Senior Benefits, Insurance, and Medicare Information

Senior Health Insurance Benefits and Medicare Medicare is health insurance offered by the federal government to people who are 65 or older and meet the eligibility requirements. Some younger people who have disabilities, permanent kidney failure or Lou Gehrig disease can also qualify. Medicare helps pay for healthcare, but does not cover all medical expenses. The United States Medicare system is managed by the Centers for Medicare & Medicaid Services.

If you know what you are looking for, you can contact us to set up an appointment or fill out an application to get rate quotes. If you need additional information, send us a message or give us a call.

Long Term Care

What is Long Term Care (LTC)?

It’s personal care for people whose health has declined to the point where they need  need someone to help them with two or more “activities of daily living” which includes dressing, bathing, eating, taking medication, toileting and transferring (getting in and out of a chair or a bed.) The other indication that someone is in need of Long Term Care is that they have become cognitively impaired. Cognitively impaired may be defined as the impairment to judge accurately, reason and act prudently in everyday actions. The impairment is considered severe enough to cause possible injury or damage to oneself or others in bodily harm or loss of property. LTC may include a long term care facility such as a nursing home, assisted and independent living facilities, adult day care as well as home health care.

Why is LTC planning more important than ever?

1. Cost. The average cost of a nursing home in the U.S. in 2011 was $193 per day and $213 per day for a private room. Assisted living costs $3,261 per month and home health care goes for about $20 an hour that according to Genworth Financial.

2. Increasing longevity. We are now living longer. According to “World Life Expectancy” life expectancy in the U.S. once we turn age 65 in 2011 is 85 years old for males and 88 years old for females. We are living longer than ever and just because we are living longer doesn’t mean we will not end up in a Nursing home…it could mean we stay alive in a nursing home a lot longer.

3. Underwriting may not be favorable. According to one nationally known personal finance radio talk show host age 60 is the optimal time to buy LTC Insurance (LTCi.) In a perfect world this seems reasonable unfortunately, as we get older passing underwriting requirements becomes more difficult. The LTCi carriers report about a 30% decline rate if you wait until you’re 57 years of age. The most procrastinated tasks is acquiring insurance. You don’t wait to watch your house to catch fire before calling to insure your house against a fire…it’s too late then.

4. It’s a bad economic choice unless you’re extremely wealthy or extremely poor. To work hard and save your money over the course of 40 or 50 years and then to be hit with a stroke or Alzheimer’s Disease could wipe out your savings. A stay of 5 years in the nursing home would set you back about $300,000 if you paid out of pocket, $600,000 if both spouses are in need. A simple $2,000 per year premium for a LTC policy for 10 years would be $20,000.

5. “But what if I grow old and never need LTCi?” A common objection although you never complain about having to spend $20,000 on fire insurance when chances are good you will never have a fire. Chances of needing LTCi: 3 out of 4 seniors age 65 and over, 75%. Chances your house will burn down: .08%

6. “Well doesn’t Medicare cover Nursing Home and Home Health Care?” No, very little if any is paid for by Medicare. Medicare as well as all health insurance is designed to get from a position of sickness or injury back to normal everyday life. LTCi is designed for people who will usually not return to a normal wellness state. LTC basically allows you to live with as much comfort as possible for the long term (until death.) People receiving LTC are not expected to make a comeback in terms of a normal productive life. The only type of coverage for this is LTCi.

7. “But how about Medicaid? I heard that once you can get on Medicaid your LTC is paid for by the state.” Medicaid is only available for those who live in poverty. Here is what’s necessary to receive Medicaid payments for LTC.  1) Your assets have not been transferred to someone else (like your children or someone else) in the past 5 years from the date you actually need LTC. 2) The spouse needing LTC (referred to as the “Institutionalized Spouse”) will have all their monthly cash flow such as a pension and Social Security income going straight to the nursing home before Medicaid kicks in. In addition, the stay at home spouse officially called the “Impoverished Spouse” or the “Community Spouse” must show that there is no more than $113,640 (in 2012 and adjusted annually for inflation) in assets, a maximum of $1,500 of cash value life insurance, one automobile, some personal affects such as jewelry and furniture and of course only one house which is is the primary residence. 3) The institutionalized spouse will be limited to facilities that accept Medicaid. What if the nearest facility is 100 miles away from the impoverished spouse’s home? 4) Medicaid is not an entitlement program, but rather a loan. At the passing of the impoverished spouse assets including the home will be sold to satisfy the amount of services Medicaid paid for also known as Estate Recovery. 5) In most states, Medicaid only covers the cost of nursing homes, not home health care, adult day care or assisted and independent living facilities.

