I am asked this question many times each day so I have decided to write this post to provide a definition, summary and an overview of some benefits related to each program.

Medicare

Medicare is a health insurance program for those 65 or older and those receiving Social Security Disability disability for 2 years or more. Some will also receive Medicare for certain medical conditions such as end-stage renal disease or Lou Gehrig’s disease.  Medicare is administered by the FEDERAL Government.

Original Medicare is composed of Part A (hospital benefits) and Part B (outpatient services). Anyone American citizen who has worked a combined total of at least 40 quarter in their lifetime and paid taxes is eligible for Medicare A with no premium. There is a premium for Part B. The Part B monthly premium is loosely based on your income bracket.  For specific  premium information please refer to the

Medicare And You 2011 Handbook

Medicaid

Medicaid  is a health insurance program for those who are considered low-income based on specific guidelines set forth by Federal, State and County agencies. Medicaid is funded by States and Counties as well as subsidies from the Federal Government. Medicaid is NOT Medicare and is administered at the COUNTY level. To apply for Medicaid you will want to visit your local Social Services office.

Dual Eligible Beneficiaries

There are some who may be eligible for both Medicare And Medicaid. If a beneficiary is eligible for both programs the term used is “dual eligible”. In these cases Medicare would be the primary payer. Dual eligible beneficiaries must re-certify with Social Services each year and report any changes or increases in income.

I will be adding more detailed information related to this topic in the very near future, however, you can find many guides, forms and publications by visiting http://www.choicesformedicare.com or leave a comment and I will be happy to help.

Every Medicare Supplemental insurance plan, labeled A through N, offers the same coverage at varying benefit combinations and premiums. Not all Medicare Supplemental insurance plans are offered in every county statewide. Some states will have their own plans that offer coverage that is comparable to the countrywide plans.

Given that these are standardized Medicare Supplemental plans, the coverage is identical for all twelve plans. The difference is only in the cost of the plan. While all plans cover the same items in different combinations, there will be a difference in premium between companies.

Here are a few things that everyone should know about Medicare Supplemental coverage plan premiums. The most important is that choosing a plan with a high premium does not mean that there is a higher level of coverage. First, Standardized means that these plans are uniform right down to how claims are filed. Many companies will imply that their coverage is better than another company, however this is not true. Remember that these are standardized plans which means that they are identical plans, so they all have the same coverage.

Next, it is important to keep in mind that Medicare benefits are amended the first of every January to stay in step with cost of living increases. The Medicare Supplemental coverage plans, or Medigap benefits, correspond with Medicare coverage so the Medigap premiums will also increase annually.

Last, Medicare Supplemental insurance plan premiums are determined by using three different methods. These methods are attained age, issue age, and community rated. With attained age, premiums increase as the policy holder ages. This increase is in addition to the annual increase that occurs due to the amended Medicare benefits. Unfortunately this means that premiums will continue to increase and will be at their highest when the policy holder is in his or her eighties and nineties.

The Issue age method to set costs of policies, uses the age the person is at the time that they purchase the policy to figure their premium. This premium does not increase as the policy holder ages. However, the premiums will increase annually when Medicare makes its adjustments. Finally, the community rate method does not take age into consideration, this method sets the premiums identical for everyone living in the same geographic area.

After you have decided on the combination of benefits that will meet your needs, you will want to buy the Medigap plan with the lowest premium that is either issue age rated or community rated. The reason for choosing issue age or community rate plans is that even though you may pay a slightly higher premium it will not increase other than the annual change due to Medicare adjustments. Although there are many health insurance options for seniors, many may need assistance in understanding just how they work. There are state agencies that help the individual to understand how to choose a plan.

You may visit our main site at http://www.choicesformedicare.com to get detailed information pertaining to your area.

The simple answer is Government subsidies. When you sign up for a Medicare Advantage plan the Federal Government pays the Insurance company a certain amount or “Premium” each month to handle all of your medical claims. The amount of money is determined by many factors such as the cost of Medical care in your County and other factors.

As you know the government takes money from your Social Security check each month for your Medicare Part B premium. If you were to decide to stick with Original Medicare ONLY the government would pay a portion of your bills and you would be responsible to pay the rest.

The problem with Medicare has always been the “GAPS” in coverage and the co-insurance. Without going into too much detail here’s some of the expeses you will encounter with Original Medicare ONLY:

1. $1100 Deductible for inpatient hospital stays
2. $155 yearly deductible for outpatient services (doctors, lab tests, etc….)
3. 20% of all outpatient services (after the $155 deductible is met)

With the Medicare Modernization Act of 2006 came Medicare Advantage (formerly Medicare+choice) and      Medicare Part D to help Seniors with prescription drug costs (prior to this there was no Medicare drug coverage).

The Federal Government had a team of experts find and determine how much was being paid in claims each month per each Medicare beneficiary. Once this number was established they decided that private insurers may be able to deliver more efficient results with the same or less per month. A number was agreed upon with a yearly inflation increase and thus the beginning of Medicare Advantage.

