Health Insurance 101: Medicare 101

  • By proadAccountId-388931
  • 14 Sep, 2017

It's almost time for the annual election period! Time to soak up as much information to make the most educated decision in the coming months!

Health Insurance 101 is a series in the Lerner, Csernai & Fath Benefits Blog that goes over concepts of insurance to make them easier for you to understand. As always the best source of information is a trained agent.
This year's annual election period runs from October 15th through December 7th. Now is the time to begin to start thinking about what option is best for you. Of course, a licensed and certified medicare agent is full of information when they meet with you between 10/15 and 12/7! Here is a little bit about the basics of medicare for you to digest between now and then. Also, be sure to register for one of our upcoming events !

Medicare can be confusing. That’s why we are here to help educate and guide you along your journey. There are four parts to Medicare: Part A, Part B, Part C, and Part D. What each of them covers is detailed as follows:

·      Part A: Hospital Care. This part covers most medically necessary hospital, nursing and hospice services. As long as you work for 40 calendar quarters you do not have to pay a premium for this part.

·      Part B: Medical Insurance. This covers services such as preventative care, doctor visits, lab tests, some ambulatory services, mental health, outpatient services, and durable medical equipment. There is a premium that is adjusted annually for this part of your Medicare.

·      Part C: This part is not a separate benefit, rather it is an arrangement to allow private insurance companies to provide Medicare benefits under what are known as Medicare Advantage Plans.

·      Part D: Prescription Coverage. This is only provided by private insurance companies that have contracted with the government, and offers a structure for coverage on prescribed medications.

There are really three avenues that individuals can take once they become eligible for Medicare:

1.    Stay with Original Medicare and buy a Part D plan

2.    Buy a Medicare Advantage Plan and have a private insurance company administer Medicare Coverage

3.    Buy a Medicare Supplement plan to supplement Original Medicare and pair this coverage by purchasing a Part D plan.

 

Out of those three options the most common are Option 2 and Option 3. These options involve determining the differences between a Medicare Supplement and a Medicare Advantage plan to decide what route is the best for you.

Medicare Advantage Plans

·      Medicare benefits administered by a private insurance company

·      Can come with Prescription Coverage built-in

·      Work similarly to Individual/Family/Group insurance plans

o  Deductible, coinsurance, maximum out of pocket

·      Less costly premium in most cases

·      More open for out of pocket expenditures

 

 

 

Medicare Supplement Plans

·      Supplement and do not replace original Medicare

·      Does not come with Prescription Coverage built-in

o  A separate Part D plan will need to be purchased

·      Generally, covers more costs associated with services

·      Premium is generally more expensive than a Medicare Advantage Plan.


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Derek A. Lodholtz, Benefits Specialist
Lerner, Csernai & Fath Financial Group
15505 Waldron Way
Big Rapids, Mi 49307

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The above content is meant to inform and does not convey the opinion of the author (Derek Lodholtz) or the Firm (Lerner, Csernai & Fath Financial Group).

Benefits Blog

By proadAccountId-388931 14 Sep, 2017
This year's annual election period runs from October 15th through December 7th. Now is the time to begin to start thinking about what option is best for you. Of course, a licensed and certified medicare agent is full of information when they meet with you between 10/15 and 12/7! Here is a little bit about the basics of medicare for you to digest between now and then. Also, be sure to register for one of our upcoming events !
By proadAccountId-388931 14 Aug, 2017

 

Lerner, Csernai & Fath Financial Group is sponsoring 2018 Medicare Sales Events!

 

Who?

These events are open to the public – anyone who is on or will be going onto Medicare can come!

 

What?

These events will go over Medicare plans and their structure with opportunity to schedule appointments for plan enrollment with either of Lerner, Csernai & Fath’s two Benefit Specialists!

 

Where?

Our office!

Lerner, Csernai & Fath Financial Group             

15505 Waldron Way

Big Rapids Mi 49307

 

When?

 We have three times to best accommodate you!

 

October 19th, 2017 from 3pm to 5pm

October 26th, 2017  from 10am to Noon

November 3rd, 2017 from 10am to Noon

November 13th, 2017 from 10am to Noon

**PLEASE ´╗┐CALL TO RSVP**

 

Why?

Medicare can be confusing, our Benefits Division at Lerner, Csernai & Fath is here to take that confusion away from you! By coming to see us you can rest assured that you will be educated on the offerings and the enrollment process will be helped along by our licensed and   certified staff members. This all takes place at our local office, which is available to you should questions/concerns ever arise!

 

 

Questions?

Feel free to contact us!

 

                                                                                     

DEREK A. LODHOLTZ                                                     JACQUELINE N. HOLMES

Benefit Specialist                                                                 Benefit Specialist

Direct Line: (231) 629-8628                                               Direct Line: (231) 629-8617

 derek@lernerfinancial.com                                             jackie@lernerfinancial.com 
By proadAccountId-388931 14 Aug, 2017
The moniker surrounding HSA's is that they are a guise from insurance companies that allow them to avoid paying claims until a subscriber reaches a very high deductible, or that they only are beneficial for the young and healthy -  this is FAR from the truth. An HSA account when utilized correctly can be an important tool not only for your health, but also for your finances. HSA accounts prove themselves to be versatile with many uses, and surprising amounts of flexibility with the account.  In order to fully understand an HSA we need to start from the beginning.

