If you started taking Social Security benefits at age 62, you will receive automatically Medicare Part A and B. Your card will arrive in the mail about 10 weeks before your Medicare start date, which occurs on the first day of the month that you turn 65.

If you delay taking Social Security benefits, you will NOT automatically get Medicare Part B when you turn 65. You will need to take an extra crucial step and apply for Medicare Part B directly through the Social Security Administration.  A good time would be about two months before your Medicare eligible start date, which again is the 1st day of the month that you turn 65.  The charge for Medicare Part B depends on household income, but is usually $134 per month for new beneficiaries and is deducted from your Social Security check. If you are not taking Social Security yet, and apply for Medicare Part B, Social Security will send you a periodic bill for your Medicare Part B coverage.

If you are on an Employer or Union group plan and will continue on this plan past Medicare Part B eligibility, check with your group benefits administrator to see if you may delay applying for Medicare Part B.

Use this Social Security link to apply for Medicare Part B.   Or call Social Security Admin at 1.800.772.1213

You can also refer to Medicare.gov for more details.

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Tom Russell & Associates are licensed independent health insurance sales representatives, with 24 years of experience and representing many companies. You can meet personally with us at our convenient local meeting room behind Fargo’s Steakhouse in Payson. Our administration and mail office is 1704 W. Bonita St., Payson AZ 85541. We also can assist you by telephone/internet. Go slow, and avoid the heavy and confusing “act now” marketing. Let’s make sure you’re well informed.  (928) 474-1233

We can help you find, compare and enroll in a Prescription Drug Plan. Give us a call to set up an appointment time: 928-474-1233. 

You can compare Prescription Drug plans yourself by going to: www.Medicare.gov. 

Easy Step by Step Instructions: Print these step by step instructions out, so you can refer to them while at www.medicare.gov  Click for Step by Step INSTRUCTIONS FOR MEDICARE.GOV PLAN FINDER.

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This article by Tom Russell has appeared appeared twice in the Payson Roundup Newspaper, in the “Your Health” Section. This is an educational article, with no discussion of particular companies and their plans. For many years, Tom has been an invited writer for our local paper.

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Understanding Your Options as a Medicare Beneficiary
by Tom Russell – Independent Health Insurance Broker 

Medicare provides choices to beneficiaries as to how they receive their Medicare benefits.  It’s an important decision and merits careful consideration. All too often people rush into a decision at a public seminar, or buy what their sister or neighbor has, which might be a poor decision for their own particular needs.

Fundamentally, there are three ways to receive one’s Medicare benefits:

1.  Original Medicare, and the option of adding a Part D Rx drug plan.

2. Original Medicare and the addition of a Medicare Supplement, and the option of adding a Part D Rx drug plan.

3. Medicare Advantage, also known as Medicare Part C.

Medicare Part A

Original Medicare is divided into Parts A and B.  (Part D is for prescription drug coverage). For example, Medicare Part A is primarily for hospital admissions. In 2018 there’s a $1340 hospital deductible per period of care, which is 60 days.

Medicare Part A has daily co-pays for unusually long hospital stays, starting at day 60, and it has a 2018 $167.50 per day co-pay for extended skilled and rehabilitative care on days 20 through 100. This is for a skilled level of medically related care – not custodial care. Medicare does not cover long-term care.

Medicare Part B 

Medicare Part B covers doctor visits, outpatient surgery, ambulances (including air vac), emergency room visits when NOT admitted, tests and diagnostics, etc. In 2018 Medicare Part B has a $183 one time annual deductible, then Medicare pays 80% of approved charges. Providers can elect to charge an additional 15% called the “Excess.”  When a provider “accepts assignment” it does NOT mean she is waiving the 20%, but that she does not charge the additional 15%. The beneficiary is still liable for the 20%.

In 2018 for those new to Medicare there’s approximately a $134 monthly charge for Medicare Part B (could be less if you’re already in Medicare). Those with higher incomes may pay more.  If a beneficiary starts taking Social Security benefits at age 62, they will automatically be enrolled in Medicare Part B. If delaying Social Security benefits, one will need to contact the Social Security administration a few months before turning 65.  Medicare coverage starts the first day of the month you turn 65.

