking in on you regularly to make sure you are still happy and to ensure you are still paying the best price for your plan. If this isn’t happening, give Sonia Ashford a call at 817-689-3536 or email her at seniorhealthtx@gmail.com. She has been specializing in helping seniors with their insurance needs since 2005 and would be happy to help you save money and ensure you are in the best plans to fit your needs.

Ashford Insurance Services is a Senior Health Care Insurance Agency. We specialize in Medicare Supplement/ Medigap plans, Medicare Advantage/Medicare Part C, Prescription Drug Plans/Medicare Part D, Senior Term Life Insurance, Final Expense Insurance, and Dental and Vision plans. We specialize in helping seniors in Texas including Dallas, Fort Worth, HEB and surrounding Counties as well.












Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.


Monday, May 16, 2016

Attend a Turning 65 Workshop Near You


Question: Do Attained Age Medigap Plans Cost Less over Time?

Medicare supplement insurance carriers can base their policy rates on several factors. A large number of carriers use a traditional and proven system where your policy rate will increase naturally with inflation as you age. Several carriers may base their rate factors more on the geographic area or community in which you live. This may or may not benefit you. Also, there are some carriers who offer a policy where your rate is based upon the age at which you bought it, or “issue age”. Several insurance agents who sell these issue age-rated Medicare supplement policies claim that this means you will always pay what a 65-year-old person new to Medicare will pay.

While this is true, it is also misleading. It sounds like it will be cheaper over the long run, but that is usually not the case. Knowing all the facts about which policies keep their value over the long run, as opposed to which ones will often cost you more over time, can be a helpful determining factor when choosing your first policy.

When reviewing your choices, knowing how the rating models work is critical to determining the long term costs of your coverage. The advertising about issue-age policies can be misleading allowing people to believe they will never have rate increases. Medigap carriers selling this policy type might not use your increasing age as a rate factor, but they can and do often impose an annual rate increase to keep up with medical inflation.

This means it is entirely possible that you will pay a lot more over the life of your policy than if you had selected an attained-age policy. Also, lower initial pricing makes attained-age plans so popular that they gain a larger pool of people over which to spread the risk and rate burdens. Lastly, the simple laws of supply and demand tend to keep the rates more sustainable although you will have small increases as you age.

More evidence to the fact that issue-age rated policies do not save consumers from rate increases is how rarely they are offered. The majority of carriers do not favor this form of pricing. When you do come across one, you often learn that the agents selling these policies are just captive agents. Captive agents are limited to selling only that one particular company's policies. It is never in your best interest to work with an insurance agent that can only get you quotes from one company.

If you really want to save money on your Medicare supplement insurance over the years, talk with an independent insurance agent who can offer insurance plans from many of the top carriers. Have them explain the different types of pricing models offered in your state. Find out which plans are sold the most and what the rate history trends have been with each company over the last several years. Learning all you can before you make a purchase will help you to feel secure in your decision.












Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.



Thursday, May 12, 2016

Question: Why am I Paying More for Prescriptions in 2016?

Several of our clients have been asking “Why am I paying more for my prescription drugs costs in
2016, even when I didn’t change my Part D insurance plan?” If you’re living on a fixed income, even a small change in what you have to spend for the prescriptions you depend on can have a huge impact on your day to day finances. Even, if you are not on a fixed income it still can be a concern.

There can be several things that have changed in your coverage which resulted in increases in what you pay. Here’s a list of some of the causes:

You may have purchased your medication out of network at a non -network pharmacy. Insurance companies negotiate special rates with pharmacies, just like with doctors and hospitals. Make sure you’re buying your drugs at a pharmacy that’s in your network, so you can receive full coverage for it.

Some insurance plans charge more for using their mail-order pharmacy. Some will charge less. If they charge less it is beneficial to use the mail order pharmacy on your maintenance prescriptions because of the cost savings involved.

You may still be paying for your initial deductible, if there is one. Don’t forget, every calendar year you have to satisfy your initial deductible all over again. So, you’ll have to pay the full cost of your prescriptions until you do so, and that amount varies based on the insurance plan that you have.

The plan you have may be using coinsurance to share the costs. Several plans require that you pay a copayment, which is a fixed amount, for the cost of each prescription. A few require instead that you pay “coinsurance,” which is a percentage of the cost of each prescription. If your plan changed from copayments to coinsurance as a “cost sharing model”, and your prescriptions are relatively expensive, the amount you pay may have gone up.

The drugs you use have gone up in price and your plan uses coinsurance. If the retail cost of a drug you use has increased, and your insurance plan requires that you pay a coinsurance, the amount you pay will increase, since coinsurance is based on a percentage model of cost sharing.

The medication you’re using isn’t covered anymore. If your medication has been dropped from your insurance company’s formulary (the list of drugs they cover) because a less ­costly generic drug has become available, you now could be paying for that medication in full. You may, however, request an “exception” by having your doctor contact your Part D insurance plan provider, and perhaps receive special coverage for that medication.

