Winder, GA Individual and Family Insurance Information

Winder, GA Individual Health Insurance Benefits
Click on the heading below to expand each topic. Here you will find info on Winder, GA Life Insurance, Winder, GA Health Insurance, Winder, GA Dental Insurance, Winder, GA Accident Insurance, Winder, GA Cancer Insurance, Winder, GA Critical Insurance Insurance, and Winder, GA Illness Insurance.
Within each category is detailed information about the services offered for each. Get all the information you need to make informed decisions about your insurance coverage.

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.

Life Insurance (Permanent VS Term)

Life Insurance Benefits

There are two main types of Life Insurance that are the most sought after – Term Life and Permanent Life Insurance

Winder, GA Term Life Insurance

Term Insurance Insurance is life insurance that is for a specified period of time typically between 10 and 30 years. If the insured outlives the period of time no payout is made. You can usually renew the period as long as you medically qualify up to an age of 70 – 80 years old. This is the least expensive type of life insurance which protects your family in the event of your premature death. If the wage earner is deceased, the family would loose the income that is generated by the wage earner(s) so a life insurance pay-out would off-set the lost income of the deceased. Proponants of Permanent Life Insurance would use the analagy that term life insurance is like renting verses owning a home. The family is protected by the term life insurance but you don’t get to keep it. If the insured survives the specified term the insurance disappears. The philosophy behind term life insurance is that when you are relatively young you tend to have young children, expenses, some debt and minimal savings. As you get older the idea is that you tend not to need life insurance because you should have less debt, the children will have grown and left the home and the family should theoretically has a good amount of savings. I repeat, IN THEORY the need for insurance is unnecessary. I have never met a beneficiary that complained that they received too much in life insurance proceeds.

Winder, GA Permanent Life Insurance

Permanent Life Insurance is life insurance that is created to last for the entire lifetime of the insured. It will be a higher premium but will allow you to have a number of options you could not get from any other financial instrument. One advantage is that when you pre-decease your beneficiaries you will leave them with a sum of money that in theory, they will not need but will be very grateful to have and it will allow them more options than if they had no life insurance proceeds. Another benefit is the tax advantages – not only does your cash value accumulate tax deferred but you can pull out the cash as tax free income in later years when you retire. Proponants of Term Life insurance would tell you that you will end up with more money at retirement age if you buy term and invest the difference rather than placing the same amount of money into a permanent life policy. On the surface this may be true, but if you take a close look you will find that premise to be false. When you calculate the tax advantages and the safety of the cash accumulation you will come out way ahead with permanent life insurance?

Health Insurance (HSA VS High Deductible VS Standard)

Individual Health Insurance Benefits

Winder, GA Traditional Co-pay Plan

Traditional Co-pay Plans will have an annual deductible ($1,000 to $5,000) which must be met before the major medical claims will be paid including, surgery, hospitalization, out-patient surgery or out-patient procedures. Once the deductible is met the insured and the insurance company will cost-share the next $5,000 to $15,000 at a typical rate of 80/20 (insurance company pays 80%, the insured pays 20%), 90/10 or 70/30. After the insured pays their portion of the cost-sharing the insurance company will pay 100% of the rest of the bill. January 1 resets the deductible and co-insurance amounts all over again. Doctor visits for sickness and prescription drugs will have a co-pay of $20 – $50, even up to $75. Sometimes a plan will have a separate drug deductible (typically from $200 – $1,000) that must be met before you can access drugs that have a co-pay. You will usually have 3 or 4 tiers of co-pay drugs, the 1st tier is the cheapest being generic drugs. Tier 2 are brand name or preferred drugs. Tier 3 is the non- formulary drugs that are not on an insurance company’s preferred list of drugs. Tier 4 would be the mail order drugs that you can buy 90days at a time. As of September 23, 2010, wellness visits such as physicals, mamograms, pap-smears and PSA screenings are free of charge to the insured.

Winder, GA High Deductible Plans

High Deductible Plans like the name would imply these plans have a high deductible anywhere from $2500 up to $10,000 or even higher. These plans suit people that have a sum of money set aside that they can use to pay for the high deductible if needed. Not only is this suited for people with savings but also those that are fairly healthy who rarely go to the doctor’s office. When they do go to the doctor’s office they pay the office visit out of pocket at a network discount. (All networks have a discount for their members). In order for a provider to be included in a health provider network, they agree in advance to see member patients of the network at a discount. This saves the insurance company money, it saves the member patients money and it also fills up the waiting room of doctors who are contracted with the network.) A typical example would be a patient going in to see a doctor for a sick visit. After the visit the patient shows the office worker their insurance card. When the insurance card is checked and the patient is verified that they indeed are a member of the network a standard charge is applied based on the code the doctor checks off on the billing. The charge for a non-member coming in off the street might be $125 for the visit, the contracted price that the doctor charges the network member might be $70. Of the $70 the insurance company may pay the doctor $35. The remaining $35 would be charged to the member and that would be applied to the deductible if the annual deductible has not been met.