Traditional Medicare Supplements

Medicare beneficiaries may elect to add a Medicare Supplement to help address these gaps. Medicare establishes the template for coverage, and insurance companies offer that particular template at a given price.  This makes it easier for beneficiaries to compare plans from company to company, since a given letter plan is identical coverage.

Then why not just buy the cheapest one?  One reason is ongoing yearly rate increases.  All insurance companies can and do raise rates.  Some insurance companies might offer a low price the first year, with definite marketing strategies to raise one’s rate (perhaps dramatically), starting next year, or sooner.

“No problem. I’ll just change to a different company if that happens.”  Not so fast.  When someone is turning 65, or getting Medicare Part B for the first time, they have an Open Enrollment window. The insurance company is required to take them without qualifying health questions. But in Arizona (some states differ) once this window closes one might be unable to answer the health questions to qualify for coverage with a different company.  Thus, a company that charges more the first year may be a better, less costly and more secure choice for the long run.

Types of Medicare Supplements

Beneficiaries have choices of Plans A, B, C, D, F, G, K, L, M, N and high deductible Plan F.  Fortunately Medicare provides an excellent chart and other resources to make help clarify the choices. Still, it can get at least a little confusing.

I call Plans F and G the Cadillac plans.  Plan F covers all the gaps, if Medicare first approves the charge.  Plan G covers everything that F does, except the one time Part B yearly deductible.  It is well worth noting the difference in premium one pays for Plan F when compared to Plan G. Often it’s wise to pay the Part B deductible yourself, and save money with a Plan G.

Plan N could be considered a mid-level plan, and usually has a lower premium. It covers the Part A hospital charges the same as plans F and G; however, on Part B one pays the annual deductible (as one does in Plan G) but also picks up a $20 co-pay for doctor visits. Unlike Plans F and G, Plan N does NOT cover the 15% Excess.

With a traditional Medicare Supplement one needs only ask if the provider accepts Medicare.  All Medicare Supplements (whichever one you choose) work with original Medicare in the same way.  You never need to check if a provider takes a given company’s Medicare Supplement.  One of the pluses of traditional Supplements is you need not worry about a limited network of providers, nor do you need to get referrals to see specialists. It’s all based on original Medicare.

Medicare Part D

If a beneficiary elects original Medicare or original Medicare with a supplement, they can elect to add prescription drug coverage.  A window opens when they first become eligible for Medicare (including Medicare Disability Beneficiaries under age 65).  Plus, a window to change Part D Rx plans occurs every year between October 15^th and December 7^th.  Anyone can elect to change Rx Part D plans during the Annual Enrollment Period without having to answer qualifying health questions.

www.medicare.gov is an excellent website. Just enter your prescriptions and the computer shops all the plans offered in your area. It’s wise to compare your prescription drug plan every year during the Annual Enrollment Period. Your plan may change its formulary (list of available prescriptions). What was covered this year may not be covered the next year, or it could be placed in a different tier (co-pay).

Medicare Advantage – Part C

Medicare Advantage usually combines Medicare Parts A, B and D into one program. Some companies add limited coverage for dental and/or vision.  Your choice of Medicare Advantage plans depends on where you live.

Medicare Advantage plans work differently than original Medicare.  In fact, Medicare Advantage is NOT, I repeat, is NOT a Medicare Supplement. It is against regulations for agents to refer to it in this way, or even hint that it is the same.

Companies that offer Medicare Advantage plans are required to thoroughly train and test their agents every year.  The plan’s “Summary of Benefits” must be reviewed, and several crucial disclosures must be made. A decision to enroll in a Medicare Advantage plan should never be made quickly, for example at the end of a marketing seminar “just because other people are signing up.”

Take the information home. Review it carefully. Ask questions. Be clear about all the co-pays and potential out-of-pocket expenses. Check the provider directory and the prescription Rx list.  What can be attractive is (usually) a lower monthly premium.  However, a lower premium does not necessarily mean lower cost.

Furthermore, when beneficiaries join a Medicare Advantage plan they may not be able to answer the health questions to qualify to get their Medicare Supplement back.  Medicare does provide a one year trial period in certain situations, for example, if one enrolls in Medicare Advantage when they first become eligible for Medicare at 65.  See Section 3 on page 21 of Medicare’s publication Choosing a Medigap Policy for a list of guaranteed issue situations.

