What is Coinsurance?

This is how coinsurance works with most other health insurance plans. For most individual health insurance plans, you are responsible for meeting a deductible before your health insurance will pay for your healthcare cost. Once your deductible is met, then you pay you are responsible for your coinsurance or percentage of the remaining costs until you reach your out of pocket maximum.

For example, if somebody has 60/40 coinsurance, this means once they have met their deductible, the insurance company will then pay 60% of the remaining cost and you will pay 40% of the remaining cost until you reach your out of pocket maximum. Once you reach your out of pocket max, then you should be covered 100% for the rest of your calendar year for covered services. Let’s give another example.

Health Insurance Plan
$5,000 deductible
80/20 coinsurance
$8,00 out of pocket max

Let’s say I fell and broke my arm which actually did happen and I needed to have surgery. The total bill comes to $20,000 and now I would be responsible for the $5000 because that is my deductible. That leaves a remainder of $15,000. From there, I will now pay my coinsurance or percentage of that remaining balance. In this case, I will be responsible for the remaining 20% and my insurance will help me pay 80%. So if I take the remaining bill of $15,000 and multiply that by 20%, that total comes to $3,000. So if I add up my deductible of $5,000 and the coinsurance I paid of $3,000, that comes to a total of $8000 which is my out of pocket max. This means that my insurance will take care of the rest of the bill. so for that $20,000 bill, my insurance will pay $12,000.

To sum it all up, you first pay your deductible, then pay your coinsurance , until you reach your out of pocket maximum, at which then you will then be 100% covered for the remainder for the year for the covered services.

There are three important factors that you need to take into consideration before picking a medicare plan. 

The three most important factors that you should take into consideration before selecting a medicare plan or As I like to call them the ABCs.

I like to call them ABCs because A+B+C would lead you to D, a decision. 

Let’s start with A. A represents your doctors. Is your doctor the most important factor when selecting a plan? In many cases, most people who have a specific doctor that they prefer to see don’t like to change. If you are one of those people or if this is the most important factor in deciding on which medicare plan you’d like to go with, then you might want to consider a Medicare supplement plan or a medicare advantage PPO plan. 

Now we come to B, which represents your benefits/costs. Do you want more benefits such as vision, dental, hearing, and prescription drugs all in one? If benefits/costs are most important to you, you may want to consider a Medicare Advantage plan. 

And finally, we come to C which represents hassle. Do you care about restrictions of in/out of network situations? Does not needing a referral or prior authorization to see a specialist or not needing to stay in the network to receive benefits the most important to you? If that is the case, then you may want to consider a Medicare supplement plan or a Medicare Advantage PPO plan.

By deciding on which of the three ABCs means most to you with 

  1. Doctor
  2. benefits/costs
  3. Hassle

This will lead you to a decision when it comes to picking a plan that best fits your needs. 

If you have any questions on which type of plan might best suit your needs, feel free to give our office a call at (888) 959-1028

What is IRMAA?

What’s the first thing that comes to your mind when you hear the word “IRMAA?”

If you are thinking of the famous hurricane that hit the US, that is what we are talking about here. 

What is IRMAA and how it may apply to you?

IRMAA is an acronym that stands for income-related monthly adjustment amount. This means that those of you who are higher-income earners may experience a higher part B premium and a Part D premium than those who are average earners that only pay the standard part b premium of $144.60 in 2020. Most individuals don’t experience a higher part B premium and a Part D premium while they are on Medicare. It does happen to those who make over a certain amount and it can change from year to year.  

How do you know if you are going to be paying IRMAA?

Social security uses the most recent tax return provided by the IRS to determine whether you are eligible to apply and if so how much. In 2020, the IRMAA determination is based upon your 2018 tax return. If an individual filed $87,000 income or an individual who is married and filed jointly has a  joint income of $174,000 in 2018, you will experience a higher part B premium than others. 

This table shows the different brackets of income levels. Depending upon which income level you fall in, it will show what your part B premium will be for the year 2020. These numbers do change every year.

For part D, the IRMAA calculation works similar to that of part B. It is just added on top of whatever part D premium you have for the drug plan that you choose. 

Can you appeal to IRMAA?

If you feel like you shouldn’t be subjected to IRMAA, you can try and appeal the decision. Some circumstances include things such as marriage, death, divorce, stop working, or reduced working hours. 

How can you appeal to IRMAA?