8. “I’ll let my children take care of me like I did for my folks” Really? Have you had that conversation with your adult children? Sure they might feel obligated but what a sacrifice to ask of them. Who wants to ask their children to care for them? What about your adult child’s spouse and their own children? I know their are some living like this because there is no other choice but this is no way you want to be remembered. Take action now! Maybe your children can help pay for LTCi; if they can afford it great. Asking them to help pay your LTCi is much easier than asking if you can move in with them and have them take care of you.

Medicare Part A (Hospital)

Medicare Part A - Hospital Coverage

Medicare Part A (Hospital)

Medicare Part A (Hospital) is the original Medicare insurance coverage and it helps pay for hospital bills. When you sign up for Medicare, you automatically get Part A. Part A covers hospital costs, such as: in-patient hospitalization, nursing services, Hospice care, home health care and blood.

Most people will not have to pay a monthly cost (premium) for Part A, because they or their spouse paid Medicare taxes while they were working. If you have not paid Medicare taxes through your employment you will have to pay a Medicare Part A premium. The Premium amounts are as follows:

  • You paid Medicare taxes for more than 7.5 years but less than 10 years (30 to 39 quarters, then your premium will be $254.00 per month.
  • You paid Medicare taxes for less than 7.5 years (less than 30 quarters), then your premium will be $461.00 per month.

Medicare Part B (Medical Insurance)

Medicare part B Medical Insurance

Medicare Part B (Medical Insurance)

Medicare Part B (Medical Insurance) helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B. You pay the Part B premium each month. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more. Your modified adjusted gross income is your taxable income plus your tax exempt interest income. Social Security will notify you if you have to pay more than the standard premium. If you have to pay a higher amount for your Part B premium and you disagree (even if you get Railroad Retirement Board benefits), call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

How to Get Part B:

  • If you get benefits from Social Security or the Railroad Retirement Board (RRB), in most cases you’ll automatically get Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, your Part B will start the first day of the prior month.
  • If you’re under 65 and disabled, you’ll automatically get Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You’ll get your Medicare card in the mail about 3 months before your 65th birthday or your 25th month of disability.
  • If you don’t want Part B, follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
  • If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease), you automatically get Part B the month your disability benefits begin.

What You Pay for Part B Services: Costs for Part B services depend on whether you have Original Medicare or are in a Medicare health plan. For some services, there are no costs, but you may have to pay for the doctor’s visit. If the Part B deductible applies, you must pay all costs until you meet the yearly Part B deductible before Medicare begins to pay its share. Then, after your deductible is met, you typically pay 20% of the Medicare-approved amount of the service. You can save money if you choose doctors or providers who accept assignment.

Medicare Part C (Medicare Advantage Plans)

Medicare Part C - Medicare Advantage Plans

Medicare Part C (Medicare Advantage Plans)

Medicare Part C (Medicare Advantage Plans) is a way to get Medicare benefits through private companies approved by and under contract with Medicare. It includes Part A, Part B, and usually other benefits Medicare doesn’t cover. Most plans also provide prescription drug coverage.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are health plans offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan provides all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Medicare Advantage plans always cover emergency and urgent care. Medicare Advantage Plans must cover all the services that Original Medicare covers, except hospice care. (Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan.)

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most plans also include Medicare prescription drug coverage.

Medicare Advantage Plans must follow rules set by Medicare. However, each plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

You usually pay one monthly premium to the Medicare Advantage plan, in addition to your Part B premium.

Different Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Medical Savings Account (MSA) Plans
  • Special Needs Plans (SNP)
  • Point of Service (POS) Plans (Similar to HMOs, but you may be able to get some services out-of-network for a higher cost).
  • Provider Sponsored Organizations (PSOs) (Plans run by a provider or group of providers. In a PSO, you usually get your health care from the providers who are part of the plan)
  • .

What You Pay in a Medicare Advantage Plan- Your out-of-pocket costs in a Medicare Advantage Plan depend on:

  • Whether the plan charges a monthly premium in addition to your Part B premium.
  • Whether the plan pays any of the monthly Part B premium. Some plans offer this option, usually for an extra cost.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service (copayments).
  • The type of health care services you need and how often you get them.
  • Whether you follow the plan’s rules, like using network providers.
  • Whether you need extra coverage and what the plan charges for it.
  • Whether the plan has a yearly limit on your out-of-pocket costs for all medical services.
  • How to Join a Medicare Advantage Plan: Not all Medicare Advantage Plans work the same way, so before you join, find out the plan’s rules, what your costs will be, and whether the plan will meet your needs.
    Contact the specific plans you’re interested in to get more information about their benefits and costs. Once you choose a plan, you may be able to join by completing a paper application, calling the plan, enrolling on the plan’s Web site. Get started comparing Medicare Advantage plans in your area.

