MYM Podcast 33: Medicare Advantage Disenrollment Period Ends Feb 14

You can disenroll in Medicare Advantage, but time is running out....

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MYM Podcast 25: Don't Give Away This FREE Medicare Option

Totally Confused? Buy Yourself Time...Free
Many people don't know where to begin, and the questions continue from there. One very popular one: which is better, Medicare Advantage or Medigap? That is complicated, and seniors are faced with many, many options. If you absolutely not decide, or if you are running out of time to decide, then you can use the 12-Month Trial Period, one of Medicare's Special Enrollment Periods (SEP). Find out how it works, and why this is important.

Listen to the podcast here.

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MYM Podcast 11: Why Would I Cancel My Retiree Group Coverage?

If You Require Substantial Medical Care....
The total out-of-pocket expenses can exceed the difference in premium. Many people believe that they cannot make a change in coverage if this happens to you. That is not quite right, but you will need to think of a number of different issues. That said, the financial difference may make it worth the effort.

You can listen here.

Send me your questions: jae [at] maximizeyourmedicare [dot] com

MYM Podcast 6: Can I Still Change Medicare Coverage Now?

Surprise: The Rules Work For You, Not Against
People keep the age-old thought that they have to use the Annual Election Period only in order to make changes to their Medicare configurations. Nope. The reality is that you have options under the current rules, and in some situations, it is highly favorable to do so. MYM Podcast 6 tells you about some ways that you can make a change even after the Medicare Annual Election Period is over, with a few examples included.

Click here to listen.

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O is for Obamacare

Readers of my message, listeners to my comments can understand now what I have thought: there was almost no chance for opponents of Obamacare to win. If you are an ardent member of the GOP, your most optimistic spin, at best, is "we raised the issue." Meh. The pertinent question now: what am I supposed to do?

The Negatives

Implementation, and the participation rate of the young and healthy were, and remain, the biggest question marks. Here is what you need to know. And here is what to do.

Pre-Existing Condition? Obamacare is a Huge Plus

If you have a pre-existing condition, particularly if you require immediate attention (including prescriptions), then you are well-served by Obamacare. No insurance company can deny you, and there is no concept of waiting period. Diagnosed with cancer on Decmeber 31st? No problem: if you have enrolled effective on Jan 1, 2014, you are covered.

The question is now affordability and plan design. That is a matter of calculation, depending on the anticipated total costs. Rule of thumb: if you take a large number of expensive prescriptions, then your plan should include prescription benefits. It will not be cheap, but the insurance will more than pay for itself. Note: prescription benefits ALONE will raise the premium by more than $100/month, so you need to be careful.

Here is the problem with those that support Obamacare: they are reporting that health insurance is affordable. Tell that to someone who needs a "Gold" plan in their 60s. $1000 a month. Now you know why Medicare is a screaming bargain and why correctly configured, Medicare & a private plan can save you many thousands of dollars, a year.

Exchange Plans Pros and Cons

Leave your politics at the doorstep. Here are the pros: transparency. You can compare prices among within tiers. Someone has calculated it for you. Cons: coverage within tiers varies. 

Here are the important points. First, HMO vs PPO. You need to know the difference. HMOs won't pay if you don't go to your primary care physician first. Second, prescription coverage. Some plans have prescriptions as part of the plan, and some do not. Third, the deductibles can vary widely, even within tier. 

Medicaid expansion? Maybe, but the problem here is that you need to speak with the government, and it isn't clear that they have the right information or that they are correctly transferring it to insurance companies. This is a fundamental problem with many implications (the opponents are right here).

If you do not qualify for Medicaid expansion, it is a virtual guarantee: you can find a plan that almost identical, and with superior benefits (hmo v ppo, prescriptions, deductible) off the Marketplace. You can contact an expert to help identify these alternatives, and one other thing: no dealing with 1-800-Government.

Young and Healthy? Get Ready to Pay

Due to the way that Obamacare is structured, the net payers are over 30 with families. If you are employed and your employer offers health insurance benefits, you will need to take it. That may or may NOT include your spouse or children. Your spouse, if also employed, should individually check his/her available benefits from his/her employer. Children may be able to purchase separate policies in the private market. Families, as a unit, are frequently more expensive in a group plan than the individual parts added together, unless there is a subsidy from the employer.

If everyone is healthy, then you may be able to save hundreds of dollars a month by looking into non-Obamacare compliant plans, but you must act now. Reason? Deadlines for enrollment are in early-mid November. There is no getting around this: if you starting thinking about this during Thanksgiving dinner, you are too late.

Employee with Benefits? Check Anyways

It depends. If you are healthy, then you should check the market according to the previous paragraph. Employers don't want to say this, but your best option may be to take 2014 using a private plan, and then opt back in for 2015. Why? You may be able to save money in 2014, but won't be able to in 2015, when all new plans must be Obamacare compliant, which will be much more expensive.

If you have a pre-existing condition or require extensive medical attention, it is most likely that your group plan is superior to the Obamacare alternative. In addition, if your employer offers health insurance, then you cannot apply for Medicaid expansion.

Small / Private Employer? Tick, tock

If you are a small employer (even with as few as 2 employees), and you have not checked the market by now, it is the bottom of the 9th inning. There are viable alternatives (too many to mention). The difference among alternatives can easily be over $300 per employee. Now multiply by employees/enrollees, and then multiply by 12.

You will see complaints in the press, but what you don't see is this fact: many small employers are sitting on their hands without thorough thought of the implications of this paragraph. This is one of the most imprudent approaches I can possibly imagine. 

If you are an employer that has been able to navigate this economy, then you can handle this. Putting it off til later? Well, you can excuse me for not being sympathetic: one hour of attention can save or cost a small employer tens of thousands of dollars. Waiting until Thanksgiving? You will be too late to consider many of these options. 

