For more information about the author, click to view their website: Logical Insurance Solutions
HEALTH INSURANCE is more
important than ever! There is no way to determine when something will
happen or when you could be diagnosed with a serious medical condition. So,
saying I am healthy, so I don’t need health insurance makes no sense. Insurance
is moving the financial risk from you to the insurance company. There are
always options for about every budget. Work with a professional that is
contracted with many carriers and offers multiple options. Many plans are
available year-round, the government plans such as the Marketplace and Medicare
have specific times that you can enroll unless you have a Special Enrollment
Period due to, as an example loss of coverage, marriage, moving out of the
plans service area, etc.
MEDICARE –
Annual Enrollment Period October 15-December 7th, 2023, for
January 1st, 2024, effective. Medicare Advantage –
Part C & Part D Prescription Plans
Most of the plans in your area
have made many changes and things you might not notice, especially important,
are your doctors still in network, what tier are your medications and maybe the
tier changed, copays, coinsurance. What extras are the plans offering? Maybe
you need extra dental, vision, hearing aids. Many plans include some wonderful
extra benefits, but it is also particularly important to know how to use the
benefit and if they work for you. If the insurance company, you are with comes
up with a better plan they will NOT switch you to it automatically. Your insurance agent should be making you
aware of a better option. It is illegal
for a insurance person to call you regarding Medicare, do not talk to someone
you have not given permission to call.
Ask them for their National Producer number and report them to Medicare
for a unsolicited call.
CMS has made many rules for 2024
Medicare season. If you want to enroll or review your plan over the phone, you
need to agree to be recorded and Medicare requires us to keep the recording for
10 years. In person appointments do not have that requirement, but you need to
sign a scope of appointment that authorizes us to talk to you about Medicare
Advantage or a Drug Plan it does not allow us to do anything but talk to you
about these topics. Many plans have decreased the cost of Insulin which will be
a huge savings for so many in 2024. Part
D after you, the plan and the pharmaceutical company paid $8,000 you no longer
have a cost for your medications for the rest of the year.
When you turn 65 you are
eligible for Medicare, once you have worked 40 quarters roughly 10 years there
is no cost for Medicare Part “A”. Part A covers Hospitals, Skilled Nursing,
Home Health & Hospice. Medicare Part B you can choose to take at 65 or you
can hold off if you are still working and have credible coverage. If you do not
have group health insurance that is considered qualified, and then you want it
you would have a late enrollment penalty for each month you did not have Part B
& Part D and that penalty will last for the rest of your life. Part B
covers, doctors, imaging, blood work, ambulance, durable medical equipment, etc.
Part D is a Medicare Drug Plan and covers medications. During your initial
enrollment period it is especially important to understand your options! Medicare
Supplements/Medigap Plans are NOT guarantee issue you may need to medically
qualify. You can purchase a Medigap Plan during your 1st 6-month on
Medicare Part B without medical underwriting. There are a lot of things you
need to know. Again, work with an agent you can trust! Especially
important: when you move you need to know your options.
Can you keep the same plan? Do you need to make a change and what does that
look like?
We offer Free Medicare Seminars
in Lee & Collier County please e-mail info@logicalinsurance.com to
register or call 239-362-0855 for dates. Medicare’s website is www.Medicare.gov.
MARKETPLACE -Obama
Care/Affordable Care Act – open enrollment starts November 1st-
December 15th for January 1st effective. December
16th to January 15th will have February 1st,
2024, effective. The website is HealthCare.gov, your local
insurance agent can help you through the maze. The government also changes each
year what how much you can earn to receive subsidy to help lower your cost for
insurance. Many people are not aware that they do not need to forgo having
health insurance and there are affordable options for them. Insurance is not
just about the price of the premium but particularly important the network of
doctors, hospital, etc. that you can have access to. Be careful carriers that
are selling in your area might not have a good network, so the price might be
right but if your hospital and your doctors are not in their network that is a
problem. So always check the network! Understanding deductibles, out-of-pocket
maximums, what applies to the deductible? Do I have to pay the deductible
before the plan pays? This differs by each plan, Copays vs. coinsurance if you do
not understand ask, become informed about what you are buying and how it works.
Individual/Family Health
Insurance – Being young and healthy does not mean you do not need
health insurance. Do you know anyone that knew when they were going to be
diagnosed with cancer, or when they were going to have a heart attack or even a
serious accident? I do not, it happens, and insurance is there to help you get
the care you need and limit your financial exposure. What are your insurance
options, and what is best for you? Employer Group Coverage, Individual
Medically Underwritten Health Insurance, Medicaid, or the Government Market
Place Guaranteed Issue Health Insurance. There is a lot to know about the differences,
as well as the cost. The monthly premium should not be your only consideration.
You do not know what you do not know so ask the experts, which do know
about all of plans and can help educate and guide you thru the enrollment
process. When it comes to medically underwritten plans, most of them you can
enroll all year long, but you can also be denied based on medical underwriting.