    More about Medicare Advantage Plans:

    • As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
    • Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
    • You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
    • You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
    • You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.
    • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
    • If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.

Medicare Part D (Prescription Drug Coverage)

Medicare Part D - Prescription Drug Coverage

Medicare Part D (Prescription Drug Coverage)

Medicare Part D (Prescription Drug Coverage) is run by private companies approved by Medicare, which can either be Medicare Advantage Plans or separate Medicare Prescription Drug Plans. It helps cover the cost of prescription drugs. Each plan can vary in cost and drugs covered.

Medicare prescription drug coverage (Part D) is available to everyone with Medicare. To get Medicare drug coverage, you must join a Medicare drug plan. Plans vary in cost and drugs covered.

Two types of plans offer Medicare prescription drug coverage:

Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.

Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”

Who Can Get Medicare Drug Coverage?
To join a Medicare Prescription Drug Plan, you must have Medicare Part A and/or Part B. To get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B

How to Join a Medicare drug plan?
Once you choose a Medicare drug plan, you may be able to join by completing a paper application, calling the plan, enrolling on the plan’s Web site, or through the MPDPF LINK. You can also enroll by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Contact the specific plan you’re interested in to find out how to join. Medicare drug plans aren’t allowed to call you to enroll you in a plan. Call 1-800-MEDICARE to report a plan that does this.

Financial Strategies For Seniors

Financial Strategies for Seniors

Financial Strategies for Seniors

Financial Strategies for Seniors can show you how to reduce or eliminate taxes on Social Security benefits. When Franklin D Roosevelt first introduced Social Security back in 1935 he was constantly asked if Social Security benefits would ever be taxed. His answer was “NO!” What happened? FDR died and the promise died with him. In 1982 Congress passed a bill call the Omnibus Budget and Reconciliation Act which allowed congress to tax 50% of the Social Security benefits of an individual earning over $25,000 per year or a married couple earning over $32,000 per year. That worked so well that in 1992 Congress added another layer of taxes increasing the amount of Social Security benefits to be taxed to 85% for individuals earning over $28,000 and married couples earning over $44,000. How can you tell if Social Security benefits are being taxed? Look on IRS form 1040, line 17a and see what amount is taxed. Line 17b indicates the dollar amount in tax you paid on your Social Security benefit. Has your advisor caught this on your 1040? If not you are paying more taxes than you should be.

Your CD’s and Treasury Bonds are not paying you much and the market is too risky? As a senior you have worked hard all your life since you were 20 years old. The time to invest was when you were age 20 all the way up to age 60. You have seen the market surge and plunge over the years. The thought of a market plunge at this stage in your life would certainly make you lose some sleep. Could your investments come back? I do not have a time span to regain what I have
lost. I must start living on my savings but I only have 50 or 60% of what I had before the market bottomed out. You put your money in something “safe” like a Certificate of Deposit or a Treasury bond but only making 1 or 2% is not appealing. Is there an alternative? YES! How about a return that has a guaranteed minimum of 2% but yet can earn as high as 10% that is guaranteed never to lose your principle and it is safer than a CD?

Want to have access into a Nursing Home without Long Term Care or spending down all of your assets? Many seniors find themselves without Long Term Care that covers them in the event they need a nursing home because they do not qualify due to underwriting or for some reason never purchased coverage. What happens if and when you, your doctor and your family agree that you need more care, treatment and assistance than the family is able to give? What now? A nursing home costs on average from $60-85,000. You have some assets but your stay at home spouse has nothing to live on if the assets go to the nursing home. Hope is not lost. There is a way to have your assets go to your spouse rather than to the nursing home. Want some information?

Would you like to double or triple the amount of your IRA that you intend to leave to your heirs? If you have 4 children and you would like to leave them $25,000 each you will find that you have another heir…Uncle Sam! How will this work? At the death of the 2nd spouse your IRA is distributed to your 4 children. Taxes will be incurred on each child’s income tax bracket. If each child is taxed on the distribution at 30% each child would receive $17,500 and Uncle Sam would receive $30,000. Is this what you intended? If properly set up your children could receive as much as $50,000 to well over $100,000 after taxes.