Maximize Your Medicare (2014 Edition) Coming Soon

For married couples, some very, very important changes and strategies to deal with Obamacare, when are involved in employer-sponsored plans. For those of you that own the 2013 Edition (ebook), you can get a free update when you update the book. For those that own the paperback version, the strategy is unchanged, and they way to understand Medicare is also unchanged. The ebook will be part of Amazon's Kindle Matchbook, which allows you to purchase the ebook version for $2.99 if you have previously purchased the paperback version.

One more reason for the ebook: the next revision will include ways for enrollees to directly select carriers or other service providers to receive personalized attention.

Disclaimer and Fiduciary Responsiblity

This is not individual, specific financial advice. It isn't an offer of any financial product or contract. You can consult with a financial advisor on a private basis in order to receive individualized attention.

That said, there are certain advisors that have a fiduciary responsibility on behalf of their clients. If you require financial advice, then you can ask if they are subject to this responsibility. It is a technical term with a specific meaning. If you advisor doesn't know what it is, then I will leave it to you to make your own conclusion on the answer to the question. It is difficult to ascertain who is an "expert" and who is not, but this standard is a very good start.

This Happens: Companies Changing Retiree Benefits

This Happens

Large, stable employer has to compete on a global scale. Employee benefits erode, for active employees and retirees. This year, a dramatic change to prescription drug benefits may warrant an entirely new strategy and approach.

Group Plans Used to Have No Coverage Gap

The point is that group plans frequently eliminated the Coverage Gap. That point alone may have led a retiree to choose to stay enrolled in the employer's plan. However, the employer has created a new structure of prescription drug benefits. The previous superiority of prescription drug benefits may be eliminated. If this is the case, then the price and extent of medical (non Rx) benefits need to be examined.

Can You Change? Yes.

For those that determine that the existing group plan should be cancelled, a private Medicare alternative (Medicare Advantage / Medigap) can be selected. A stand-alone PDP (Medicare Part D plan) can be selected. The person would qualify for a Special Election Period, which allows this selection when a group plan is cancelled, whether or not that cancellation is voluntary or involuntary.

Problem: Timing

Companies frequently have a very limited calendar, i.e. their enrollment/selection period is very tightly defined, and may/may not coincide with the Medicare calendar. As a result, your group benefits should be examined as soon as you receive it. This is one of those instances when a qualified advisor may need to be contacted.

PPACA and Medicare: One Very Positive Development

The PPACA Helps Married Couples

The Patient Protection and Affordable Care Act (PPACA) is known by the term “Obamacare.” The term “Obamacare” itself evokes an emotionally-charged response ranging from elation to rage. You may have noticed that Maximize Your Medicare has almost no political statements or opinions. We are not going to resolve the debate, and it is not the intent of this book to settle this complicated, highly politicized matter. That said, there is definitely one very good outcome for married couples facing a particular situation.

Pre-Medicare Spouses Can Opt Out in 2014

Under employer-sponsored plans, one spouse may be Medicare-eligible, and the employer-sponsored plan may be very expensive, or have significant out-of-pocket expenses. Nevertheless, the married couple stays with the employer-sponsored plan because the other spouse may have required very good health insurance due to his/her health situation. In the past, the spouse may not have been able to do this, because the spouse may have been denied individual health insurance coverage due to pre-existing conditions. That is no longer the case under the PPACA. Insurance companies cannot deny coverage based on medical facts, which means that the barrier that may have prevented the Medicare-eligible spouse from enrolling in a Medicare Advantage plan or Medigap plan no longer exists.

Depending on the state, the spouse that is not Medicare-eligible will be able to shop for an individual plan that may be cheaper or provide superior coverage. In the past, this may not have been possible, with the exception of those states that had already disallowed denial of coverage due to medical conditions. The bottom line: couples that had no other viable choice than stay enrolled in an employer-sponsored plan can choose freely under the PPACA. You will need to examine the premiums and plan-specific cost sharing details in order to make the correct choice. Nevertheless, this is an unequivocally better situation than before the PPACA was enacted. In addition, the spouse who is not yet Medicare-eligible may face lower premiums due to the structure of the PPACA and the limitations placed on insurance companies. So while the “Obamacare” debate does not seem like it will ever end, married couples facing the situation described above may be able to benefit greatly.

This Happens
There are many different scenarios which describe how Medicare decisions may vary, depending upon the situation of the household. This is just one, and will be included in the 2014 edition of Maximize Your Medicare. The new version will be released on October 15th, the beginning of the Medicare Annual Election Period.

Group Retiree Health Benefits Require Thought

Annual Enrollment is Occuirng at Employers

From now through the middle of December, employers have been sending out health benefit prices and alternatives to both active and retired employees.  Unfortunately, the calendars being provided require some thought under duress, because there isn't much time to decide.  For many Medicare beneficiaries, this means just staying with the existing plan.  That is not a very good idea.

Group Benefits Getting Weaker

Almost certainly, the book which describes the benefits for 2013 are weaker, either because the price is higher, or the coverage isn't as good as it was in the past.  Maybe you will shrug your shoulders, and just say "That's the way it is."  Maybe this is correct.  BUT, maybe not.  Medicare beneficiaries should check their actual schedule of benefits and compare it to the plans in the private market (Medicare Advantage / Medigap).

Maximize Your Medicare Shows You How

Maximize Your Medicare goes through the steps of how to understand the benefits provided by your employer.  It illustrates examples of how retirees should look at the private market, and compare for themselves.  In addition, it also illustrates the consequences when you do not consciously think about the matter.  No one will do this for you: not the human resources department, and not your ex-colleagues from work.  Maximize Your Medicare will inform you on how to approach your individual situation.