Your medication moved to a different formulary tier. When medications themselves get more expensive, insurance companies will often move them to a different “tier” in their formulary. Generally, this means that you pay a higher portion of the cost of that prescription yourself.
It is possible that you got moved to another plan. Sometimes insurance plans consolidate, and something called “cross walking” happens. When your plan merges with another plan, you may be “cross walked” right into a plan that requires that you shoulder a higher amount of the costs of your prescription drugs.

You may have reached the Coverage Gap, or “donut hole”. For 2016 once your drugs have reached the cost of $3,310, you’ll pay a higher percentage of the costs of your drugs until you reach the next level, Catastrophic Coverage. Remember, it is about what you and the insurance plan pay added together to get to the Coverage Gap. Catastrophic coverage level begins when your prescription out of pocket amount reaches $4850.00. Then your prescription costs plummet.

Keep in mind that the insurance plans send out an Annual Notice of Change every year right before the Annual Enrollment Period which runs from October 15 to December 7 each year. This Annual Notice of Change explains all about the next years benefits. You can check all your prescriptions and calculate how much you will be spending in the next year. 

If you are unhappy with the amount you will have to pay for your prescriptions with a Part D prescription drug insurance plan or a Medicare Advantage Plan you may choose another plan during the Annual Enrollment. With a Medicare Advantage Plan this means you may have to change your Primary Physician, Specialists and Hospitals.

If you need help finding the right plan please call.

Sonia Ashford
817-689-3536













Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.

Monday, May 9, 2016

Question: What if I Need Help With Transportation?



Texas Seniors Needing Help With Transportation



We come across quite a few seniors in the HEB and surrounding areas that need some help with transportation to their doctor, hospital or to just pick up a prescription.

So, we have compiled a small list of a few sources that can provide transportation assistance.

We have included internet links and phone numbers to help you get in touch with these transportation providers.

We do not endorse any of these providers but just wanted to get a handy list out to the seniors whom may need assistance.







CCFW

Catholic Charities' Transportation Program
If a Hurst, Euless or bedford resident is in need of medical transportation anywhere in Tarrant County, they can call the Catholic Charities’ Transportation Program and request a trip. This county-wide medical service, primarily funded by United Way, is a donation-based program that assists anyone without transportation, not just older adults or individuals with disabilities. Trips are scheduled as space allows, and are not guaranteed.  Service is provide Monday through Friday from 6 a.m. – 6 p.m. For more information, or to request a trip, please call 817-336-8714.

NETS
The Northeast Transportation Service (NETS) offers door-to-door transportation services to residents of Bedford, North Richland Hills, Keller, Grapevine, Hurst, haltom City and Euless who are disabled or 55 or older. Trained drivers are available to assist passengers in getting on and off vehicles. This service is available in Euless from 6 a.m. - 6 p.m. Monday through Friday and costs $1.50 per one-way trip.Trip requests are taken from 7 a.m. - 5:30 p.m. Monday through Friday. You must give at least two business days' notice in advance of the trip date. For more information, please contact NETS at 817-336-8714.

Mid-Cities Care Corps
MCCC is a non-profit organization established in 1981 with a mission “to preserve the independence of senior neighbors in Northeast Tarrant County.” Volunteers provide transportation services to routine medical appointments as well as quality of life drives on the weekends. Services are provided to seniors 65 and older, 60 plus with a disability, in Bedford, Colleyville, Euless, Grapevine, Haltom City, Hurst, Keller, North Richland Hills, Richland Hills, Southlake, and Watauga. For more information, please call 817-282-0531 or visit www.midcitiescarecorps.org.

Texas Health and Human Services Commission

Texas Medicaid & CHIP Transportation Services
The Texas Department of State Health Services provides rides to those without transportation and on Medicaid or in the Children with Special Health Care Needs. Covered trips include rides to the doctor’s office, dentist, hospital, drug store or any place that provides medical services covered under Medicaid. You must call MTP at least two business days before the day you need the ride. Clients in most of Texas can call MTP at 1-877-MED-TRIP (1-877-633-8747). This is a free call in Texas. Clients in the Dallas/Fort Worth Service Delivery Area (SDA) should call LogistiCare at 1-855-687-3255 Toll Free to arrange services.

This list compiled by Sonia Ashford, 817-689-3536 seniorhealthtx@gmail.com
Ashford Insurance Serices



Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.

Thursday, May 5, 2016

Question: What Are My 2016 Medicare Costs?

Medicare Costs For Part A (Hospital Insurance)
Part A Monthly Premiums

The Cost for most people for Part A premium is zero because either you or your spouse paid Medicare taxes while working 10 or more years in the United States. If you have to purchase Part A, you will pay up to $411 every month.

