Deciding whether to enroll in Medicare is an important decision, so you will want to make sure you are as knowledgeable about this health coverage program before you make it. You also need to be aware of enrollment requirements and timeframes. If you miss your initial enrollment period, which begins three months before you turn 65 and runs until three months after, then you will need to wait until a general enrollment period opens, unless you qualify for special enrollment. Also, keep in mind that if you fail to sign up for Part B or prescription drug plan (part D) when you first become eligible and do not have an approved exception, you face penalty premiums for each year you do not register.
What is Medicare? Medicare is a federal health insurance program, primarily for people who are 65 years and older. It has four parts, each of which has a distinct intent:
• Medicare Part A: Covers hospital stays, care in a skilled nursing facility, hospice care and some home health. Deductibles & copays are the patient responsibility.
• Medicare Part B: Covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Medicare pays 20% of all covered expenses – except for the annual deductible.
• Medigap: Supplemental coverage for Parts A and B provided by private insurers that in most cases eliminates all copayments, coinsurance, and deductibles.
• Medicare Part C (also known as Medicare Advantage): Supplemental coverage provided by private insurers that often reduces copayments and coinsurance and may include dental, vision and prescription coverage.
- Medicare Part D: Supplemental plans that cover prescription drugs costs for Parts A and B supplemental plans. Prescription coverage is mandated by Medicare. You will incur a penalty if you do not have creditable prescription coverage which remains in effect for as long as you have coverage.
Medicare C or Medigap: what are the differences? Now you have Medicare A & B how can you avoid the high copays & deductibles from Medicare? You cannot purchase both Medicare Part C and Medigap. You will need to choose the option that best fits your needs.
Here is how they compare:
Medicare C (Medicare Advantage) --- (Follow Rules)
• Lower premiums
• Higher out-of-pocket costs that vary by plan; each plan has an out-of-pocket maximum.
• HMO or PPO option: possible limited in-network doctor selection or out-of-network rules.
• Referral to see specialist often required.
• Usually only local or regional coverage.
• Usually includes Medicare Part D as part of the premium.
• Some include extra coverage for vision, dental and hearing aids and exercise programs.
Many Medicare Advantage plans offer zero to various premiums. With more Medicare Advantage plan options being sold by more providers, the increased competition between insurance companies helps keep costs low for consumers. And with more benefits being approved for use, plan providers may gain even greater flexibility with their pricing and coverage offerings.
The Affordable Care Act (also known as Obamacare) put an incentive system in place for Medicare Advantage plans. Beginning in 2012, plans that provide high-quality care will receive a bonus or rebate. By law, the bonus money must be reinvested in additional plan benefits.
Going forward, Medicare Advantage plan providers will no doubt continue to adapt and improve the quality of the plans they offer to meet these bonus requirements. In addition to the bonus program, Medicare issues star ratings for all Medicare Advantage plans each year, and these Medicare Star Ratings can be a large point of emphasis for shoppers. In 2018, Centers for Medicare and Medicaid (CMS) expanded its definition of the “primary health-related” benefits that insurance companies can include in Medicare Advantage plans. As a result, new benefits were available to be added to some Medicare Advantage plans.
These new benefits may include services such as:
• Home-delivered meals
• Air conditioners for people with asthma
• Transportation to doctor’s offices
• Grab bars in home bathrooms
If you sign up for Medicare Advantage, review your coverage annually. Coverage, benefits, and costs of Medicare Advantage plans change each year.
Reviewing your plan could save you money, help you find a better coverage fit — or both.
Medigap (Medicare Supplement Insurance) --- (Peace of Mind)
• Higher premiums.
• Usually, Medicare annual deductible, which is $203 in 2021, depending on the plan you choose.
• Accepted everywhere that Medicare is accepted.
• Usually, referrals are not required to see a specialist.
• Generally accepted in every state or U.S. territory and some plans may be accepted internationally when traveling.