In most cases a Medicare Advantage enrollee must take the drug coverage that comes inside the plan. You cannot get a Medicare Advantage plan and add a separate Part D drug plan. If you do, you will be dis-enrolled from the previous plan you signed up for.  This can be true even if the Medicare Advantage HMO or PPO plan you chose does not have a drug benefit. It’s true on all Advantage plans except a Private Fee for Service (PFFS) plan that does NOT have a drug plan.  

Conclusion

Explore your options and be well-informed. If you choose to work with an agent, ask if they are independent and represent several companies, or if they are a “captive agent” with only one. A captive agent may still be experienced and helpful — you simply need to know. Medicare itself provides excellent publications and websites to assist you. When you take the time to understand your options, you always feel better about your choices.

About the Author:  Tom Russell is an independent health insurance broker with 23 years of health an life insurance service to the Rim Country. (928) 474-1233 — 1.800.745.3570

If Medicare approves the charge, the Part B gap in this charge will be covered by your Medicare Supplement plan. As a Medicare beneficiary who owns a Medicare Supplement, please question (???) the need for memberships aggressively sold (usually with incomplete information I believe) to cover AirVac.

TAX FORMS FOR THOSE ENROLLED IN A MARKETPLACE METAL PLAN

The Health Insurance Marketplace will mail Form 1095-A to eligible individuals by Jan. 31, 2016. If covered under different metal-level health plans purchased through the Marketplace during the year, individuals will receive more than one Form 1095-A. Individuals who do not receive Form 1095-A, or receive a form with incorrect information, should call the Federal government’s Health Insurance Marketplace at 1 (800) 318-2596. Agents are available 24 hours a day, 7 days a week.

Those looking for additional information are directed to one of the following:

The Health Insurance Marketplace:

• Visit Healthcare.gov/taxes
• Call  1 (800) 318-2596 [TTY: 1 (855) 889-4325]. Agents are available 24/7.

The IRS:

• Instructions for Form 1095-A are available at IRS.gov/pub/irs-pdf/i1095a.pdf
• Instructions for Form 8962 (the tax form individuals fill out using information on Form 1095-A) are available at IRS.gov/pub/irs-pdf/i8962.pdf
• A  tax professional or accountant

Note: Tom Russell and Tom Russell & Associates, Inc are NOT licensed to offer tax advice.

1. Have you had a conversation with your family, friends, and loved ones about care-giving while you are emotionally and physically able to have the conversation?

2. Where do you want your care-giving to begin? For most of us, home is first choice, but can be more expensive.

3. Who do you want to be responsible for your care-giving? See Stress of Care-giving Article.

4. How will you pay for your care-giving? Family, cash flow, asset liquidation, or own a Long-term Care insurance plan? Click Here to review Arizona’s cost of Extended Care Services.

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Long-term care insurance must be planned for when one is relatively healthy, and can qualify for coverage. It is NOT guaranteed issue — you cannot have a significant change of health or mobility, then decide to acquire coverage. The younger you are when you start the policy, the cheaper the premium for the rest of your life.

Here are SIX KEY WEBSITES to conduct your  research on the need for extended chronic care:

1. http://www.lifehappens.org/insurance-overview/long-term-care-insurance/

• Find videos, a cost of care map, graphics and more from Life Happens.

2. http://www.kiplinger.com/fronts/special-report/long-term-care-insurance/

• Kiplinger’s has a variety of great long-term care insurance advice articles.

3. www.longtermcareinsurance.org

• Find a cost calculator, helpful videos, stats, a planning guide, checklist and more.

4. http://www.aaltci.org/long-term-care-insurance/

• A variety of long-term care insurance information from a leading LTC organization and advocate.

5. http://longtermcare.gov/

• The U.S. Department of Health and Human Services provides a plethora of long-term care planning information, facts and tools.

6.  State of Arizona Long-term Care Partnership

• Review how the State of Arizona encourages its citizens to own long-term health care insurance.

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LTC Pre-Appointment Instructions:  Call (928) 474-1233  Let’s schedule our appointment at least a week out. The first step is a pre-appointment questionnaire. We will email this form to you first, and ask you to return it to us (by email, snail mail, or you can drop off at our office in the locked black box by our inside Suite door) and we can do customized health based research BEFORE our schedule appointment. It makes our first LTC meeting together much more productive. If you decide after reviewing options and careful consideration to self-insure, then no harm done and no time wasted. And no obligation! It all just might be more affordable and sensible than you thought. People like the educational, no pressure approach we use in our 22 year business. — Tom Russell

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Completing the Health Insurance Equation
By Tom Russell

Does enrollment in Medicare, an under 65 Affordable Care Act plan, or employer group health insurance, complete the health insurance equation? No. How can we strengthen our health insurance coverage, and plug potential costly gaps?

