Senior Health Care 

Medicare Supplements:

Best place to find information about Medicare:

WEBSITE:  http:// www.medicare.gov
HANDBOOK: Medicare & You Handbook
KWS INSURANCE AGENTS:  Talk to JoAnne Winslow

  • There are only  many kinds of Medicare Supplements that are options for  anyone who has Medicare: 
    • An Advantage Plan for seniors over 65, those under age 65 and disabled individuals
    • A Medicare Supplement Plans A, B, C, D, Plan F, Plan F High Deductible, G, K, L, M and plan N for members over 65.
  • Part A (Basic Medicare) has a $1288 Deductible for each stay in the hospital in a 60 day period.  IF YOU ARE ADMITTED BACK INTO THE HOSPITAL FOR THE SAME THING OR SOMETHING DIFFERENT, AFTER A 60 DAY TIME FRAME, YOU WILL HAVE ANOTHER $1288 DEDUCTIBLE. 
    • If you are in the hospital continuously, by day 61, you will pay $315 a day and by day 91 to 150, you will pay $630 a day.
    • Skilled Nursing is covered by part A: At a Skilled nursing facility you pay $0 for the first 20 days each benefit period and $161.00 per day for days 21-100.  After 100 days in a skilled nursing facility, you have no coverage unless you self-fund.  You need Long Term care to help you with Nursing home or convalescent home coverage.
  • Part B (Basic Medicare) has a $166 deductible each year and after that an 80/20 split of the bills.  These are for all outpatient procedures.  This includes:
    • Surgeries done on an outpatient basis.  These have become more and more frequent with gallbladder, knees and feet surgeries done on an outpatient basis where you are not admitted and sent home the same day. They can add up to high amounts with no cap.
    • Lab work, diagnostic imaging, CT Scans and MRI's.
    • Physician visit and specialist visits. 
  • Plan C Also known as an Advantage plan:
    • Sometimes you will pay a lower premium, even NO premiums.
    • You will have co-pays for services inpatient and outpatient.
    • You will have Co-insurance to pay.
    • You have coverage in network with an HMO and out of network with a PPO plan and co-insurance that may have an out of pocket of as much as $7,000 worst case scenario.
    • You can get a plan that includes a plan D for your prescriptions.
    • In most cases, this plan is the only alternative for those who are UNDERAGE 65, DISABLED on Medicare Part A & B.  Most Companies that offer Medicare supplements do not offer them to someone under the age of 65.  In New Mexico, only BlueCross offers a Medicare supplement to someone under the age of 65. 
  • Plan D This is specifically for prescription drugs.  You only use this card when you go to your pharmacy to collect prescriptions.



2016 Medicare Plan D

1

Yearly Deductible

 

Up to $360

2

Co-payment or Coinsurance

 

The amount you pay for each of your prescriptions after you have paid the deductible (if your plan has one) is either a copayment or coinsurance. Some Medicare Prescription Drug Plans have different levels or " tiers " of copayments or coinsurance, with different costs for different types of drugs.

  • With a copayment, you pay a set amount (like, $10) for all drugs on a tier. For example, you may pay a lower copayment for generic drugs than brand-name drugs.
  • Coinsurance means you pay a percentage of the cost (like, 25%) of the drug.

3

Coverage Gap

 

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. In 2016, once you and your plan have spent $3,310 on covered drugs, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
Brand-name prescription drugs
Once you reach the coverage gap in 2016, you'll pay 45% of the plan's cost for covered brand-name prescription drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans has set with the pharmacy for that specific drug. 
Although you'll only pay 45% of the price for the brand-name drug in 2016, 95% of the price—what you pay plus the 50% manufacturer discount payment—will count as out-of-pocket costs which will help you get out of the coverage gap. What the drug plan pays toward the drug cost (5% of the price) and what the drug plan pays toward the dispensing fee (55% of the fee) aren't counted toward your out-of-pocket spending.
Generic drugs
In 2016, Medicare will pay 42% of the price for generic drugs during the coverage gap. You'll pay the remaining 58% of the price. What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020. The coverage for generic drugs works differently from the discount for brand-name drugs. For generic drugs, only the amount you pay will count toward getting you out of the coverage gap

4

Catastrophic Coverage

 

You have spent $4,850 and now will pay small copayments of 5% on the cost of all your medication.


  • Rule of Thumb:  If the actual cost of your drugs is more than $275 a month, you most likely will hit the donut hole by the end of the year.  

