Tag: Medicare

Need Help?

Insurance is ridiculously complicated. And what saddens me is that the people who need it the most, are the ones least capable of obtaining it. Even if they can afford it, it’s just really hard to know who to turn to for answers. Heck, it’s not even easy to figure out what the questions are supposed to be.

Help Me!

Lately, I’ve been expanding my contracting in the states I’m licensed in. And that means I’ve been doing all sorts of additional training. My goal is to offer best of class healthcare coverage in every county. Life insurance is easy by comparison. It’s by state. If I’m licensed in your state, counties don’t matter. You’ll be covered. Health Insurance – that’s a different beast. First, there is the type you need. Then there is where you need it. What county do you live in? And then there is the type of network you want. Will you lose your doctor, or a much needed specialist if you change plans? Will your drugs all be covered? And what about if you have a chronic illness? What if you’re terminal? What if you’re in a nursing home? What if you are very poor and can’t afford standard healthcare?

With all these questions, you would be right if you guessed that it’s a little more complicated to provide a health plan than a life insurance policy. And to be honest, it doesn’t pay me as much. Many of my peers in the insurance business avoid it because it is a lot of work.

But I can’t do that. My inescapable reality is that I have a bleeding heart and it’s the people that need my help the most, that cry out for attention. I want to help them. The rich have more than enough helpers. The seriously infirm, the marginally qualified, those with special needs, those who might qualify for Medicaid and Special Needs Programs, those who need translators – these all need better support than they now have. And most don’t know how to ask for it. On a daily basis, I find that I’m like a sponge soaking up all I can to prepare myself to help. And be ready next time someone calls for it.

It can be distressing. Look at the lingo. According to the Centers for Medicare and Medicaid Services (CMS), those who qualify for dual special needs programs, (where they could get Medicaid and the state to pay for all or part of their Medicare expenses), are classified into the following five possible types. When I help them apply, I’ve got to classify them correctly. Tell me if this all sounds clear as mud to you.

FBDE – Full Benefit Dual Eligible only

  • Full Medicaid coverage refers to the package of services, beyond coverage for Medicare premiums and cost-sharing, that certain individuals are entitle to when they qualify under eligibility categories covered under a state’s Medicaid program. Some of these coverage groups are ones that states must cover (for example, Supplemental Security Income [SSI] beneficiares), and some are groups that states have the option to cover (for example, the “special income level” institutionalized group for individuals or home-and community-based waiver participants and “medically needy” individuals).
  • These indivudals get Medicaid only, are enrolled in Medicare Part A and/or B, and qualify for full Medicaid benefits, but not for Medicare Savings Program c ategories. However, the state may pay for their Part B premiums.
  • Beneficiaries pay no more than the amount allowed under the state’s Medicaid program for services furnished by Medicare providers.

QMB – Qualified Medicare Beneficiary Only without Other Medicaid

  • Medicaid pays Part A (if any) and Part B premiums.
  • Medicaid pays Medicare deductibles, coinsurance, and copayments for services furnished by Medicare providers for Medicare-covered items and services (even if the Medicaid State Plan payment does not fully pay these charges, the QMB is not liable for them).

QMB+ – Qualified Medicare Beneficiary Plus

  • Medicaid pays Part A (if any) and Part B premiums.
  • Medicaid pays Medicare deductibles, coinsurance and copayments for services furnished by Medicare providers for Medicare-covered items and services (even if the Medicaid State Plan payment does not fully pay these charges, the QMB is not liable for them).
  • Get “full Medicaid” coverage in addition to coverage for Medicare premiums and cost-sharing.

SLMB – Specified Low Income Medicare Beneficiary Only

  • Medicaid pays Part B premiums.

SLMB+ – Specified Low-Income Medicare Beneficiary Plus program

  • Medicaid pays Part B premiums.
  • Get full Medicaid coverage in addition to coverage for Medicare Part B premiums.

2023 & 2024 Qualified Benefit Levels & Qualifications

So what does all this mean?!

What this means and what to do about it are two different questions. What it means is some people qualify for extra help as spelled out above. Any US citizen falling on or below the poverty line is likely to qualify for state Medicaid. Even if they are as much 20% above the Federal Poverty Level (FPL), they can at least qualify to get their Medicare Part B premium covered. When people are on a low fixed income, every dollar counts.