The best way to appeal is to contact social security. You may be asked to provide documentation on the appropriate situation that applies to you. There is no guarantee that the IRMAA determination will be reversed. But it can’t hurt to try, especially one of those situations applies to you.  The easiest way to get in touch with social security is by contacting them at 1(800) 7721213. If you have any more questions about IRMAA and how it can apply to you, feel free to contact our office at (888) 959-1028

 

We are going to talk about Medicare supplement and Medicare Advantage plans and its pros and cons.

But first, It is important to know some basic facts about Medicare. Original Medicare is made up of two main parts. The first part is Part A which is the hospital insurance and the second part is Part B which is the medical insurance. 

For most people, Part A is given at no additional charge. However, Part B does have a  monthly premium and in the year 2020, the average earner will pay $144.60 a month. If you are taking Social Security, that will just be deducted from your monthly check. Otherwise,  you will be billed quarterly for it. 

What does that have to do with Medicare supplements and Medicare Advantage? It’s a requirement to be enrolled in Part A and Part B in order to select either a supplement or an advantage plan. 

 

What plan is best for me?

The first option is Medicare Supplement or Medigap plan. This plan goes side by side with the original Medicare to help cover your Part A and B cost. With the original Medicare,  they pay 80% of your costs after certain deductibles. That means you are responsible for 20%. What the supplement does is it helps cover that 20% that you’re responsible. If you go with the supplement route, you have your original Medicare, your Medicare supplement, and then you can also purchase a separate D which is a prescription drug and can be affordable depending upon what medications you’re taking. When you are thinking about going the supplement route, look into your prescription, and see how the different drugs would best cover you. The supplement helps cover that Medicare doesn’t cover. 

Pros and Cons

Medicare Supplement

Pros: There really isn’t a network. As long as your doctor or the hospital accepts Medicare,

They will accept your supplement. It’s very freeing when it comes to deciding which plan you want to go with. When you pick a supplement plan, that’s a whole other story because they decided to make it even more difficult and name plans after the alphabet. The plans are really great in terms of flexibility and being able to see the doctors that you would like to see. The other great benefit is you can travel with it.

Cons: The downside is it does have a monthly premium. The better the plan, the more expensive it is.  

Medicare Advantage Plan

Pros: Private insurance company helps manage your healthcare expenses. They are in charge of paying the claims for your medical expenses. This plan is what we like to call a one-stop-shop. Their plans are bundled with a lot of benefits and some benefits that are not included in Medicare like dental and vision. These plans typically have co-pays for doctor’s visits and procedures and some of them even have a built-in prescription drug plan so you don’t have to purchase a separate one. For most of these advantage plans, it doesn’t cost an additional premium. All you need to make sure is to pay Part B premium and Advantage plan is offered to you at no additional charge.

Cons: There is a  downside depending upon your situation and how you look at it. The biggest thing to know is your network. Check to make sure your doctor is in the network (this could change at any time in the year).  Make sure that your doctor accepts that carrier. It can be limited and it is not like the supplement where you could travel all around. It does have restrictions.

I hope this information is helpful and if you have any other questions about Medicare supplement or Medicare advantage applies to your situation, feel free to give us a call at (888) 959 1028 or visit our website at www.myhealthcaredirect.com

We’ll show you the ways that you can enroll in Medicare Parts A and B.  Before we teach you how you can enroll, we want to go over when you can enroll. For those who have Social Security before turning 65, they are automatically enrolled in Parts A and B. But for those of you who are turning 65 and have not taken social security, you need to self enroll and there are three ways you can do that. Note that you can do this as early as three months in advance before your 65th birthday. 

Here are the three ways you can enroll.

The first option is to set an appointment at your local social security office and you can register there. However, with the current coronavirus throughout the United States, that’s really not an option right now so you’re pretty much left with two other options. 

The second option is to call the social security office and enroll over the phone. Here is their telephone number: 1-800-722-1213.

The third and final option is to go ahead and enroll online and that is how we are going to teach you.

Go to Medicare’s website (www.medicare.gov) and when you get to the main website and click the first blue box all the way on the left that says sign up /change plans.

 Click the box then choose the first blue row that says get started with Medicare. 

You’re going to see this note box where it says sign up for Medicare online.

It will take you to another webpage. Then, click Apply for Medicare only. 