Items that count towards the coverage gap

  • Your yearly deductible, coinsurance, and copayments
  • The discount you get on brand-name drugs in the coverage gap
  • What you pay in the coverage gap

Items that don't count towards the coverage gap

  • The drug plan premium
  • Pharmacy dispensing fee
  • What you pay for drugs that aren’t covered
  • ARE YOU ELIGIBLE FOR HELP WITH YOUR MEDICARE PART D?
    • SINGLE: Income under $17,655 a year ASSETS less than $13,640 
      • ASSETS ARE NOT  your house or the property where it is located or your car.
      • ASSETS ARE: Stocks, Bonds, Savings accounts, checking account funds, annuities, money market accounts, real estate you may own on the side, cash value in a life insurance policy, secondary income or vehicles and businesses you may own.
    • MARRIED: Income Less than $23,895 a year ASSETS less than $27,250
      • ASSETS ARE NOT  your house or the property where it is located or your car.
      • ASSETS ARE: Stocks, Bonds, Savings accounts, checking account funds, annuities, money market accounts, real estate you may own on the side, cash value in a life insurance policy, secondary income or vehicles and businesses you may own.
  • Plan F  
    • These plans are being phased out entirely by the year 2020. 
      If you go on Medicare in 2020 you will have to pay the part A and part B deductible.  No supplement will pay either of these costs for you. 
    • If you turn 65 before 2020, you might want to get a plan F before they are no longer offered.  Current plan F policies will be grandfathered.
    • Plan F's currently offer the benefit of no medical bills.  You should never get a bill you have to pay.
    • you will pay higher premiums
    • these plans DO NOT include a part D
    • Rule of Thumb:  If you are paying more that $250 a month in New Mexico, there is usually the same plan offered with a different company for a lower premium
  • Plan G
    • Your premium will be lower that a Plan F premium
    • You would still pay your Plan B deductible of $166
  • Plan N
    • Your premium will be lower that a Plan F premium
    • You pay your Part B deductible of $166
    • You pay a co-pay at the Dr of $20
    • You pay a co-pay of $50 at the emergency room visit.  That fee is waived if you are admitted.

 


Dreaded Disease Coverage:

  • These policies are comfort policies that offer benefits over and above what a normal medical insurance would cover. Do you need this? It is often less costly than the surprise bills that come from long term and emotionally draining illnesses.
  • For those who have a history of cancer in the family.  While you are healthy now you know there is a high chance that you will get cancer in the future.   A cancer policy works in many different ways.  
  • Some offer a lump sum benefit from, $10,000 to $50,000 should you become diagnosed with internal cancer.  This will allow you to travel to the utmost world specialist to seek treatment, or provide for the relief of bills for your family should the diagnosis be terminal. 
  • Some policies will pay your family hotel bills or travel expenses should you need to travel far for Chemo treatment.
  • Some will pay a flat $100 to $500 a day hospital room benefit should you be admitted into the hospital.
  • Premiums are as low as $25 a month if you are the age of 25 to 30 when you buy the policy.
  • Call us and we will endeavor to offer you the solution you need!

Long Term Care Coverage:

  • One out of every 4 adults over the age of 60 end up in a: 
    • Nursing home confined care facility
    • Assisted living facility
    • Personal care facility
    • Residential care facility
    • Alzheimer center
    • Adult day care
  • This usually lasts for an average of 3 to 5 years. 
  • Insurance for a nursing home is an indemnity plan which may pay most of the costs for your care in any of the above facilities.  
  • The average daily amount for a nursing home facility in New Mexico is $120 a day. 
  • Choose a plan with inflation protection
  • Choose a plan with return of premium option
  • The younger you are at the time the policy is purchased the better your premium which can be locked in for a period certain. At the age of 45, you could be locked into payments for a 10 or 20 year period and then never have to pay another dime. 
  • It may be too late to apply for Long Term Care insurance if you are already having problems in these areas: 
    • Arthritis, muscle, joint or bone disorders including osteoporosis, joint replacements, or fractures
    • If you have any major surgery, medical testing planned, or medical consultation planned.
    • If you need assistance with transportation outside of the home
    • If you use any device or appliance to assist you, such as a wheelchair
    • If you show signs of cognitive impairment
    • If you have motor vehicle accidents or other moving violations
    • If you require assistance performing 2 of 6 activities of daily living: bathing, eating, toileting, transferring, continence or dressing
  • The best time to purchase this coverage is NOW! Medicare will not cover this cost.



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