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  • Medicare Explained
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The Modern Medicare Agency Blog

What You Can Get From Final Expense Insurance

2/22/2021

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​When you are retired and don't have family members who are dependent on you, life insurance won't be the best choice for you. It may be difficult to accept, but death is inevitable, and it will entail a lot of payments for funeral arrangements. To ensure that you have the funds for your funeral, you can get final expense insurance. What is final expense insurance, you say? Well, continue reading and find out.

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Find Out Why People Are Getting Life Insurance

2/16/2021

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​Every dollar truly counts. People should come up with wise financial decisions, especially when they get to support their loved ones’ future. Some income earners opt themselves to be armed with life insurance as their strategic financial tool. In fact, its market penetration industry is relatively stable at 57% over the years, based on statistics. Below are some of the reasons why people buy life insurance:

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The Donut Hole Cost's Explained

2/4/2021

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2021 Medicare Part D Deductible, Costs & Copays. Donut Hole Discount Explained

Medicare Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan.
The 70% paid by the drug manufacturer; the 5% Part D plan discount together with the 25% you pay, count toward your TrOOP (True Out-of-Pocket) or Donut Hole exit point.
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Part D changes for 2021 are:
  • Initial Deductible: will be increased by $10 from $435 in 2020 to $445 in 2021.
  • Initial Coverage Limit: will increase by $120 from $4,020 in 2020 to $4130 in 2021 where the 2021 “Donut Hole” begins.
  • Out-of-Pocket  threshold cost: or (TrOOP true out of pocket) will increase from $6,350 in 2020 to $6,550 in 2021.
  • Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($4,130 in 2021) and ends when you spend a total of $6,550 out-of-pocket in 2021.
  • Generic Drug when one reaches Medicare Part D Donut Hole: pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).
  • For example: If you reach the 2021 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
  • Lower costs when one comes out of the Donut Hole and enter Catastrophic coverage until December 31 and then a new year begins. Then the Medicare Part D cycle begins again with a new deductible on January 1 of every year.
Does the Donut Hole really go away? No, the name changed. In 2020, the Donut Hole began being called Donut Hole Discount.
Paul’s Part D Tips      During Medicare’s Annual Enrollment Period from October 15th to December 7th be sure that all your prescriptions are covered by your standalone Medicare Part D plan or a Medicare Advantage plan with prescriptions and if your drugs are expensive make sure you compare options, which will begin January 1st.
Remember you will pay 100% of the cost if any prescriptions (generic or brand name) are not covered on your Medicare Part D plan.
Talk to your doctor or doctors about which brand name drugs can be changed to generics.
Be aware of available prescription assistance programs there are 12 State Pharmaceutical Assistance Programs for people on Medicare depending on what state you live in you may be eligible.
Remember most of us don’t see a doctor every month but we take our prescriptions daily and refill them every month, choosing the right Part D plan can be very important and you should choose wisely.
For help with your Medicare questions or choosing the right part D plan, call us 1-800-219- 0453 0r 631-358-5793  email questions to  medicare@paulbinsurance.com
 

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Retiree Insurance & Medicare

2/3/2021

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Retiree insurance & MedicareIf you're retired and have Medicare and group health plan (retiree) coverage from a former employer, generally Medicare pays first for your health care bills, and your group health plan coverage pays second.
4 things to find out about your retiree coverage
  1. Can you continue your employer coverage after you retire? Generally, when you have retiree coverage from an employer or union, they control this coverage. Employers aren't required to provide retiree coverage, and they can change benefits, premiums, or even cancel coverage.
  2. What's the cost and coverage? Your employer or union may offer retiree coverage for you and/or your spouse that limits how much it will pay. It might only provide "stop loss" coverage, which starts paying your  out-of-pocket costs only when they reach a maximum amount.
  3. What happens to your retiree coverage when you're eligible for Medicare? Retiree coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it. When you become eligible for Medicare, you will need to enroll in both Medicare Part A and Part B to get full benefits from your retiree coverage.
  4. How does your retiree coverage work with Medicare? Get a copy of your plan's benefit booklet, look at the summary plan description provided by your employer or union, or call your employer's benefits administrator.
If your former employer goes bankrupt or out of business, Federal COBRA rules may protect you if any other company within the same corporate organization still offers a group health plan to its employees. That plan is required to offer you COBRA continuation coverage. If you can't get COBRA continuation coverage, you may have the right to buy a Medigap policy even if you're no longer in your Medigap open enrollment period.
You may want to talk to a knowledgeable insurance broker for advice about whether to buy a Medicare Supplement Insurance (Medigap) policy or enroll in a Medicare Advantage Plan.  Since Medicare pays first after you retire, your retiree coverage is likely to be similar to coverage under Medicare Supplement Insurance (Medigap). Retiree coverage isn't the same thing as a Medigap policy but, like a Medigap policy, it usually offers benefits that fill in some of Medicare's gaps in coverage—like coinsurance and deductibles. Sometimes retiree coverage includes extra benefits, like coverage for extra days in the hospital and often covers part D prescription coverage.
Everyone’s situation is different if you have questions about Medicare & retirement coverage contact my office and we would be happy to walk you through the steps you need to take.
Call                        email
631-358-5793      medicare@paulbeinsurnace.com


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Which Medicare Insurance is Best?