What you can do about it is help me help people. Get them onto Medicaid, if you can. If not, see what they qualify for by helping them pay their bills. See if you can help them prove their income at their local Medicaid office.

If you’ll do that, I’ll do this

It takes a village. Having a bleeding heart is sweet, but I’m about maximizing the good I do. I know that if I spend my time tirelessly helping people get onto Medicaid and helping them with their bills, that I won’t be able to help those who have already taken those steps and now just need to get plugged into the best dual special needs plan for their needs so they can get to their doctor. Let me focus on the insurance side of the problem. Let their church friends and family help them with their Medicaid applications. Then let me know immediately what they’ve qualified for once they are approved. What is their individual or family income? Have they been approved for FBDE, QMB, QMB+, SLMB, or SLMB+? If you’re not sure which is which, call me. I can decipher bureaucracy-speak.

NOT AFFILIATED WITH OR ENDORSED BY THE GOVERNMENT OR FEDERAL MEDICARE PROGRAM.

Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal. 

I do not offer every plan available in your area. Currently I represent 6 organizations in Tallahassee which offer 42 plans and other organizations with numerous but not all plans in six total states, including Florida, Georgia, Texas, Arizona, California and Virginia.

What is Holistic Insurance?

You are problably aware by now that as an independent insurance consultant, I am like a virtual insurance mall. While I don’t have contracts with every carrier, I am licensed in multiple states to produce not just Medicare of every type, but also Obamacare for those under 65 and private insurance, as well. And I have more options for life insurance than most other agents too – more carriers, more products, more variety, sorting from among 95 top rated carriers based on your personal qualifications.

But do Insurance Malls offer shopping assistants?

The problem with the insurance mall concept is that it suggests casual browsing. If you treat shopping for insurance casually, then you are taking the wrong approach. You should be diligent and make a good decision. Good decisions can save you thousands of dollars. Bad decisions can cost you tens of thousands of dollars. All this affects those you love.

Also, in a mall, there is no consultant to guide you through a mass of complex options so that you can make the right decision about something you could need immediately and just don’t know it yet. What you need is an experienced coach. As I see it, my job is to encourage you to take the world of insurance seriously. There is nothing that affects your pocket book more dramatically than lack of adequate health or life insurance when you or your family needs it.

Being Over-Insured

You could have an accident tomorrow. You, or a loved one could have a stroke. Bad things happen to seemingly healthy people all the time and you never know when. I don’t have to tell you this or you wouldn’t be here reading about it. But don’t let such facts frighten you into buying more insurance than you need. You are buying too much insurance if you are unlikely to be able to make the premium payments. That part is obvious. But you are also buying too much insurance if the odds of you ever needing it are exceedingly poor, or if the same insurance would be included in another type of policy. You don’t want overlap. Third, you may be paying too much and probably are, plain and simple. Why pay more money for less insurance? Usually, the problem is being under-insured, of course, and then finding this out too late. Many, for instance, rely on their employer’s insurance, or their VA benefits, only to discover that their coverage has limitations. I strongly advise that you take the time to have me review your policies.

What To Expect From Me?

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I take a holistic and realistic approach as I help you shop for insurance. I leave my teaching to my blog. I assume you don’t have unlimited time to research this. So I will simply explain why one product is better suited for you than another and give you a recommendation based on your personal needs and qualifications. My goal is to get you set-up with an insurance plan effortlessly and without delay once we’ve identified the right products you need and searched for the best price. As always, insurance is highly regulated.

Scan here to Get Obamacare in Season

On the health side, there are only certain times of the year you can make changes. I’ll let you know when those are. For Medicare, you will need to complete a Scope of Appointment form to even talk to me about specific plans and there will be a 48 hour minimum delay before the appointment. That’s the law. For Marketplace products (Obamacare, AKA ACA), you’ll need to grant me permission to contact you.

Of course, I won’t contact anyone who hasn’t asked for help anyway. Same for life. If I call you, it is because you asked me to. I only ask that you keep your appointments and have the documents you will need on hand.

What Documents Do You Need?

In almost every case, you can expect simplified underwriting and instant approvals. The carriers I choose generally don’t require medical appointments. Instead they utilize information from the Medical Information Bureau (MIB) under HIPAA.