There will be a Benefits Application Terms of Service where we encourage you to read it and then click on the button that says “I understand” then select next. 

 Now you’re getting ready to start your application. Check the middlebox that says apply and complete and click on start a new application. 

It would ask you a few questions for instance who is completing this application. For most people, you’re applying  it for yourself. Then it’s going to ask you if you have my social security account. If you’ve never created one before, select no and it will prompt you to ask if you have an address in the United States then you can select next.  

From there, create an account but before you do it, click on the information you need and it would give you some helpful guides.

Once you’re done reading the helpful tips, click create a new account and it will give you again more terms and service agreement where it goes over the information from the previous page for verification. Then click you “agree to the terms of Service and select next. 

Now here’s where you start the application. Make sure you select an email address that is easy to access and one that you have the login information too. 

I hope this information was helpful and if you have any other questions, feel free to contact our office at (888) 959 1028 or check out our website at www.myhealthcaredirect.com 

What is Medicare

What is Medicare? When do you enroll? How many parts are there in Medicare? What is Medicare Supplement? Do you need part D? All of these questions are going to get anybody’s head spinning so here are the basics of Medicare.

Medicare is a national health insurance program that is set up for most individuals that are 65 and older.  There are some exceptions for those under 65 and that would include individuals who are on disability or have terminal illnesses. 

For most individuals, when they turn that magic age at 65, that’s when they go into medicare a full time. When you’re about 64 and half-ish, you will start to get lots of Medicare information in the mail as well as some probably unwanted calls.

There are some who turn 65 and continue to work past 65 and are on your employer insurance and that’s okay. Once you fully retire that’s when you will go on to medicare full time. 

What are the parts of Medicare and how many parts are there? There are 4 main parts of medicare with an optional fifth part. Parts are made of A and B, C, and D. 

Part A is hospital insurance and this helps cover your hospital care. Most individuals get this automatically when they age into Medicare and is usually at no additional cost to you .

Part B is Medical insurance and that includes things such as doctor’s visits, outpatient procedures, lab work, MRI and etc.

Part C is also known as Medicare advantage plan. In order to get Part C, you have to have part A and B, that is the requirement. These Medicare Advantage plans typically have the additional  benefits that Parts A and B don’t cover which are things such as dental and vision. 

Part D is an optional prescription drug plan that you can either purchase separately or a lot of times, you can build into your Part C Medicare advantage plan. 

The optional fifth part is Medicare supplement or a Medigap plan. This plan is basically the bee’s knees. It basically help work side by side with the original Medicare and they help cover the cost that parts a and b do not cover.

Do you need part D? There are two reasons why we suggest that you do get a prescription drug plan when when you go into Medicare.

First reason is you incur a late enrollment penalty when you finally do eroll in a prsecripion drug plan. If you wait a couple years and then you change yur mind,  the amount of time you went with that one, you will paying a penalty and it’s not a one time penalty. so to spare you from having to do that, I recommend getting a prescription drug plan when you finally go into Medicare. Second reason is because we don’t have a crystal ball and we can’t predict what our health is going to be like in the future years to come. 

Most people tend to not get healthier as we get older so if you skip the prescription drug plan and at some point during the year something happens and now you are taking prescriptions and you don’t have any coverage at all, you can be incurring hundreds and hundred of dollars in prescription drug costs that you should not have to pay if you had a prescription drug plan.  We always recommend that you get a Part D drug plan whether you purchase it separately and get medicare supplement or you get a built in to your medicare advantage plan. 

We hope all this information is helpful and if you have any other questions, feel free to give us a call at 888 959 1028 or check out our website www.myhealthcaredirect.com for more details about Medicare.

 

Medicare prescription drug benefit or Medicare Part D is the US government’s optional federal government program to help Medicare beneficiaries pay for self-administered prescription drugs. While Medicare Part B covers all professionally-administered prescriptions, Part D covers all prescriptions taken by the patients themselves or with the assistance of a non-professional.

Before Medicare Part D was signed into law in 2006, Medicare beneficiaries in America paid for thousands of dollars’ worth of medicine with their own money. Fortunately, they can now get Plan D as a stand-alone plan or as part of their Part C plan.

The benefits in 2020 are also much better than what beneficiaries received when it was first enacted.

In simple terms, Part D is insurance for your prescription drug needs. You pay a monthly premium to an insurance company and in return, the insurance carrier’s network of pharmacies will give you a discount or coverage when you buy your prescription medications through them.