Ongoing Extended Care
Does Medicare cover extended, chronic care? No. On page 63 of the government’s “Medicare and You” Handbook we read, “At least 70% of people over 65 will need long-term care services and support at some point. Medicare and most health insurance plans, including Medicare Supplement Insurance (Medigap) policies, do not pay for this type of care, sometimes called “custodial care.”

Medicare pays for limited days of “Skilled Care” (medical level and rehabilitative care) – not custodial care for assistance with activities of daily living. Do under 65 employer based health insurance policies or Affordable Care Act plans cover long-term care? No.

When we consider extended care insurance, many options exist. We can start by obtaining a “recovery care” policy insuring for up to one year of care. One does not have to immediately access his or her checking account or home equity to pay for nursing home or home health care. The cost of the care is high – up to $6000 per month, or more.

New options now exist with “living benefit” life insurance policies that provide chronic care options. The face amount of the policy can tapped for these costs. The amount of the life insurance NOT used for care is then paid to the estate on death. This addresses one of the objections to traditional long-term care insurance – What if I don’t need it? Perhaps the cash value in an older policy can be transferred to obtain one of these new policies, sometimes without additional cash outlays. People live longer today, and life insurance is more affordable than it used to be.

Existing annuities (or CDs) can be transferred into a new type of annuity policy that can triple the amount of money available for long-term care. If care is needed, one spends through the original deposit first. If the cost of care continues, the insurance then kicks in. If care is never needed (or money from the original deposit is left over), the original annuity deposit (plus interest) is paid to one’s heirs. When someone has considered traditional LTC insurance and decided to self-insure, this annuity/LTC option is definitely worth consideration. New laws allow the tax free transfer from existing annuities into one of these annuity/LTC combo policies.

Yet, traditional premium based long-term care policies have benefits not available in most life insurance/LTC combo or annuity policies, including more options to tax deduct the premium. They usually have more liberal definitions of “assistance” making it easier to qualify for benefit payments. For example, traditional ongoing premium based LTC policies usually have a “standby” definition of needing assistance, rather than a chronic “hands on” definition. To trigger benefits, someone needs be standing by within arms length, not placing their hands on you to help you in the bathtub, for example. Big difference!

And remember, extended care LTC insurance can likely not be acquired if you have a new significant diagnosis. It must be obtained when you’re relatively healthy and can qualify for coverage. Hopefully we never need it, but we can never acquire long-term care insurance when and if we need it. Educating ourselves on this type of insurance deserves to be a major part of our retirement and lifestyle planning. An experienced agent can prove invaluable, and help paint the big picture of all the different options.

Critical Illness Insurance
Policies exist that will pay a lump sum on the diagnosis of a critical illness. They compliment, but are never intended to replace a traditional healthcare plan. Critical Illness policies have improved over the years. It used to be that invasive cancer was the only illness covered. Newer policies have expanded to also cover heart attack and stroke. Insurance companies offer plans with lump sum payments of $10,000 to $100,000.

If Medicare or an under 65 Affordable Care Act health plan covers these big three conditions (which they are likely to do), why consider adding this additional protection? Because of potentially high out of pocket expenses from deductibles and co-insurances, as well as travel and lodging expenses. Out of pocket expenses might also include lost time at work or in one’s business. Perhaps most importantly, Critical Illness policies can help pay for natural and holistic treatment options that may not be covered by traditional health insurance. To have extra liquidity if a big diagnosis hits can ease much stress.

Critical Illness policies can help strengthen anyone’s health insurance, but if there’s a family history of cancer, heart attack or stroke, they should be at the top of one’s insurance priority list. However, only a few of the policies on the market will not cut the benefit when one reaches 65. Read the fine print carefully.

Disability Income Protection
In our working years, our greatest asset is our ability to earn a living. The number one cause of home foreclosures in the United States is not death or bankruptcy, but disability.