LIFE INSURANCE DOCS YOU’LL NEED TO HAVE ON HAND

  1. Drivers License or proof of identity
  2. List of Medications insured takes, dosages, how long taken
  3. Names, Addresses, Phone Numbers of all proposed insured and their beneficiaries.
  4. A good email address of the policy owner.
  5. Policy owner’s social security number.
  6. Bank Routing Number and Account Number to draw premiums from

HEALTH INSURANCE DOCS YOU’LL NEED TO HAVE ON HAND

  1. Same as for Life (see above) except list of meds and beneficiary info aren’t needed
  2. Medicare card if applicable
  3. Name and address of Primary Care Physician if you have a preference
  4. Name and address of any specialists you want to keep
  5. Current Policy Info. (Carrier names, plan details)
  6. List of drugs you want to see the prices of. (You don’t have to volunteer any medical information when applying for Obamacare or Medicare but it is often helpful when comparing plans)

What is Private Health Insurance?

In general, you will save money with private insurance and get the same or greater benefits if you qualify. On the downside, with private insurance you won’t get tax credits and cost sharing help from the ACA state or federally facilitated marketplace and you may not qualify if you have pre-existing conditions. On the positive side, you don’t have to pay for other people’s pre-existing conditions or subsidize their healthcare costs and this saves all of the members money. Generally, it is best suited for those who earn too much to qualify for significant tax credits in the marketplace and who don’t have significant pre-existing health conditions. Not everyone qualifies.

Most ancillary plans are also private. Ancillary plans cover serious conditions like cancer, heart attack and stroke on the one hand, and dental, hearing and vision, on the other. Many plans also offer network discounts and other benefits for things such as lab work, imaging and genetic analysis. Most private plans include medical appointments and counseling online or over the phone with little or no extra cost. Some private plans also specialize in short term medical and in-home care, which is not covered by traditional plans.

What is a Holistic Approach?

A holistic approach to life and health insurance looks at goals and budgets. It analyzes gaps in coverage and counts the cost of filling them and the risk of not filling them. Many people are surprised when they find they have been paying huge premiums only to encounter budget busting deductibles that prevent plans from paying the first benefit when a health crisis comes along. A holistic approach is educational. It is not enough to be insured. A person should know what is not insured and what risks they are taking and what the consequences of being under-insured can be. An independent insurance agent is your friend and guide. It is their job to keep you informed and adequately and appropriately insured. Many plans also offer incentives and benefits for going to the gym or for planning a healthy diet and for going in for regular check ups. An ounce of prevention is worth a pound of cure. Some plans also offer over the counter drug benefits, allowing you to purchase vitamins and other non-prescription drugs. As your guide, it is my job to help you weigh out these options. Sometimes a traditional plan saves you more money than a plan with lots of perks. If I can get you to fully understand what the trade offs are without overwhelming you with too much information, I’ve done my job well.

A holistic approach also considers your whole family. It helps you plan long term and considers your final expenses and legacy. On account of marketing regulations in the health insurance business, I generally start a discussion about life insurance first. I am not permitted by law to cross-sell life insurance to my Medicare clients. But my aim in producing life insurance is to help families keep homes, protect inheritances and build savings. Instruments like Indexed Universal Life insurance policies build wealth that can be transferred to loved ones at death without inheritance tax and free from creditors. Annuities and IULs can both be indexed to S&P etc. for more earnings than banks, yet guarantee against loss. Some offer living benefits. This means that if a chronic or terminal illness occurs, a life insurance policy can cover what a health insurance policy doesn’t. Life and health insurance are related through living and accelerated benefits. So, typically a conversation about life insurance will lead to a conversation about health insurance and savings plans.

Ultimately then, I’m simply your insurance guy. I don’t offer everything. Who does? No property and casualty insurance here, for instance. But I can offer group health and life, or individual and family health and life, as well. I’m very versatile. And if you’ve got a 401K, I can even show you how to convert it into an annuity that won’t be subject to market losses. Very cool. Like I said, I’m a virtual insurance mall. Just don’t be so casual. And don’t be too proud to ask for a guide. Everyone needs help. And very few people understand what being under-insured actually means.

Caviat:

  • NOT AFFILIATED WITH OR ENDORSED BY THE GOVERNMENT OR FEDERAL MEDICARE PROGRAM.
  • Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment depends on the plan’s contract renewal. 
  • I do not offer every plan available in your area. Currently I represent 6 organizations in Tallahassee which offer 42 Medicare plans and other organizations with numerous but not all plans in six total states, including Florida, Georgia, Texas, Arizona, California and Virginia.