Part D is divided into four parts:

  • the Annual Deductible
  • Initial Coverage
  • Coverage Gap
  • Catastrophic Coverage.

Each part is designed to help beneficiaries spend less on prescription medicines.

Annual Deductible

A deductible is a specific amount a beneficiary must pay before they can make claims. Insurance carriers may charge the full amount, a percentage, or waive it completely. It’s important to research your options thoroughly. In 2020, you pay the discounted price for your medication until you make an accumulated purchase of $435.

Initial Coverage

Once you pay enough to match the deductible, the insurance company begins to pay a copay to cover part of the cost. Each plan separates medications into their own classifications and assigns the corresponding amount you have to pay. The insurance company will track how much you and the insurer have paid, until it reaches a total of $4,020. Take note, this total does not include the amount the government covers.

Coverage Gap

You will continue to receive significant discounts for your prescription medications after you exceed the amount for Initial Coverage. You only pay 37% of the price for generics and 25% for brand name prescription drugs. You enjoy these discounts until your total out-of-pocket expenses for prescription drugs have reached $6,350.

Catastrophic Coverage

At this point, your insurance carrier will start to pay 95% of the costs for your medications for the rest of the year. This is particularly helpful for beneficiaries who have expensive prescriptions.

Overall, Medicare Part D is a great way to save money while getting the medication you need. As you battle lifestyle diseases or serious illness, it’s important to have this kind of support. Protect your health from deteriorating any further by taking your medications as prescribed, living a healthy and active lifestyle, and following a balanced diet.

In your mission to pursue a healthier lifestyle, you might have encountered the term ‘superfoods’ more than once. Nutritionists and scientists, like New York University’s Langone Medical Center’s Despina Hyde, would say that ‘superfoods’ is just a marketing term for foods with high nutritional benefits.

The American Heart Association also says there is no clear definition of what a ‘superfood’ is. One thing’s for sure, superfoods aren’t magic bullets that will make you instantly healthier. Instead, they can help you reach your nutritional requirements with a smaller amount of calories.

Superfoods are generally described as foods known to be packed in nutrients or nutritionally dense. A smaller amount may help you absorb the nutritional equivalent of a bigger serving of another food. Most superfoods are plant-based, but some dairy and fish food items have also earned the title.

Most superfoods made their way to popularity for being rich in antioxidants, which are believed to fight or prevent cancer. Other nutrients include healthy fats, which help counter heart disease; fiber, which is helpful for diabetics or those with digestion problems; and phytochemicals or the substance in plant-based foods which may have a variety of benefits.

1,312 of the nation’s top Registered Dietitian Nutritionists (RDNs) were surveyed in the 7th Annual Pollock Communications and Today’s Dietitian “What’s Trending in Nutrition” survey. They placed their predictions on which superfoods will be highly sought-after in 2019.

The top 10 superfoods, according to experts, include the following:

  1. Fermented foods
  2. Avocado
  3. Seeds
  4. Ancient grains
  5. Exotic fruits like acai, golden berries
  6. Blueberries
  7. Beets
  8. Nuts
  9. Coconut products
  10. Non-dairy milks

Fermented foods include yogurt, kombucha, kimchi, miso, tempeh, and sauerkraut. They are popular for boosting gut health and reducing inflammation. These foods are rich in probiotic or good bacteria. They introduce healthy enzymes into your body, resulting in a boost in immunity. This can be helpful for aging adults who may be at higher risk for infectious diseases.

Avocados, on the other hand, lead as the 2nd most popular. This fruit contains more potassium than bananas, fiber, and heart-healthy fatty acids. Avocado is also used as a healthier substitute in recipes that need that creamy texture from other fats. Some nutrients are fat-soluble. This means that they need to combine with fat so the body can utilize them. Examples of fat-soluble nutrients include Vitamins A, D, E, and K, as well as antioxidants like carotenoids.

Most other superfoods are known to be healthier alternative sources protein, healthy fats, and an assortment of vitamins and minerals.

While it’s good to eat foods rich in nutrients, it’s more important to make sure you meet your personal nutritional requirements – including calories. Consult with your health provider or an RDN to learn how you could change your eating habits to maintain a healthy lifestyle.