This program was enacted with the intention of providing affordable and predictable healthcare costs which it has done. It was also designed to create predictable healthcare costs for the United States Government which it has also done.

Many Medicare Advantage plans offer additional benefits not offered by Original Medicare such as Dental, Vision, Hearing and even Health Club memberships or fitness classes in some cases. Since Insurance companies receive additional subsidies, in many cases they will include Part D coverage with no additional premium.

If you shop around you can find some great deals on Medicare plans. Due to our free enterprise system when companies compete for our business it brings costs down and benefits up.

Wellpoint who is the parent company of Anthem Blue Cross, Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Empire Blue Cross of NY and Empire Blue Cross Blue Shield of NY to name a few came into 2011 with a very competetive portfolio of plans and was well positioned to take a large share of the Medicare Advantage market also revamped their Medicare Supplement rates to become more competetive than in past years.

While having minor compliance difficulties in past years, Wellpoint came out ready for the 2011 season with efficiency and incredible organizational improvements and looks like it is going to be another profitable year.

With Medicare Advantage plans offering extra value added benefits such as the popular “Silver Sneakers” fitness program, preventative dental, vision allowances, and even hearing benefits the Blue Cross plans for 2011 have something for everyone.

Even more important than the value added benefits are the reasonable co-pays, large networks and low out of pocket maximums. With the many PFFS plans dissapearing this year Wellpoint has not missed a beat replacing them with the very popular PPO plans which allow members to use Doctors and Providers In OR Out of Network giving the patient more freedom of choice these popular plans are called Freedom Blue which is a very appropriate description.

Although these Blue Cross plans have very large networks it is always quite re-assuring that you can keep ALL of your doctors and providers which makes everything a lot easier. Anthem, Anthem of California and Empire Blue Cross and Blue Cross Blue Shield have also implemented a very convenient online shop and enroll tool for those who are computer savvy. If you’re not so comfortable online simply request an enrollment kit and you will have one at your doorstep in just a few short days.

To request materials or shop online visit www.bluecrossmedicare.org or www.bluecrossmedicare.net

In many California counties there are very few Medicare Advantage plans to choose from and this can drive prices up. If this is the case in your County, you may want to consider purchasing a Medicare Supplement plan along with a stand alone Part D drug policy.

Anthem Blue Cross of California is offering HMO and PPO plans for 2011. The  HMO plans will be available in heavily populated Counties in Southern California whil the PPO plans will be offered in all California Counties. These plans are very competetive and offer a robust benefit package.

Many people ask us which Medicare plan is the best. There is no single answer to this question. Each person has specific or unique needs and therefore should choose a plan to suit their particular situation although there are a few basic tips to follow.

If you are planning on traveling or would like a greater freedom of choice in medical providers you will probably want a PPO plan. If you stay near home most of the time you may get a better deal with an HMO

You will save money if you choose a plan with a large network or if most of your doctors are in network providers.

You are usually better off with a specific dollar amount for a co-pay rather than a percentage.

You can usually get good information from a broker representing multiple companies rather than calling each single company individually.

If you are looking for some factual information or a qualified Medicare insurance advisor try one of the links listed below.

www.californiamedicareplans.net

www.californiamedicare.org

www.californiamedicareadvantage.org

While a number of plans have left the market, many of the remaining plans could provide lower premiums and co-pays than last year.  A few of these plans are also offering value added benefits such as preventative vision and dental along with health club memberships and an expanded part d prescription drug formulary.

The key to finding a good plan based on your specific needs is to be well informed and to know what to look for. With the reduced number of plans available in each county this year your choice should be less confusing and with a little bit of assistance, relatively stress free.

When seeking professional assistance you will want to find someone who is familiar with your specific state and familiar with Medicare rules, regulations, and special programs available. Many Medicare beneficiaries are eligible for special assistance for prescription drug premiums and co-pays and in many cases even qualify for help with Part B premiums.

Once you know what you are looking for in a plan, be sure to be specific when asking for different plan  benefits and premiums. This will speed up the process of finding a plan and you will surely be happier with the plan you choose throughout the year.

Some good picks for California plans in 2011 looks like Anthem Blue Cross PPO or Healthnet for those seeking an HMO type plan while in  NY State Empire Blue Cross looks good for PPO AND HMO type plans for the northeast and NY city areas. Unfortunately Western NY is very county specific so it is hard to tell unless you consult with a NY State insurance broker.

Gerogia, Delaware, Florida, Indiana, Kentucky, Ohio and many Midwestern states all have very good Blue Cross Plans while Humana and Coventry health care also provide very  good options depending on your personal needs.

While I would always suggest consulting with an experienced Broker or Adviser, I have found some helpful websites that will provide you with a basic knowledge and some valuable Medicare resources. Listed below are some sites I have found to provide helpful information in certain states. The links to these sites are followed by a brief description based on my experience.

California

California Medicare Plans This site has current California Medicare related information, publications and videos. A very reliable source for Medicare insurance plans and questions. Toll Free number to cal if ou have any insurance related questions.

