Health Insurance and Medicare
This presentation involved an interview with Gerry Flanagan. She is an agent with Human where she specializes in Medicare advantage plans. She and I worked together In Florida, Alabama, and Georgia as Insurance agents.
She was my supervisor and a good friend. During the Interview, Gerry and discussed the three issues that agents and supervisors face In the industry. Licensing, MedicareMedical regulations, and how the Affordable Care Act would change Medicare. Licensing Is a big Issue, as there Is a lot to do to get a license. First, a person must complete a background check.
This requires a fee and a fingerprinting process. Twenty-four pre-licensing courses must be completed. These classes involve life, accident, health, and annuity education. Once these are completed a state exam must be passed in order to hold a license. Many people are not aware of all the requirements involved. Gerry gets to weed out those not meeting the basic elements to be an agent. Medicare has changes that occur yearly, agents have a lot of rules they have to follow. Center for MedicareMedicaid Services (CAMS) does a good job of protecting seniors.
There are certain ways to handle clients. Agents cannot call them. We use to do a lot of cold calling when we got leads. Everyday seniors could get many calls from agents trying to get them to sign up for their plan. This created a lot of frustration and contusion tort seniors. Some other things that are restricted: we could not buy them lunch to hear our sales-pitch or offer them a gift tort listening. CAMS makes these rules & If you don’t follow them, pay a fine or you could lose your license. Basically, Medicare Is a health Insurance plan you pay Into prior to retirement.
It has 4 parts A, B, C, ; D. There Is an annual enrollment period, which this year Is 10/15-12/7. Ten thousand Baby Boomers will age In everyday between the years 2012-2031. This Is an amazingly large amount of people to have in the system. Medicaid is an income-based insurance plan. It can help with fees for all parts of Medicare. There are 4. 6 million seniors that qualify for Medicaid. Of those, there are 3. 7 million seniors that have a disability of some form. All together, there are 8. 3 million seniors that meet the criteria for both Medicare and Medicaid, being dually eligible.
The Affordable Care Act will have a big effect Medicare. It will provide an out- of-pocket expense at a cap of $6700. The new Annual Enrollment Period is now 10/1 5-12/07/2012. It gives a reduction of donuts-hole costs. There will be an increase in premiums for seniors with higher incomes. CA will provide more managed care than fee for service in health care services. Advisory boards implemented that will attempt to reduce spending per person. Providers will have an Accountable Care Organization where they agree to be more accountable for over-all Medicare infirmaries w/ their primary care physician.
Finally, an insufficient care clause where there Is a 1% reduction In payment for excessive admittance of seniors. Most of these parts are to be In effect by 2015. This concluded my Interview with Casey. Being a former agent, I know the importance of being informed about Medicare. Seniors would wait patiently for me as I worked with clients Just to ask a question. I want to briefly go over Medicare ; shed some light. Odds are that you will know someone turning 65 this year. Medicare NAS 4 parts ; D Witt each avian a different function and fees.
You must be 65 years old or have a disability. Part A is the hospital care received as inpatient, a skilled nursing facility, hospice, or home care. No fee is required if you paid into the system prior to retirement, if not $AAA month is the fee currently. With Part B, which is the medical part of Medicare, seniors will pay 104. 90 a month with a $147 deductible. You have a deductible for Part A as well per benefit period, which begins when you are admitted and ends when you are discharged 60 day consecutively. These can be many per year as well. For days 1-60, there is a deductible of $1184.
For days 61-90, expect a $296 coinsurance per day per benefit period. For day 91 and over, there is a $592 coinsurance per “lifetime reserve days”. A senior can have 60 over the scan of their lifetime. These 2 parts are known as Original Medicare. It has three key gaps with additional expense: prescription drugs are not covered, Parts A and B have out of pocket costs, and there is no cap on annual out of pocket expenses. Part C is seniors’ Medicare Advantage or Media-gap policies. These options are extremely important as Original Medicare can get very expensive.
Both of these choices offer the same benefits as Original Medicare but some offer additional benefits like vision and dental and have a cap on out of pocket expense set at $6700 with Medicare Advantage. Media-gap policies are more expensive but have more benefits. They offer that same basic benefits like host, med, but can cover 100% of costs associated with health care. Prices can start as low as $75 a month. Some of the basic benefits are hospitalizing of Part A coinsurance plus 365 additional days after Medicare benefits ND.
The first three pints of blood are covered each year. Hospice is covered through part A coinsurance. Each Media-gap policy has many plans. Plan A-N can be chosen depending on the need and can pay up to 100% of coinsurance & deductibles, 50-75% of fees for SIN, provide coverage for foreign travel. Prices can start at $75 a month. There are many plans to choose from. It pays to do some research. Medicare Part D is prescription drug coverage. Seniors must enroll when they turn 65 years old or will face penalty of $31. 17, plus a premium each month.
Monthly premiums are based on a senior’s income. The yearly deductible is $320. However, some plans have $0 escapements or deductibles. However, this depends on formula and tier of drug. Part D plans can cover costs in the coverage gap, called the “Donuts Hole”. So let’s talk about the “Donuts Hole”. All costs do not include a deductible. From $0-$2930 is spent, seniors are in the gap. In there, seniors will receive 52. 5% discount on drugs. This is an out of pocket expense. After seniors spend $4700, they come out of the “donuts hole”.
Then seniors qualify for catastrophic coverage for medicine. They will then pay a small Coplay or coinsurance for remainder of the year for all medication. In summary, do your homework and read all you can to learn about Medicare and the costs associated with it. Start preparing now; it is never too early to start. Try to stay updated each year with all the changes. You can check an agent’s license at this website: http://insurance. KY. Gob/Agent/Default. Asps? Manuel=46;Diva_id=2 . All information with this presentation was verified through the Medicare. Gob website.