Logical Insurance Solutions is a
SWFL Insurance Broker that works with most of the carriers, we are
happy to help you through the maze. This is what we do daily, it is second
nature to us. We offer virtual seminars, one on one WebEx, phone and in person
appointments.
To learn more about your
options call to schedule an appointment contact: Logical Insurance Solutions
for all your insurance needs, we I am licensed in 30 states.
www.Logicalinsurance.com 239-362-0855 info@Logicalinsurance.com
By Ulla-Undine Merritt
(Dee) National Producer Number (NPN) 8853366
Congress recently made significant changes to Medicare's Part D prescription drug benefit as part of the Inflation Reduction Act. While some changes aim to help seniors afford their medications, others may have unintended consequences.On the positive side, insulin costs are now capped at $35 per month for Medicare beneficiaries. This has already provided relief for many seniors with diabetes.Starting in 2025, out-of-pocket Part D drug costs will be capped at $2,000 annually. Seniors will also have the option to spread these costs throughout the year through the new Medicare Prescription Payment Plan. These changes can benefit seniors who rely on multiple brand-name medicines or have fixed incomes.However, awareness of the new payment plan is low. Medicare could do more to inform seniors about this option, which requires opting in. Seniors should consider contacting their Part D insurers during open enrollment if they would benefit from spreading out pharmacy costs.The law's drug price negotiation provision has led to some unintended effects on drug development. At least 36 research programs and 22 experimental drugs have been discontinued as a result.Part D premiums have also increased. This year, standalone Part D plans were set to cost 21% more on average compared to last year. Many seniors switched to lower-cost options as a result. The number of available plans has decreased by about 25% since 2020.Some insurers have moved certain medications to tiers requiring higher out-of-pocket costs, restricting access to previously covered drugs. New rules like step therapy requirements have also been implemented, potentially making it harder for patients to access drugs their doctors recommend.It's important for seniors to understand these changes and their potential impacts on drug access before Medicare's open enrollment period begins in October. Contact Carleen Lachman, Independent Insurance Specialist at 724-571-4688 to learn more.
Health insurance jargon can be the hardest to understand for consumers. Thats why you have a broker who goes to work for you and explains your policy options with clarity. However, not all brokers work ethically. You may not have an insurance broker who values you and may not elaborate on your policy limitations. The omission of these limits is illegal and should result in the termination of that broker. In contrast, the insured typically doesnt take legal action, and the broker makes his or her desired commission.This is not to say that all health insurance brokers operate in this zone of immorality. Just as with any profession, there are good and rotten eggs. Your moral compass and ability to judge a persons intention is a significant factor people can typically smell a sleazy salesperson. Below, are the most common limitations obscurely mentioned in health insurance policies. This information should adequately equip you for when you are asking questions of your broker.Heres a screenshot from the summary of the benefits of an insurance carriers product:*Note these limitations do not exist in all policies. Ask your broker.The list of benefits above is towards the end of the policy summary. Most people are interested in seven factors when it comes to their health insurance:Deductible/coinsurance/max out of pocket, doctor visits/specialists/urgent care, the network, prescription coverage, preventative/wellness coverage, emergency room fees, and ambulatory services. If your insurance broker goes over those seven things, this is how the policy would look and sound:Choice of $500-$10,000 deductible/max out of pocket (1 million in coverage)Choice of 70/30, 80/20, or 100/0 coinsuranceUnlimited $25 copay to doctor, specialist, and urgent carePHCS Network (PPO)$50 copay for annual wellness/preventative checkupER subject to deductible and coinsuranceAmbulatory services (above) $500 per transportMost people would agree that those seven things sound fantastic for health coverage. You have all your daily doctor needs taken care of and one million dollars in coverage, right? Wrong, let me show you a scary breakdown if you had an appendectomy while being covered by this policy.On average, the Fair Price for an Appendectomy lies somewhere between $7,000 and $25,000 (may vary due to zip code). If there are complications, it could be upwards of $35,000 or more. Heres a breakdown of the services and their estimated costs. You can always check on any surgery, and its price by visiting Healthcare Bluebook.Hospital Services for a 2-day admission, itll cost roughly $9,700.Physician Services the fee for procedure and routine postoperative care costs around $1,400.Anesthesia the price for an average surgery time of 1 hour and 15 minutes costs about $750.This cost adds up to the lower end of about $11,000 for an appendectomy. If you look above at the example policy, youll see that for the entire coverage term an appendectomy will be given a $2,500 coverage benefit. Even though your plan has a deductible, coinsurance, and max out of pocket; theres a specific limitation for appendicitis. With this knowledge, the insured will be left an $8,500 bill as an out of pocket expense! Keep in mind; these numbers are on the low end with no complications.Of course, its always better to have health insurance instead of going uninsured. With insurance, that remaining $8,500 for the appendectomy may negotiate to a lower bill. Policygenius.com does a great job explaining the functionality of network negotiated rates. Without insurance, you would be paying the almost full retail price for your medical surgery, which is a terrifying thought!
