Medicare Part B

DTS_hands_1 Post-it notesHow well do you understand Medicare, particularly Part B? Do you know the answers to the following questions?

What does Part B cover? While Part A covers hospitalization, Part B covers doctor visits and outpatient services. Like Part A, there are deductibles and coinsurance amounts to consider, based upon the services you have.

Do you have to pay for Part B? Yes. Unlike Part A, when you sign up for Part B you will pay monthly for your coverage. The amount will depend on such factors as your family income and if you signed up at first opportunity. Premiums may be deducted from your social security check, but can also be paid directly or by arranging for an automatic draft from your bank account.

Can I be penalized if I delay or do not take Part B coverage?  YES!  There are penalties if you delay signing up for Part B coverage. Also, by law Medicare is always primary with the one exception below so most other insurance, including most COBRA, will not pay the portion Medicare B would have paid even if you do not have Medicare.

Exception: If you or your spouse have coverage through an employer you may be able to postpone Part B without penalty while you are still actively employed. The good news is that you will still be considered coming in at first opportunity even if you postpone signing up until you (or your spouse) retire. You will then have a short window to sign up before Medicare will penalize you. Technically, Medicare B is optional, but the penalties can make it feel mandatory.

How did you do? Could you respond correctly to all the questions before reading the answers? Medicare eligibility begins at age 65, regardless of whether you enroll in Social Security or continue working (or do both). Medicare Parts A and B are considered Original Medicare. Talk to a Medicare specialist if you have questions about how Medicare may impact you.

Century Health Solutions is a subsidiary of Stormont Vail Health, Topeka and provides free Medicare Educational Seminars. We are your local expert in Medicare insurance planning and will help you find the best option for your personal situation. Call us at 785-270-4593 with questions or to sign up for a free seminar. Our business hours are Monday-Friday, 8:00am-4:30pm.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

Medicare Part A

DTS_farm_10 SunsetDo you know and understand Medicare? Let’s talk about the first part of Medicare, Part A.  How well do you know it? Check out the mini-quiz below.

1) What does Medicare Part A help cover?

  • Hospital costs
  • Routine dental visits
  • Long term care
  • All of the above

2) How much does Part A cost for most people?

  • $0.00
  • $33.33 per month
  • Depends upon your income
  • Trick question

3) You may not qualify for Social Security until you are 66, but you still qualify for Medicare at age 65.

  •  True
  • False

Medicare Part A is piece of what is known as Original Medicare (which also includes Part B). If you said Part A covers hospital costs, you are right. Part A only covers hospital costs (less deductibles and coinsurance). Part B covers doctor visits and outpatient services, and Part D deals with prescription drugs. Part C, also known as Medicare Advantage, covers a combination of B and D and often a few other things as well.

Question two was a trick question, so if you answered anything except the second choice you were correct. 1.65% (or double that amount if you are self-employed) of your salary is paid into the Medicare fund every paycheck during your entire working career. The more you earn, the more you pay in. However, Medicare does not charge recipients of Part A one cent to receive benefits.

Final Answer: True. Medicare eligibility begins at age 65, regardless of whether you enroll in Social Security or continue working (or do both). In fact, certain penalties may apply if you fail to apply for Medicare at your earliest opportunity. Talk to a Medicare specialist for specific details if this may impact you.

Century Health Solutions is a subsidiary of Stormont Vail Health, Topeka and provides free Medicare Educational Seminars. We are your local expert in Medicare insurance planning and will help you find the best option for your personal situation. Call us at 785-270-4593 with questions or to sign up for a free seminar. Our business hours are Monday-Friday, 8:00am-4:30pm.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

 

Bringing in the Heat

CenturyE02

Renea Dennison

Growing up I longed for the Dog Days of Summer. Few of us had the luxury of air conditioning, but a cool clothe on the forehead at night helped you drift off to sleep. It was even hotter during the day, but who cared when you could play in the sprinkler and occasionally go swimming in the creek or the pool at the park?

I still enjoy the summer, but now I am much more aware of the health dangers. The truth is that heat kills. Every year more than 600 people die from heat in the U.S. Fortunately, or unfortunately, these deaths are preventable.

The most at-risk group are people over 65, but infants, people who work outdoors, athletes, people with chronic illnesses, and lower income households are all high risk groups too. Finally, pets are also at risk during high heat periods. If you are in one of these groups you are at risk because your activity or health might prevent your body from communicating the danger you are in, or you just might be more susceptible to heat.