Georgia Medicare Plans Great site for Georgia residents. A wealth of information focusing on Medicare specific insurance plans and programs. Site is updated regularly and provides a toll free number to call for answers

New York Medicare Plans A trusted site for NY State private insurance plans for those with Medicare. Site is updated regularly and has many forms and publications.  Also has a Toll Free Helpline and you can obtain hard to find forms and publications by request.

California Medicare Supplement Plans This site will allow you to obtain quotes from several Medicare Supplement companies all in one place without having to talk to multiple representatives. You can get all your quotes in one location.

Blue Cross Medicare Plans A very interesting and helpful website. This is simply a broker referral source. You can call or request a quote or simply ask questions. You will be referred to a local representative when necessary or you can have information sent directly to you. A very good response time and very courteous staff.

I use New York only as an example. This is because since the rates are the same for everyone. This makes it easy for you to see how the plans work. Insurance is regulated by each State. For most other States the policies are medically underwritten unless you are within 6 months of your initial coverage election period (ICEP) which means you are new to Medicare. For all other States you should visit www.choicesformedicare.org. Another site to put in a request is www.todaysmedicare.org.

I generally don’t like to put a lot of links on my posts but in this case it is necessary to deliver the proper resources to help you find exactly what you are looking for. The sites I have mentioned are good because they do not give your information to any third parties and you will not receive any spam or numerous phone calls. You will only receive unbiased information directly related to what you are asking for. You can be sure to get a fast response and they offer Toll Free Insurance Helplines that you can call and speak to an actual person rather that a computer. Being in the insurance industry myself I have done the research to find good websites and reputable companies to deal with. 

I would also like to remind you that Medicare Supplements do NOT  offer presciption drug coverage (Part D) as part of the Plan like many of the Advantage Plans do. You will need to purchase your Part D policy seperately so make sure you factor this in when choosing your supplemental insurance.

So in closing I would like to say that it is important that you ask a lot of questions. Find a company that specilizes in Medicare plans to help you with these quesstions. If they cannot answer your questions to your satisfaction or you feel that they are not knowledgeable. Find another company and try again. A broker is usually the best bet since they can pull up information for all of the companies and you can compare all insurance from one source. It sure is a time saver and beats the alternative of calling each individual comany one at a time.

FOR IMMEDIATE RELEASE

Century Benefits Group, Inc. Receives 2009 Best of Business Award

Small Business Commerce Association’s Award Honors the Achievement

SAN FRANCISCO, November 7, 2009, Century Benefits Group, Inc. has been selected for the 2009 Best of Business Award in the Insurance agents, brokers, and service category by the Small Business Commerce Association (SBCA)

The Small Business Commerce Association (SBCA) is pleased to announce that Century Benefits Group, Inc. has been selected for the 2009 Best of Business Award in the Insurance agents, brokers, and service category.

The SBCA 2009 Award Program recognizes the top 5% of small businesses throughout the country. Using statistical research and consumer feedback, the SBCA identifies companies that we believe have demonstrated what makes small businesses a vital part of the American economy. The selection committee chooses the award winners from nominees based off statistical research and also information taken from monthly surveys administered by the SBCA, a review of consumer rankings, and other consumer reports. Award winners are a valuable asset to their community and exemplify what makes small businesses great.

About Small Business Commerce Association (SBCA)

Small Business Commerce Association (SBCA) is a San Francisco based organization. The SBCA is a private sector entity that aims to provide tactical guidance with many day to day issues that small business owners face. In addition to our main goal of providing a central repository of small business operational advice; we use consumer feedback to identify companies that exemplify what makes small business a vital part of the American economy.

SOURCE: Small Business Commerce Association

CONTACT:
Small Business Commerce Association
Email: Press@SBCAAwards.org
URL: http://www.SBCAAwards.org

###

Michael King, CRSP

Principal – Century Benefits Group, Inc.

1. Do you take mostly brand or generic drugs
2. How many medications do you take on a regular basis
3. Can any of your  brand medications be substituted for less expensive generic drugs
4. Are any of your prescriptions available by mail order (you  may save money this way

After determining the answers to these simple questions  your next step should be to prepare  a list of all ou the prescription drugs that you take on a regular basis including

1. The name of the drug spelled correctly (you can copy this right from the bottle)
2. Your correct dosage
3. The number of pills per month

Once you are armed with this information you can begin searching for an affordable Medicare Part D plan that will suit your specific needs. Each company has its own formulary and while one plan may list your drug as a tier 2 another may categorize it as a tier 3 drug and there may be certain drugs which are not offered by all plans.

In summary I would like to say that there is no “one size fits all formula” and your choice should be taken seriously and proper research and choosing the correct plan could save you thousands of dollars per year. Listed below are several websites which will assist you in you search. You can submit a request for help and then your prescription drug list and they will supply you with comparative estimates.

http://www.todaysmedicare.com

http://www.choicesformedicare.org