HSA accounts were initially enacted as a part of the Medicare Part D (Prescription Drug) legislation that was Enacted by President George W. Bush in 2004. These accounts started with relatively low amounts that individuals and families were allowed to set aside, and these amounts have since grown . How money is set aside into these accounts can happen in two different ways: the employee deposits the money into the account, or the employer deposits the money into the account (note: if an individual/family purchases their health insurance on the exchange they lose the employer deposit option). Contributing to an HSA where an employer offers the benefit to their workforce is very beneficial to both the employee and the employer, this is made possible by having a Section 125 document in place. The employee is able to set their money into their HSA account and avoid paying taxes on the money, and the employer avoids paying their share of the employee FICA (Federal Insurance Contributions Act tax) match.
By proadAccountId-388931 10 Jul, 2017
 Deductibles. Coinsurance. Maximum-Out-Of-Pockets (MooP). Insurance in the public eye has revolved around terms like these for quite some time now, and is sure to as we continue moving forward . When it comes to health insurance there are not numbers that are more important than your deductible and MooP, other than of course your monthly premium to keep coverage active. In my time in the industry there are many individuals who I come across who do not fully understand how these numbers work, how they are structured and how this all stacks up into their maximum health liability. We are going to explore both the Deductible and MooP for you and explain the workings so you can come to your meeting with us familiar with how these work and what you are up against. I find it easy to relate health insurance, when you can, to another popular insurance product: Car Insurance.
Deductible is defined by Investopedia.com as follows:  "A deductible is the amount of money an individual pays for expenses before his insurance plan starts to pay." A deductible is a way for insurance companies to give incentive towards proper usage of coverage. If we relate this to car insurance this deductible functions on Layman's Terms in the same sense as your auto insurance deductible. In both cases you pay the deductible BEFORE the Insurance Company begins to pay. The main difference comes in how deductibles are accrued over the policy term. For auto insurance you pay the deductible every time there is a loss that you want to claim, there is no limit to your deductible expenditures. Health insurance gives you a deductible that spans the entire year, you have one deductible that all of your expenditures (other than premium) stack up against - we will call this deductible 'Box A.' Once you fill up Box A with the pre-determined dollar amount, then you have met your deductible and the insurance company begins to pay out on claims. You may not meet this deductible all at once like you do with an auto insurance claim, it may take you a couple of trips to the doctor before you meet your deductible - remember, though! You only have one deductible all year. You could meet this deductible in January and the insurance company could start paying on claims for the remainder of the year!
By proadAccountId-388931 26 Jun, 2017
 As it started well before last November when President Trump was voted into office, health care reform is one of our Nations hottest topics. In may when a bill was brought to the House floor and pulled it took the wind out of many Americans sails. Since that point there has been a bill passed by the house, and much debating by the Senate which culminated in the Better Care Reconciliation Act of 2017 coming to the public eye last Friday (06/23/2017). There seems to be a division in GOP lawmakers as to where they stand on the bill, if you peruse www.thehill.com  you can see posts that litter the healthcare section detailing how many GOP Senators are not fully confident in the bill or will not vote for the bill. 

 The Bill itself differs from the bill the House of Representatives passed just a while ago, and while there are stark differences in the eyes of some Senators that does not change the reality of this: Time is running out. For a Budget Reconciliation to be able to be applied it must be passed before the end of our Fiscal Year, which ends each year on September 30th. If Congress is unable to pass a decision on healthcare before then it is back to the drawing board. Another detail about budget reconciliation that many are unfamiliar with is how if Congress moves onto a different topic planning to use the same vehicle for amendment, in this case reconciliation, the efforts on prior topics cannot be used again. What this means is as follows: If Congress were to move onto an issue such as taxes/fiscal policy that would signal the end of healthcare efforts for the time being. 

 Senator Mitch McConnell is reportedly pushing for a decision to be made on healthcare soon, and for good reason. Congress takes a recess to celebrate the week of Independence Day, and after that they go on a recess for the month of August, a full five weeks. Once they return from the August Recess the clock is sure to be ticking on healthcare reform. 

 Change is sure to happen eventually, but many differences need to be sorted out, sooner or later, for anything to culminate. Here at Lerner, Csernai & Fath we are keeping our eyes open for any changes in the landscape. Until the a good rule of thumb is to follow all laws that are in place with the Affordable Care Act as no changes have been made official as of now. 

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Derek A. Lodholtz, Benefits Specialist
Lerner, Csernai & Fath Financial Group
15505 Waldron Way
Big Rapids, Mi 49307

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The above content is meant to inform and does not convey the opinion of the author (Derek Lodholtz) or the Firm (Lerner, Csernai & Fath).
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