MYM Podcast 35: Supreme Court, PPACA, and Medicare

The PPACA is facing a Supreme Court challenge. A plain-spoken English explanation of the case, and lessons for Medicare beneficiaries.

Subscribe to the Maximize Your Medicare Podcast click HERE.

MYM Podcast 21: Guest Susan Im, Immigration Attorney and Asian-American Advocate

I Know Her as "Sue," But She's An Adult Now...
We talk about Susan's professional practice in Immigration Law, and let her talk to how the process currently plays out. She also talks about a variety of outreach programs for minorities and newcomers to the U.S. Website: www.imlaw.biz

I remind her (opaquely) that I used to call her when we were younger (we attended college together), and she never picked up the phone....good thing she still has a good sense of humor.

You can subscribe to this podcast here.

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.

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.

Responding to the Reviews

Dialogue Please
"They" say you are not supposed to respond to reviews, positive or negative.  "They" are usually wrong.  At the risk of rubbing someone the wrong way, here goes.

"Best guide out there." "First strategic book." "Well worth the money."
These were the objectives.  These are the objectives.  These will be the objectives. I priced the book for the everyday reader, well below its financial value, well below the price of other books that "explain" Medicare. I wrote it with scenarios to illustrate the effects, both intended and unintended. If you want to accept risk on your own, I am not against this. You may have good reason, and it isn't my role to tell you what to do. My role in this discussion is to lay out the choices clearly, so that you are not surprised by the results of the risks that you unintentionally take, if and when they occur. I wrote this book to help a senior (and his/her family) avoid the consequences that he/she did not intend, or did not understand in advance.

"Preachy"
This is a description that I did not expect. If anything, I haven't even come close to describing what can happen if you ignore the information in the book.  Let me put it simply: bankruptcy is a real possibility if you leave Medicare alone unchecked, become ill, and require extensive medical treatment with prescriptions. If you live alone, with no family, then that may be fine since you will be the only person to experience the consequences. For the remainder, it is now your vocation to know Medicare.  Period.  My part of this covenant? I guarantee that a reader will recover the price of the book, every year.  Send me the book back, and I will donate the copy to a group that will benefit, and I will refund your money.  Myself.

"Not Much New"
If you are experienced in Medicare matters, and have knowledge of all the options, and can compare them side-by-side, with family scenarios in mind, then you are right.  This book is not for you.  The preface to the book is "I know everything there is to know about Medicare. Said by no one."  If you are that 0.01%, then send me the book back, and I will donate the copy to a group that will benefit, and I will refund your money.  Myself.


"Don't Buy the Kindle Version"
You need to read the beginning of the book.  It is quite clear: I advised readers to READ THE GLOSSARY FIRST. It is a fact of life that there is specialized language in every profession or practice. Ask a lawyer, ask a physician, ask a plumber: jargon is everywhere. The reviewer does admit that the terms are explained. When technology improves on ebooks generally, you will be able to click on a word, and up will come the definition from the glossary. We are not there yet. We will be in the future.


"Incomplete"
I cannot comment on certain practices in certain states. I should not comment on services by governmental agencies, or groups funded by the government.  If you didn't see the news at all over the past two weeks, the government is watching, to put it mildly. Kidding aside, this is not a political book with political aims. For that you can read the Obamacare Survival Guide.  Most importantly: even when rules apply, you can get inconsistent answers from governmental agencies. I have dealt with the situation on behalf of my professional clients, and it takes a long time and persistence to undo this type of situation. The book only comments on the most blatant cases. This is intentional. If you believe that there is an omission that could benefit future readers, email me please!

Help me
If I knew then what I know now about book publishing, Maximize Your Medicare would not exist at all, for better or worse. Indiegogo is a platform for crowdsourcing, and is used to raise money to be used for objectives.  My objective? Overcome hurdles inherent in book distribution. You most likely found the book on amazon.com or at your local library. In other words, there are many, many others out there that require this information, and I need to reach them.  And I need your help. $10,000 sounds like a lot, and it is. Candidly, it is about 50% of what is required to do the job correctly. That is how high the barriers to entry are for a single book. There is a very low probability of recovering this amount, given that it is as $10 book, and there are middlemen everywhere.  So, if you found the book helpful, or acknowledge that there are countless others that would benefit, please help me by clicking on the widget below.

PPACA and Medicare

PPACA and Medicare

As it currently stands, provisions of the PPACA will make Medicare selections more transparent.  As a general statement, this is true. In addition, there will apparently be limits to the out-of-pocket expenses under Medicare.  Overall, these are positives for the Medicare beneficiary.  Now for the flip side of that coin.

Unintended Consequences

Transparency will appear in the form of "tiers," i.e. there will be Platinum, Gold, Silver and Bronze.  Alternatives will be categorized by using a notion which can be thought of covering a particular % (let's call it X%) of a person's total medical costs.  The most important concept here is that it this "X%" is ON AVERAGE.  What does this mean?  It means that your specific situation may be covered by less than average, and that your out-of-pocket expenses may exceed projections.  It is a virtual guarantee that beneficiaries misunderstand this concept today, and will do so in the future.  Please note: this is the case now with Medicare Advantage plans, i.e. the specific benefits that you receive under your Medicare Advantage plan can be, in fact, worse than original Medicare under your very specific situation.  That is because the Medicare Advantage plan has, overall, been ruled by the CMS as being at least as good as original Medicare.  This is a subtle, but important, concept.