Professionals like architects, doctors and attorneys are usually receptive to owning this type of insurance. They don’t leave college before someone speaks to the class about the importance of acquiring disability income protection. However, all occupational classes can benefit, and excellent Blue Collar policies exist.

A disability policy pays a monthly income. The insured can choose the length of time the policy will pay benefits, the amount of the monthly benefit, and how long of a waiting period before the monthly checks start. Insurance companies will usually refuse to insure anyone for more than 60% of their income. They do not want to make it too attractive to go on claim.

It’s also important that the Disability Income policy have what’s called an “own occupation” definition of disability, stating that benefits are payable if one cannot perform the material duties of his or her occupation. Many policies are more restrictive, requiring that you be unable to do any type of work. Needless to say, the “own occupation” definition is essential language in any policy under consideration.

Accident Protection
Medicare and under 65 Affordable Care Act plans cover accidents, of course, but often a deductible must first be met. Policies exist that will pay in the event of an accident, to help cover the deductible and co-insurance cost. These policies can be especially appropriate for families with minor children, especially when insured under a high deductible plan. When young children or teenagers are not covered on the primary policy, the author believes a Critical Illness or Long-term Care policy can be a much better use of premium dollars.

Be careful about “common carrier” accident plans. Often sold through financial institutions and membership organizations, the policy pays if you are injured in a PUBLIC bus, airplane, etc. The odds of this happening are very low, and “common carrier accident insurance” is one of the most overpriced and profitable type of insurance sold. People often think they have an accident policy, but closer inspection uncovers this restrictive language.

Health Savings Accounts (HSA)
How would you like to have a tax deductible, tax free account to pay for out of pocket medical expenses? If you’re under 65 and not on Medicare, and have an HSA eligible plan, you can opt to open one. Wells Fargo, Vanguard, Desert Schools Credit Union, and many other financial institutions offer them. Money placed into the account is tax deductible, and what you do not spend each year rolls over to the following year where a new contribution can be made in the amount you choose – up to $3350 for individuals and $6650 for families – plus an additional $1000 if one is over 55.

You can pay dental expenses from this account, as well as prescriptions, glasses, doctor visits, labs and tests, and much more, including long-term care insurance premiums! When compared to the cost of a traditional co-pay plan, a lower cost high deductible plan combined with a Health Savings account can make a lot of sense. High deductible HSA qualified health plans are alive and well under the new Affordable Care Act. Be sure your policy is HSA qualified and in place before you open the account.

Conclusion
Insurance is one of the least exciting topics on earth. It’s dry and often cumbersome; however, it’s well worth our time and energy to understand our health insurance gaps, and the supplemental options that may exist to fill them. Go slow and understand the fine print, since a word or two here or there in the policy definitions, can make a huge difference at claim time.

Tom Russell is an independent health and life insurance broker, serving the Rim Country for 22 years. www.TomRUSSELLinsurance.com (928) 474.1233

Table of Contents
1. Crucial Pre-Appointment Meeting Instructions
2. Special Message for Existing Clients
3. How to Get Both Premium and Tax Savings
4. Why Have an Agent

You never pay extra premium to utilize Tom Russell’s 20 years of health insurance expertise. We are compensated by the insurance company if we find a plan that’s right for you.

If for some reason you cannot keep the appointment time set, please call and let us know so the time slot can be reserved for someone else. We are glad to reschedule.

1. Crucial Pre-Appointment Meeting Instructions – Please Read if you have an Affordable Care Act appointment scheduled with Tom

Note: If you feel you might qualify to receive a Federal Income Based Subsidy to lower your premium, we will need to use the healthcare.gov official website, and Tom is certified to assist you personally with this online process. If you feel you make too much to qualify for a subsidy, we can avoid using www.healthcare.gov and work straight through insurance companies.

IF YOU FEEL YOU CAN QUALIFY FOR AN INCOME BASED SUBSIDY: When you come for your appointment with Tom, be sure to bring a cell phone where you can access your email, OR have an email address you can access at Tom’s office (google, yahoo, hotmail, etc). The reason is that we must create an account at www.healthcare.gov and as part of the account creation process, the system sends an email that you have to confirm before we can proceed. If you can access email in Tom’s office, there’s no need to do anything else for now, other than know the social security numbers of any adult or child to be insured. If you cannot access email in Tom’s office, see the account creation instructions (in red) below.