According to a 2017 report by the Centers for Disease Control and Prevention, more than 100 million US adults are now living with diabetes or prediabetes. The rate of new diabetes diagnoses remains steady, but it continues to be alarming. Nearly 10% of US adults are living with diabetes, with the CDC reporting the disease as the 7th leading cause of death in the United States – accounting for 3% of deaths in 2017. Serious health complications caused by diabetes include blindness, heart disease, kidney failure, and the need for amputation of a patient’s lower extremities. There are two main types of diabetes: type 1 and type 2. The food we eat is converted into a sugar called glucose to be used as energy. An organ near our stomach called the pancreas secretes a hormone called insulin to help move glucose into the bloodstream. In type 1 diabetes, these people’s bodies do not produce enough insulin or any at all, so they need to supplement their supply. On the other hand, the bodies of people with type 2 diabetes cannot use insulin effectively. Type 1 diabetes requires supplements but the risks of type 2 diabetes – which is more common in middle-aged and older people according to the NIDDK – can be controlled with proper diet and exercise.

Exercise

Regular exercise of at least 30 minutes a day will help you lose weight and improve insulin sensitivity, or your body’s ability to use the sugar in your body for energy. Exercise will also help use up excess blood sugar for muscle contraction. This is proven by a study by Ryan AS (2000). Cardiovascular exercises like biking, swimming, dancing, hiking, and brisk walking are great options.

Control Your Carb Intake

Blood sugar mostly comes from carbohydrates. If your body fails to regulate your glucose levels with insulin, hyperglycemia can manifest as fatigue, headaches, frequent urination, blurred vision, and increased thirst. These can greatly impede your ability to function normally. Control your carb intake by following a low-carb diet to reduce blood sugar levels and prevent blood sugar spikes over time

Increase Fiber Intake

Fiber slows down your body’s carb digestion and sugar absorption. As a result, your blood sugar will increase more gradually and reduces risks of hyperglycemia. Soluble fiber has been found to be more ideal in lowering blood sugar levels while a high-fiber diet has been found to be beneficial even to Type 1 diabetes patients. Finally, sufficient water intake has always been linked to better health. Through frequent urination, your body can also flush out excess sugar from your system. It also rehydrates your blood and reduces the risk for diabetes-related complications. Your best option is to stick to water and other non-caloric drinks for better health. With regular physical activity and proper nutrition, you can prevent diabetes and its associated complications.

Arthritis is a very common condition but it’s not well-understood. In fact, “arthritis” is not just one disease. It can be one of over a hundred diseases, but is a general team used to refer to joint pain. Arthritis can happen to anyone at any age.

The Centers for Disease Control and Prevention names arthritis as the leading cause of work disability in the United States, affecting 1 in 4 of 54.5million US adults and 300,000 children. However, it occurs more frequently as one grows older. As the most common cause of chronic pain in the country, it is also the most common chronic condition in the US.

Symptoms of arthritis include pain, swelling, stiffness, and decreased range of motion. It’s unpredictable as symptoms come in go in varying levels of severity. The chronic pain can make it difficult for one to perform daily activities and may even cause permanent joint changes.

The most common type of arthritis is osteoarthritis. Cartilage, the cushioning material at the ends of bones, would wear away and bone rubs against bone. This causes pain, stiffness, and swelling. Bones also lose their strength over time and pain can become chronic.

Age isn’t the only factor that contributes to arthritis or its symptoms. Risk factors include a previous joint injury, excess weight, and family history. Every pound of excess weight adds 4 pounds of pressure on the knees, and could cause further damage to already affected knees.

Thankfully, there are means to manage mild or moderate pain caused by osteoarthritis.

Preventative measures include:

Maintaining a healthy weight to reduce pressure on joints

  • Regular physical activity to exercise joints

  • Exercising to strengthen muscles surrounding affected areas

  • Avoiding excessive repetitive actions to avoid strain

  • Resting in between physical activity

  • Using assistive devices

Meanwhile, one can also ease the pain with the following:

Using hot and cold therapy

  • Taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines

If joint pain becomes severe, it can seriously impact your quality of life. Other ways you can manage the pain is to have a healthy diet that strengthens your joints, bones, and muscles.

Osteoarthritis can also be prevented from the onset using the same methods: maintain a healthy weight, make sure you get your required nutrients, avoid injury, and minimize repetitive movements.

You can make the most of your golden years if you keep your body healthy and strong. Arthritis doesn’t have to be a persistent part of your life if you’re mindful!