• Medicare Part D must be purchased separately.
• Coverage for extras must be added through additional plans.
• Note -- Those who need frequent medical care, or like to budget with fixed costs, often choose Medigap to keep their total medical costs flat.
Choosing the right insurance plan is the most important decision you will make for your future health. You need to make some of the most consequential decisions about Medicare at a time when you know the least about Medicare. As a licensed Medicare Advisor, Crystal Manning can assist with many options that are best for you. Contact her at 412-716-4942 or crystalmanning33@gmail.com.
As the leaves begin to change and the air turns crisp, its a beautiful reminder that autumn is upon us. While the fall season brings cozy sweaters and pumpkin spice, it also presents unique challenges, especially for seniors. With slippery leaves, shorter days, and the onset of colder weather, its crucial to take steps to ensure your home is as safe as possible. Here are some essential fall prevention safety tips to help create a secure home environment this autumn.1. Keep Walkways Clear of Leaves and DebrisFallen leaves can be beautiful, but when they accumulate on walkways, they can become slippery, especially when wet. Regularly rake and clear paths, driveways, and steps to prevent slips and falls.2. Improve Outdoor LightingAs daylight hours shorten, good lighting becomes more important than ever. Make sure outdoor lights are functioning properly and consider adding motion-sensor lights around entrances and walkways. This not only helps prevent falls but also enhances security around your home.3. Install Grab Bars and HandrailsBathrooms and staircases are common areas where falls occur. Installing grab bars in the bathroom and handrails along stairs can provide the extra support needed to prevent accidents. Ensure these are securely attached and regularly check them for stability.4. Use Non-Slip Mats and RugsSlippery floors can be hazardous, especially in areas prone to moisture, such as entryways, kitchens, and bathrooms. Place non-slip mats in these areas and secure rugs with non-slip pads to prevent them from sliding. This simple step can significantly reduce the risk of falls.5. Declutter and OrganizeCluttered spaces can be a tripping hazard. Take the time to declutter your home, especially in high-traffic areas like hallways and living rooms. Ensure that cords, shoes, and other obstacles are stored away properly. A tidy home is not only more comfortable but also safer.6. Schedule a Heating System CheckAs temperatures drop, you'll likely be using your heating system more frequently. Before the cold fully sets in, have your heating system inspected by a professional to ensure it's working safely and efficiently. A well-maintained system can prevent accidents and keep your home warm throughout the fall and winter.7. Check Fire Alarms and Carbon Monoxide DetectorsWith the increased use of heating systems, its important to ensure that your fire alarms and carbon monoxide detectors are functioning correctly. Test them monthly, replace batteries as needed, and consider upgrading to newer models if your devices are outdated.8. Consider a Free Senior Home Safety AssessmentFor seniors, creating a safe home environment is essential. TruBlue offers a Free Senior Home Safety Assessment to help identify potential hazards and recommend modifications to enhance safety. Our certified Senior Safety Specialists can provide personalized solutions that cater to the unique needs of seniors, allowing them to age in place safely.Fall is a season of change, and its the perfect time to take proactive steps to ensure your home is safe and secure. By following these fall prevention tips, you can reduce the risk of accidents and create a more comfortable living environment. Whether its clearing walkways, improving lighting, or installing safety features like grab bars, each small action can make a big difference.At TruBlue, were committed to helping you maintain a safe and comfortable home. Contact us today to schedule your Free Senior Home Safety Assessment and take the first step towards a safer autumn. Together, we can ensure that you or your loved ones can enjoy the beauty of the season without worry.