2/1/2021

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Which Medicare Insurance is Best? 
Medigap Vs. Medicare Advantage

Almost every day someone will ask me some version of this question:  “What is the difference between Medicare Advantage vs Medigap and how do I choose?” I’ve answered versions of this question thousands of times in my career.
As you may know by now, Medicare alone doesn’t cover everything. Most people buy additional insurance to bridge the gaps.  After all, who wants to come up with a $1400+ deductible each time you enter the hospital? Or shell out 20% of the cost of an expensive test like a MRI? 
When considering Medicare Advantage vs Medigap plans, it’s important to understand that both types of plans will help to reduce your out of pocket spending, understanding the differences will help you select the right plan for your needs.
 
Medigap, commonly referred to as Medicare Supplement
Medicare supplements will pay secondary to original Medicare, that means there is no provider network and patients with this coverage can go to any provider that accepts original Medicare.  If you enroll in a comprehensive plan like Plan G, you will have very little out of pocket.  Not even doctor copays!

When you enroll, you're Medicare supplement insurance company notifies Medicare that you have purchased a policy. Thereafter, as we described earlier, when Medicare pays its portion of your bills, it will automatically send the remainder of your bill to your Medicare supplement company.
Freedom of Access & No Referrals NecessaryMedicare supplements also offer you the most freedom of access to providers. You have freedom to choose your own doctors and hospitals from among the 900,000+ Medicare providers in the nation. No referrals are necessary to see a specialist on this type of coverage. Because these plans offer you the most freedom and flexibility, they have higher premiums than Medicare Advantage plans. In the New York area, for example, a female, non-tobacco user turning 65 might pay around $200 – $270/month for Plan G in 2020.
Rates in other states depend on which Medigap plan is chosen and whether that individual uses tobacco. Plans and rates also vary by region, age and sometimes gender. 
Your Retail Drug Coverage is SeparateMedicare supplement  plans cover medications administered in a hospital setting, such as injectables or chemotherapy drugs. They do not cover retail medications though, so most beneficiaries will enroll in a separate Part D drug card. There are plans available in every state starting around $10/month up to $100.
If you enroll into a Medicare supplement plan during your one-time open enrollment window (within 6 months of your Part B effective date), there are no health questions. The insurance company will approve your application.
There are also no waiting periods or pre-existing condition exclusions when you apply during this window. If you miss this window and apply later on, then you will usually be required to answer medical questions and be underwritten. The underwriter at the insurance company can accept or decline you based on your medical history.
Medicare Advantage About 36% of beneficiaries choose to enroll into Medicare Advantage policies, which are private insurance plans. They usually have lower premiums than Medigap plans….Many even a $0 premium on some plans in some areas.
When a plan has a $0 premium, it means that you will pay no additional premiums for the plan itself. You will still pay for your Part B premiums monthly though.  You must be enrolled in both Medicare Parts A and B to be eligible for a Medicare Advantage plan.
 Check Your DoctorsMedicare Advantage plans have networks which vary greatly in size, making it even more important to choose a plan with a good network that fits your needs.  
Your Medicare Advantage insurance company will pay your healthcare bills instead of Medicare paying them.  You will pay copays for the services you obtain from providers in the plan’s network as you go along. Generally the copays are reasonable, but you’ll want to review them before you enroll to make sure. Often Medicare advantage plans will offer benefits that are not covered by original Medicare like dental, vision, hearing, free gym memberships and more.
Bottom Line
There are many variables to consider when choosing a plan This is not a one size fits all, so take your time and do your homework here are a few things to consider,
  • Monthly premiums
  • Deductibles, if any
  • Expected costs of healthcare services on each plan
  • How often you use healthcare services
  • Areas where you will need access to care
  • Expected copays for your medications
  • Potential out of pocket spending for you on each plan type
  • Remember, you get what you pay for
Checking the provider networks and drug formularies for each plan can take many hours.  You can simplify your search by having Paul Barrett Insurance licensed agents  to do this for you. We’ve helped thousands of people like you with their options. We can search Medicare Advantage vs Medigap plans in your area.
We’ll be able to quickly tell you which plans your doctors take and whether your medications are covered. Working with an agent also gives you policy support when dealing with providers and year round customer service if needed.
 Call 1-800-219-0453 for help today!

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