Know the signs of heat stroke and heat exhaustion and other heat related health dangers.  Go to the Centers for Disease Control and Prevention to see the warning signs: (https://www.cdc.gov/disasters/extremeheat/warning.html) what to look for and what to do if you have them . READ them and learn them! Pay attention to these signs to avoid serious danger, and seek help immediately if you have any.

Prevent these deadly reactions by staying hydrated, avoiding extreme temperature changes, wearing loose, lightweight clothing, slowing down and staying indoors during the hottest part of the day. Take cool showers or baths to cool down, and try to avoid cooking with the oven or stove top.

Check on your neighbors and family and have them check on you. Share air conditioned spaces (libraries, theaters and malls work) during the hottest part of the day, and make sure pets have water and a shady, cool space.

Heat can kill. Enjoy your summer, but be aware and be safe. It’s good to be a ‘Hottie,’ just be the right kind.

Century Health Solutions is a subsidiary of Stormont Vail Health, Topeka and provides free Medicare Educational Seminars. We are your local expert in Medicare planning and will help you find the best option for your personal situation. Call us at 785-270-4593 with questions or to sign up for a seminar. Our business hours are Monday-Friday, 8:00am-4:30pm.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

Cataract Awareness Month

DTS_hands_5 Glasses with notesWe cannot leave the month of June without noting that it is Cataract Awareness Month. Why is it so important? Over 24 million Americans over the age of 40 have cataracts. Cataracts are one of the leading causes of blindness both in this country and worldwide. A cataract is when cells build up on the lens of the eye causing it to cloud. Light has trouble passing through, and it becomes difficult to see.  While anyone, even children, can develop cataracts, most are age-related. Therefore they affect seniors the most.

Cataracts are also one of the simplest causes of blindness to treat. The clouding of the eye lens can be repaired in as little as 20 minutes with outpatient surgery. In fact, over 3 million Americans have this surgery each year. The treatment consists of removing the clouded lens and replacing it with an artificial one. The replacement, known as an intraocular lens, or IOL, has a 95% success rate. It is one of the safest and most successful surgeries in the country.

If you think you have cataracts see your opthamologist. In the meantime, avoid or delay cataracts by avoiding smoking, protecting your eyes from UV rays or injury, and eating healthy foods.

Cataract surgery with basic lens implants is covered by Medicare. There is even an exception to one of Medicare’s rules-after you have the surgery Medicare will cover one pair of eye glasses or contacts! Contact your Medicare representative for details to find out the specifics regarding your Plan, and make sure you get your glasses or contacts from a supplier that accepts assignment. Again, talk to your representative to avoid any pitfalls such as the possibility of having advanced implants not being covered, or having to pay for your glasses or contacts up front then submit for reimbursement (and then possibly having to appeal a denial.)

If you don’t have a representative, we always recommend having an agent to help you with those little bumps in the road and questions. Feel free to call us at 785-270-4593 or you can get a list of agents from your state insurance commission.

Questions? Please contact Century at 785-270-4593 or 1-800-227-0089 for assistance or to make an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

I Can See You

CenturyE02March is National Save Your Vision Month. It’s also Workplace Vision Wellness Month. As you can see (pun intended), in March the eyes have it going on.

Seriously, vision is extremely important. You need to protect it. Follow these steps for healthy vision:

  • Schedule a comprehensive eye exam every year. Your eye doctor can do more than give you a prescription for a new pair of glasses. Optometrists are usually the first to find eye disease. Your chances of recovery, or at least reducing the damage, increases significantly when disease is found early. Your eye doctor might also discover you have a life threatening illness like high blood pressure or diabetes. Get those peepers checked regularly!
  • Maintain a healthy diet. Remember, those five servings of fruits and vegetables are better for your eyes if they contain lots of leafy greens.
  • Wear sunglasses. Give your eyes some protection from UV rays and look cool at the same time.
  • If you wear contacts, observe safe wear and care.
  • Finally, practice the 20-20-20 rule: every 20 minutes look at least 20 feet away for at least 20 seconds. Technology is not always our friend. If you use a monitor all day or stare at your phone for long periods of time, then this is especially important. You should also make sure the brightness of your monitor, as well as its height, is set at an appropriate level.

DSCF1245The 20-20-20 rule is a nice segway into the Workplace part of this article. In addition to protection from damage due to monitors, here are several other items to consider:

  • Wear protective and appropriate eyewear safety equipment.
  • Keep your safety gear in good condition. Check it frequently for damage and wear.
  • Be aware. Know what kinds of eye injuries might occur on your job, and watch out for them.
  • If you think you might need safety equipment or guards of some kind, ask for them. Prevention outweighs treatment every time.