Navigating Medicare: A Comprehensive Information Guide with MediConnectAre you turning 65 soon or approaching eligibility for Medicare? Understanding your healthcare options is crucial for ensuring you receive the coverage you need. With Medicare being a cornerstone of healthcare for millions of Americans, its essential to familiarize yourself with its information. At MediConnect, our Medicare advisory firm, were here to help you find the plan that works best for you.What is Medicare?Medicare is a federal health insurance program primarily designed for people who are 65 or older. However, it also covers certain younger individuals with disabilities and those with end-stage renal disease. It consists of different parts, each providing coverage for specific services:1. Medicare Part A: Hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.2. Medicare Part B: Medical insurance that covers outpatient care, doctor visits, preventive services, and some home health care.3. Medicare Part C (Medicare Advantage): A private insurance alternative to Original Medicare (Part A and Part B), often including prescription drug coverage and additional benefits like vision, dental, and wellness programs.4. Medicare Part D: Prescription drug coverage available through private insurance companies approved by Medicare.Understanding EnrollmentEnrolling in Medicare can be a straightforward process if you understand the information for your options and the timing of key decisions: Initial Enrollment Period (IEP): Typically, this is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. General Enrollment Period (GEP): If you missed your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. However, late enrollment may result in penalties. Special Enrollment Period (SEP): Some individuals may qualify for a Special Enrollment Period due to specific life events, such as moving, losing employer coverage, or qualifying for additional assistance programs.Making Informed Choices with MediConnectChoosing the right Medicare coverage depends on various factors, including your healthcare needs, budget, and preferences. At MediConnect, our Medicare advisory firm, we take the information you give us to offer personalized guidance and expertise. Helping you make informed decisions: Coverage Needs: Our team will work with you to assess your healthcare needs, including prescription medications, doctor visits, and any specialized care requirements. Costs: Well help you understand the premiums, deductibles, copayments, and coinsurance associated with each Medicare option to determine the total cost of coverage. Provider Networks: Well explain the differences between Original Medicare and Medicare Advantage plans, helping you choose the option that aligns with your provider preferences. Prescription Drug Coverage: Our experts will evaluate your prescription drug needs and compare Part D plans to find the one that best covers your medications at the lowest cost.Additional ResourcesNavigating the complexities of Medicare may seem daunting, but youre not alone. Here are some resources to give you additional information along the way: Medicare.gov: The official Medicare website offers comprehensive information, including plan comparisons, enrollment guidance, and eligibility criteria. State Health Insurance Assistance Programs (SHIPs): These programs provide free, personalized Medicare counseling and assistance to help you understand your options and make informed decisions. Medicare Plan Finder: Use this tool on Medicare.gov to compare Medicare Advantage plans, Part D prescription drug plans, and Medicare Supplement Insurance (Medigap) policies available in your area.As you approach Medicare eligibility, remember that MediConnect is here to support you every step of the way. Our Medicare advisory firm is dedicated to helping you find the coverage that meets your unique needs and preferences.By understanding the various parts of Medicare, enrollment periods, and factors to consider when choosing a plan, you can make confident decisions about your healthcare coverage. Let us guide you through the process and ensure you have the peace of mind that comes with comprehensive Medicare coverage tailored to your individual requirements.