Hospital Stays

For 2016, you will pay

§  $1,288 deductible per benefit period
§  $0 for the first 60 days of each benefit period
§  $322 per day for days 61–90 of each benefit period
§  $644 per “lifetime reserve day” after day 90 of each benefit period
(up to a maximum of 60 days over your lifetime)

Skilled Nursing Facility Stays

For 2016, you pay

§  $0 for the first 20 days of each benefit period
§  $161 per day for days 21–100 of each benefit period
§  All costs for each day after day 100 of the benefit period

Medicare Costs For Part B Monthly Premiums
You will pay a Part B premium each month. The majority of people will pay the standard premium amount of $121.80. However, the cost of Medicare Part B is based upon your modified adjusted gross income of your income filing tax status from 2 years prior. So, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.

Some of the items that contribute to your modified adjusted gross income include any money earned through wages, interest, dividends from investments, capital gains and a few other items. Social Security will send you a letter once a year around December or early January to tell you what your costs are for the upcoming year.

Your Part B premium will be deducted from your social security check or billed to you quarterly if you are not yet enrolled in Social Security income benefits.
To determine your Medicare cost, review the table below. It shows the amount that you will pay in 2016 for Part B, per this chart reproduced from the Medicare.com website.


If you have questions about your Part B premium, call Social Security at 1‑800‑772‑1213. TTY users should call 1-800-325-0778. If you pay a late enrollment penalty, these amounts may be higher.

The Part B Deductible Is $166 per year



Medicare Prescription Drug Plans (Part D) Premiums

The cost of Medicare Part D is also based upon the modified adjusted gross income of your income filing tax status from 2 years prior. The chart below shows your estimated prescription drug plan monthly premium based on your income. If your income is above a certain limit, you will pay an income-related monthly adjustment amount in addition to your insurance plan's premium.


To Calculate a Penalty:

2015 Part D National Base Beneficiary Premium—$33.15

This amount is used in the calculation to estimate the Part D late enrollment penalty and the income-related monthly adjustment amounts listed in the table above. The national base beneficiary premium amount can change each year. See your Medicare & You handbook or visit Medicare.gov for more information.


If you find all this a little confusing don’t worry, Sonia can help you. Many people have found that Medicare and a supplement costs much less than private insurance policies they had prior to Medicare. 

Call Sonia Ashford: 817-689-3536


Ashford Insurance Services, LLC


Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.


Monday, May 2, 2016

Question: Is the Medicare Supplement Plan F Ending?

Is the Medicare Supplement Plan F Ending?

Historically, the Medicare Supplement Plan F has been the most common Medigap plan. In recent studies, Plan F makes up approximately 40% of the market among all Medigap plans. Many seniors choose Plan F because it has “first dollar” coverage, meaning that it pays everything that Medicare does not pay at the doctor and hospital leaving you with no co-pays, deductibles or coinsurance. Unfortunately, it is this feature that now has put Plan F on the road to change. So, is Medigap Plan F doomed?

The short answer is “Yep”, barring some new legislation between now and the year 2020. In April of 2015 the “Medicare Access and CHIP Reauthorization Act” was passed into law. This legislation was touted by the media that it fixed the doctor reimbursement rates for years to come. Overlooked is that the legislation also scheduled the end to the “first dollar” coverage plans – Medigap Plan C and Medigap Plan F, to be effective January 2020.

In past instances where the Medicare Supplement plans have been re-structured, existing policyholders were “Grandfathered in”, they were allowed to keep their plans. However, rates on the eliminated plans have always been more likely to rise rapidly due to the aging population on the plan, (because of no new enrollees). That means it is very likely this will happen with Medigap Plan F as well. So, you should be able to keep your plan. However, it may not be advisable to do so, as the rates will likely go up significantly over time.

So, what should you do if you have Plan F now? Our recommendation has been away from Plan F for the past year due to this legislation and the greater overall rate stability on other plans. Specifically, if you have Medigap Plan F now, we would recommend looking at a Medigap Plan G or a Medigap Plan N as an alternative.

Keep in mind that you may have to go through underwriting, ‘qualifying medically’ when you change from one Medicare Supplement plan to another. This could be a problem if you have health issues. Fortunately, there are no restrictions on what time of year you can make this type of change.

Plan G is set to be the big winner from this situation. It has been growing considerably for the last several years. Plan G has been a better “deal” than Plan F for a while. The only difference between Plan G and Plan F is the coverage of the Medicare Part B deductible, which is $166 a year for 2016. All the other benefits are identical except maybe for some extras. The amount you save on premiums for a Plan G are typically far greater than the deductible amount and, in most cases, are in the $300-400 a year range.



To learn more call Sonia Ashford at 817-689-3536.

Sonia Ashford

817-689-3536






Sonia Ashford is an independent insurance agent in the Medicare field, and has delivered hundreds of speeches about turning 65, Medicare Advantage and Medicare supplement insurance to consumers in Tarrant County. A respected agent within the Medicare insurance industry, she is the owner of Ashford Insurance Services. Visit Sonia's agency website http://ashfordinsuranceservices.com/ to learn more about how she can help you with your Medicare decisions.