There you have it. I hope you see the importance of taking care of your eyes. Now, go set up your eye appointment.

Insurance questions? Please contact Century at 785-286-6402 or call Toll Free 1-800-227-0089 for assistance.  The office is located at 2951 SW Woodside Drive in Topeka and walk-ins are welcome.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

 

It’s the Max

DTS_Photography_Movie4For many years the insurance industry has had ‘Out-of-Pocket Maximum’ clauses in health care policies. The term included this and excluded that. It was very confusing, especially if you changed carriers to one who might have an entirely different set of rules for your Out-of-Pocket Maximum (OOPM). For example, some carriers included deductibles, but excluded copays. Other carriers included copays, but excluded deductibles. Some carriers included prescriptions, and others didn’t. As I said, it could be very confusing.

The ACA has eliminated much of the confusion. Have to pay a deductible? It applies to your max. Paying coinsurance on that hospital stay? It applies. Pay a copay for that office visit? It counts. Yay! Now you can budget for your health care because you KNOW absolutely how much you will have to pay at the most! Right? Well, not exactly.

There are still a few things that won’t count towards your OOPM:

Insurance premiums – whatever you are paying, whether you bought coverage at work, on the exchange, or some other method, the cost of having insurance does not reduce the OOPM for your share of actual health care costs. If you pay $5,000 per year for your health insurance, you will pay $5,000 plus your portion of your health care costs (deductibles, co-insurance and copays). The good news is that the OOPM limits how much you have to pay for the second part. Your carrier will have to pay 100% once you meet OOPM, unless you hit one of other exceptions listed below.

Out-of-network cost-sharing or balance billing does not apply.

Non-essential (medically unnecessary) health benefits do not count either.

Expenses that your insurance does not cover, like cosmetic surgery, cannot count towards your OOPM.

The OOPM in 2015 is $6,600 for individuals and $13,200 for families, but that can change every year. The 2016 OOPM is $6,850 for individuals and $13,700 for family plans. Also, lower income individuals/families can get help with their OOPM.

So read your policy carefully. Make sure you know what your policy will cover, and if you have to go to network health care providers, do so. Protect yourself by knowing more.

Questions? Please contact Century at 785-286-6402 or call Toll Free 1-800-227-0089 for assistance. The office is located at 2951 SW Woodside Drive in Topeka and walk-ins are welcome.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

In-Network vs. Out-of-Network

DSCF1245Health insurance can be confusing. Networks, deductibles, and out of pocket maximums are just some of the terms you should learn before you buy health coverage. Not knowing and understanding these terms can cost you hundreds, if not thousands, of dollars. One of the most important things to understand is the difference between In-Network and Out-of-Network.

Health insurance companies contract with a network of health care providers in order to keep costs down and assure better outcomes.  Providers In-Network go through a credentialing process to affirm they are fully educated, licensed, insured and in good standing. The providers agree to offer a discount (write-off) for their services. The insurer agrees to pay claims quickly, and to send the provider people covered by their insurance. The provider cannot collect the write-off from the patient, but they make up for the discounts in increased volume.

If you go to a physician not in your carrier’s network, the insurance company will not receive a discount for your services, and the provider may not have been through a credentialing process.  Out of network providers can charge a patient whatever fee they want, even if the amount is twice what other providers in the area are charging for the same service.  Insurance companies take steps to try to counter these high expenses.

Usual, Customary & Reasonable (UCR) is a term known in the health insurance field that relates to what a provider should charge for a specific service. If the average doctor charge in your area is $95 for an office visit, then $95 is the UCR amount. Your health insurance will only pay UCR. If the Out-of-Network physician charges $150, you may be billed for the difference.

Health insurance companies also may set higher deductibles, copays, coinsurance, and out of pocket maximums for Out-of Network providers. I will discuss these terms more in-depth in a later article.

When you buy a health insurance policy, it pays to check out the carrier’s network first. Is your regular doctor in network? If not, will they be willing to join? Are there many specialists in your area, or will you need to travel 50-100 miles to go to one? That $10 you save in monthly premium may cost you hundreds in Out-of-Network expenses. Know the In-Network and Out-of-Network provisions before you buy.

Questions? Please contact Century at 785-286-6402 or call Toll Free 1-800-227-0089 for assistance.  The office is located at 2951 SW Woodside Drive in Topeka and walk-ins are welcome.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.