The Role of a Geriatric Care ManagerThe share of the United States population over the age of 65 has risen to 16%, and it is expected to climb further to 23% by 2060. People are living longer, and that means that people also have more specialized health care needs.Aging life care calls for a different kind of attention, as various conditions and syndromes begin to present themselves. Depending on which conditions those are, the situation can get complicated pretty quickly. In some cases, it might be worthwhile to consider hiring a geriatric care manager.As we and our loved ones age, we usually end up needing support from the people around us to make sure our needs are met. Family members in particular tend to shoulder this responsibility. But there are many reasons that might make it difficult to have a good support network in place. The most common reason is that family caregivers simply live too far away to provide reliable senior care management.In this context, geriatric care managers can be thought of as "professional relatives." If a family member is not able to provide long term care, geriatric care managers can help provide any and all services related to elder care. They are usually licenced nurses or social workers who are trained in aging life care, and they organize care plans and advocate for their patients needs.If you hire a geriatric care manager, you will be able to count on them to navigate the complexities of the health care system. It can also be helpful to have someone who can make decisions from a neutral point of view, as family caregivers sometimes have to make difficult decisions that are deeply personal.The primary responsibilities of a geriatric care manager are:Coordinating elder care between multiple service providersDeveloping both short and long term care plansHelping manage emotional concerns, stress, and anxietiesHelping manage transitional careHiring additional caregivers as necessaryMake home visits and evaluate living conditionsOngoing assessment of aging life care needsAll of this helps take the pressure off family members and ensures that geriatric care management is always under control.When to Seek Support With an Aging Life Care ExpertThere are many cases in which families are perfectly capable of managing aging life care for someone they love. But it can be challenging to know when you might be taking on more than you can reasonably expect to handle. As discussed above, one of the most obvious challenges is that family members do not live near the person who needs their care. But other complications are not as straightforward.You should consider hiring a geriatric care manager when:You need help with a complex issue. Lots of medical conditions can lead to the kinds of behaviors that should really be handled by aging life care professionals. Issues related to dementia, verbal abuse, or physical violence are among these.Your loved one will not talk to you about their health. Whether it is out of concern for privacy, a soured relationship, or an inability to describe what they are experiencing, older adults sometimes do not let relatives help them. A geriatric care manager gives them someone they feel comfortable talking to about their health. You are having trouble communicating with service providers. Geriatric care managers have a better understanding of where other aging life care professionals are coming from, so if you have run into a wall in negotiations or are not able to get the information you are looking for, your care manager is in a position to communicate more effectively.You do not know what to do. Caring for a loved one can be complicated for reasons beyond their health. We always want the best for them, but sometimes there are multiple pathways and it is not clear which one will be best. Geriatric care managers can provide their objective point of view to help your loved one receive the senior care that is right for themFinding Geriatric Care ManagersA geriatric care manager does not have to hold a state level license. But because many of them come from fields in health care, they elect to maintain their credentials. Care managers who come from social work often have to have active licensure in order to practice in their state.So on the one hand, a lack of certification or licensure is not necessarily a deal breaker. On the other hand, it is important that they can demonstrate their experience as aging life care professionals. If you are hiring a geriatric care manager, be sure to ask about the following:Do they have direct experience with managing issues specific to your loved one? This is especially important to cover in cases of severe injury or cognitive decline.Do they have experience with crisis care management? If your loved one is prone to seizures or is at high risk for falls or heart attacks, aging life care professionals need to know how to handle this type of emergency situation. Also ask them if they are available to respond around the clock, or if they have set hours.How will they communicate information to you? It might seem like a tedious question, but being on the same page about communication methods and styles can save everyone a lot of frustration and confusion.Can they provide references? It can be hard to really understand who you are working with based on their resume alone. Talking to people who know them well is a good way to corroborate your first impressions.How are their costs and fees structured? Senior care can be expensive it is typically not covered under Medicare or most other insurance plans so it is important to understand how much things will cost up front. Geriatric care managers charge by the hour, typically within a range of $75200 per hour.When families turn to aging life care professionals for care management services, they need to know as much as possible about the roles and responsibilities of the people they are bringing into the fold. Geriatric care managers help families navigate the complexities of elder care and relieve them of the stress and anxiety that so often comes along with it. They are experienced in working with a variety of national and local resources, care providers, and care services to ensure the highest quality of life possible.Give me a call for a FREE 20 minute consultation at 714-403-7040. source: Keystone Health, 2024. https://keystone.health/geriatric-care-manager-role-responsibilities#table-of-contents
As we approach retirement, one of the greatest concerns is determining the cost of health care. Health care will likely be your biggest expense during the golden years. Obviously, these costs are a tough number to nail down and one that will vary by person, but there are estimates available. Remove the fear, uncertainty, and costly mistakes from the Medicare enrollment process. Call for a one-to-one, no charge consultation.