Here is a quick link to see if you may qualify for a premium subsidy based on household income. Anything less than 400% of the Federal Poverty Level (based on Modified Adjusted Gross Income HOUSEHOLD Income) could qualify you for a subsidy, and the less your household income the greater the subsidy amount. If your income is under 133% of FPL, based on household size, you will need to opt for MediCAID. But you do have important options. Call the local hospital for Medicaid Enrollment assistance at: (928) 472-1271. If you’ve already booked an appointment with Tom and fall into this income category, please call and let us know so the appointment time can be reserved for someone else. Thank you.

Account Creation Instructions: If you cannot access email in Tom’s office, you must create an account at www.healthcare.gov. Failure to do so will mean we cannot proceed.
1. Go to www.healthcare.gov Click Here.
2. Go to Log In upper right
3. Go to “Don’t yet have an account” upper right
4. Choose State, then click on “Apply Now”
5. Create a user name and password. Answer a few security questions.
6. The system then sends you an email. Click on the link inside the email to CONFIRM the account.
7. You can stop right there after confirming the email. Best not to go foward. Tom can help you from there.
8. Bring your user name and password to the meeting. Be careful. It’s case sensitive.

We’re independent health insurance brokers, serving the Rim Country for 20 years. We represent over 35 insurance companies, including Blue Cross of Arizona, Healthnet, Humana, Assurant, United Healthcare and Aetna. Working through us makes it much easier to understand the pros and cons of different plans. There is never a fee to meet with us and explore your options.

2. Special Message for Existing Clients:

1. Watch the mail for communications from your insurance company.
2. Unless your letter states otherwise, if you do nothing your health insurance plan will automatically renew for 2015.
3. If you qualified for a Federal Income Based Premium Tax Credit Subsidy, if you do nothing your subsidy will automatically renew for 2015. However, if your income has significantly changed from 2014 to 2015 (up or down), it is recommended to “reconfirm — recertify” your subsidy. We can help. Just call. 474.1233. But again, if things are about the same income wise, just do nothing and both your current health plan and Federal Subsidy will automatically renew.

Note: If your income has changed and you do venture online alone to “reconfirm – rectify” your subsidy, please enter my agent/broker information below, or I cannot advise you or legally assist with claims/administration, since I would no longer be your agent of record.

3. Tom’s Agent Numbers

If at any time you’re asked online or by telephone “Is someone helping you?” choose agent/broker and add my information:

* First and Last Name: Tommy (skip middle initial space) Russell
* (Skip organization line)
* Lower Left is FFM User ID: TOMMYRUSSELL (all caps, no spaces)
* Lower right is (NPN #): 6730740

How to Get Both Premium and Tax Savings

Has anyone explained the power and benefits to you of Health Savings Accounts? Perhaps a traditional Co-Pay plan will work best, but we want you to be aware of the premium and tax savings of the HSA option. More Info Here.

Why have an Agent? Your premium is the same, with or without an agent. Agents and brokers do much more than sell health insurance. They explain critical differences in plan options and coverage, which may involve substantial research and fact-finding about the client’s needs. They advocate on behalf of their clients, helping people when they have trouble getting procedures approved or claims processed. They also review coverage on a periodic basis, suggesting changes when appropriate and counseling on ways to reduce costs. The healthcare system is complex, and coverage does not begin and end with enrollment. Consumers benefit from the expertise that brokers and agents provide in servicing the plan throughout the year.

A. If you choose not to be insured in 2017, there’s a substantial tax penalty. Use this easy online calculator to figure yours.

B. You might have a “Grand-fathered” or “Grand-mothered” plan that you can keep, that would still qualify for legitimate ACA coverage. Your insurance company will let you know if your plan keeps you out of a tax penalty. “Grand-fathered” plans were issued before March, 23, 2010 and can be kept indefinitely. “Grand-mothered” plans were issued between March 23, 2010 and January 1, 2014 and can be kept for a little while longer, if notified by your company.

C. Affordable Care Act plans have no health questions, and no exclusions for pre-existing conditions, and no waiting period before coverage begins, once the policy is effective. All policies must cover preventative care at 100%, without reference to the deductible.

D. Last year the President said, “We’ve discovered that buying health insurance is complex.” Wish to better understand health insurance terminology? Dictionary of Terminology.