You can, but should you?Theres a dark stain over the insurance industry for consumers searching for quotes online. Families and individuals are aware they need to carry health and life protection but dread entering their information online, consequently experiencing the bombardment of phone calls that follow. Its so bad some people would instead go without coverage than speak with a broker over the phone. When in reality, all it takes is working smarter, not harder.Some people will advise you to buy your own auto, home, health, life, or any other insurance. They will tell you horror stories about the number of calls youll receive if you submit information online. They will present a convincing argument, and youll be tempted to accept their advice. I urge you to resist that temptation.Its no surprise that many people are turning to self quoting websites and applications. The appeal is undeniable. Theres nothing inherently wrong about this approach, and it does save the consumer the headache of having to speak to countless agents. However, should you buy insurance without speaking to a licensed broker? Its fine to quote yourself and see whats out there in terms of options, but then proceeding to purchase that insurance without educational guidance is extremely risky for the consumer. When you use past experiences, personal knowledge, and stories heard from friends to make an informed decision on your insurance; the result tends to be medical debt or bankruptcy.A licensed agent or broker has a fiduciary responsibility to you. They are mandated by state and federal law to undergo licensed certification. While you may not have had pleasant experiences in the past, having a broker perform a needs analysis to personalize the policy is a better alternative. Just like any other profession, some paid attention during class, and others did not. It isnt appropriate to blanket statement all insurance brokers as untrustworthy.Heres your solution to avoid entering your information online. Instead, reach out to family members and friends. Ask them whom they use for their insurance needs and their experience with their broker. If you cant find a family or friend who uses a local agent or broker; reach out to colleagues and people within your circle of influence for guidance. By doing so, you are acquiring a real person who is aware of your personal needs and whom others trust. Its an ideal win-win situation between a trusted broker and client. You leave feeling confident in your policy because you are informed, and youve supported a local small business owner and their family. It may not be the fastest solution, but should it?When the world is more efficient, were all happy. Quicker load times, faster test results, high-speed internet. The need for convenience and expedience permeates everything we do. Theres relief in knowing you can quote and compare prices without receiving dozens of calls.However, when you go to purchase your insurance slow down, consult a professional, ask questions, and then fill out your application with the knowledge youre protected and supported.
Logical Insurance Solutions USA, Inc. is dedicated to providing quality, affordable insurance to best suit your needs and budget. Whether it is Health Insurance, Life Insurance, Dental Insurance, Vision, Short Term Disability Insurance, Long Term Care, Catastrophic Insurance Plans, Supplemental Insurance Plans or Medicare Insurance, let us do the research to find you dependable coverage for the best possible price.Life, technologies and ways to do business are always changing. Ethics, the foundation on which Logical Insurance Solutions USA, Inc. was created, never change. It is only logical that we treat our clients the way that we want to be treated. So, it is our commitment to listen, educate, mentor and do our best for all of our clients. Our commitment is like a drop of water. It has no boundaries, just the bonds that it creates. We give nothing less than the best guidance a friend can offer. 30 years later, we are proud to say that this is still our way of doing business. We welcome the opportunity to serve you!
Logical Insurance Solutions USA, Inc. is dedicated to providing quality, affordable insurance to best suit your needs and budget. Whether it is Health Insurance, Life Insurance, Dental Insurance, Vision, Short Term Disability Insurance, Long Term Care, Catastrophic Insurance Plans, Supplemental Insurance Plans or Medicare Insurance, let us do the research to find you dependable coverage for the best possible price.Life, technologies and ways to do business are always changing. Ethics, the foundation on which Logical Insurance Solutions USA, Inc. was created, never change. It is only logical that we treat our clients the way that we want to be treated. So, it is our commitment to listen, educate, mentor and do our best for all of our clients. Our commitment is like a drop of water. It has no boundaries, just the bonds that it creates. We give nothing less than the best guidance a friend can offer. 30 years later, we are proud to say that this is still our way of doing business. We welcome the opportunity to serve you!
Logical Insurance Solutions USA, Inc. is dedicated to providing quality, affordable insurance to best suit your needs and budget. Whether it is Health Insurance, Life Insurance, Dental Insurance, Vision, Short Term Disability Insurance, Long Term Care, Catastrophic Insurance Plans, Supplemental Insurance Plans or Medicare Insurance, let us do the research to find you dependable coverage for the best possible price.Life, technologies and ways to do business are always changing. Ethics, the foundation on which Logical Insurance Solutions USA, Inc. was created, never change. It is only logical that we treat our clients the way that we want to be treated. So, it is our commitment to listen, educate, mentor and do our best for all of our clients. Our commitment is like a drop of water. It has no boundaries, just the bonds that it creates. We give nothing less than the best guidance a friend can offer. 30 years later, we are proud to say that this is still our way of doing business. We welcome the opportunity to serve you!