Winder, GA HSA Plans

HSA Plans have become increasingly popluar since they were introduced in 2004. My belief is that these plans are best for the insurance carrier, the medical provider and the insured. The idea behind an HSA is that you are self-insuring for the small stuff like doctor visits and prescriptions and out-sourcing to the insurance company the large risks such as hospitalizations, surgery and out-patient procedures. HSA’s have 2 components: a Qualified High Deductible Health Plan and a savings account. You pay a premium to the insurance company for the health insurance (which is typically a lower premium than a traditional co-pay plan) and you contribute every month to your savings account with pre-tax money. The money in the savings account accumulates tax deferred and can only be used for medical expenses as listed by the Internal Revenue Code, Section 213 (d). This works very similar to a IRA; If you take you money out of the Savings account and use it for anything other than qualified medical expenses the IRS will impose a 10% penalty and you will pay taxes as ordinary income on the monies used. At age 65 you can draw money out for any purpose without penalty or taxation. When using the money in the savings account you will exercise more prudence with the funds because that’s your money. For example, if you need an MRI you may have several to choose from. Some MRI machines are state of the art and some while just as capable will cost less. If you have a choice between a state of the art MRI machine that costs $3,000 for a scan or another imaging center may have a regularMRI machine and only charge $1,000. What would you choose when you are spending YOUR money? Maybe the $3,000 MRI but it is a choice you get to make.

Dental Insurance Plans (Traditional VS Discount)

Dental Insurance Benefits

Winder, GA Dental Insurance Plans

Before I explain the difference between the two I want to paint a picture for you. If you were to work for a large company, say 5,000 employees and dental insurance was offered to every employe and their family how many would use the dental insurance. All 5,000? How about 3,000? Try 1,500. That means that 3,500 employees and their families are not using the dental insurance and yet the premiums are paid every month. Do you think that is a good deal for the insurance company? You bet! They are getting premiums from 5,000 employees and their families and yet less than 1/3 are using the benefit. Now let’s take one individual or one family who wants dental coverage. They contact the insurance company that offers dental coverage. Do you think that the insurance company believes that this family or individual are going to really use the dental benefits? Of course they are. They would not have contacted the insurance company in the first place, right? Do you think that the insurance company is going to give them a great deal on dental insurance. Now then, lets talk about each one seperately.

Winder, GA Dental Insurance Plans

Dental Insurance Plans have a deductible of $50 or $100 and a maximum annual limit of $1,000 to $1,500 per person per year. Typically most carriers break down dental coverage into three categories; Preventive, Basic and Restorative. Preventive covers costs for your annual/semi-annual check-ups. This will include x-rays and a cleaning. Preventive care is an immediate benefit meaning you can get the coverage on day one and go to the dentist on day two for a preventive care visit.

There is no waiting period and the carrier pays 100% of the cost. Basic care is considered as basic fillings. There are some companies that have no waiting period and some that do, usually 90 to 180 days and the carrier will pay 80% of the cost.

Restorative coverage is usually dental work such as root canals, bridges, crowns and dentures. The carrier will typically pay 50% of the costs and there is usually a waiting period of 12 months or more. Orthodontia coverage is usually sold as a separate option and is usually reserved for patients who are children and teens.

The Orthodontia benefit will usually be paid by the carrier at only 25-50%.

Winder, GA Dental Discount Plans

Dental Discount Plans have several advantages over dental insurance. The coverage is good from day one with no waiting periods. There are no annual limits on the usage of your plan unlike the $1,000 to $1,500 annual limits on dental insurance plans.

You can also receive big discounts for Cosmetic Dentistry such as teeth whitening, bonding and veneers. Even if you already have dental insurance you can use your dental discount plan for even more savings after maxing out your annual limits on the dental insurance.

Disability Insurance (Long Term VS Short Term)

Disability Insurance Benefits

Winder, GA Disability Insurance

Disability Insurance is need by just as many people who need life insurance. Disability insurance is designed to insure your income. If the breadwinner cannot produce an income in the event of a disability the standard of living the family is accustomed to will be drastically affected. While a death in the family is certainly a tragic event, a disabled breadwinner will have more needs than they had previously when they were producing an income due to medical costs and custodial care. A family member may need to stay at home with the disabled breadwinner preventing a secondary source of income. Disability insurance can be sub-divided into long and short term disability insurance.

Winder, GA Long Term Disability Insurance

Long Term Disability Insurance insures the breadwinners income for longer than 6 months up to a maximum of up to age 65. The maximum amount of disability income someone will be eligible for is up to 70% of their present income. Proof of income will be required with tax returns before a policy is issued. Underwriting can be quite strict so if you can qualify it would be a great idea to get some.

Winder, GA Short Term Disability Insurance

Short Term Disability Insurance will begin from the time the insured is disabled on day one or even up to two weeks. The payout is usually for 13 to 26 weeks. As with Long Term Disability the maximum an insured can receive due to a disability is 60-70%. Short Term Disability is sometimes considered an unwise expense because you can self-insure for the short term by saving 3 to 6 months of income in case you become disabled. However, if this is not possible I can certainly help you get short term disability.

Winder, GA Disability Insurance Terms You Should Know

1. Waiting Period or Elimination Period. Time from when someone has a disability until the time a payout is received. For STD insurance the waiting period is usually 0, 7 or 14 days. For LTD the waiting period would be 90, 180 or 360 days before a monthly payout is received.

2. Own Occupation (Own Occ). If disability occurs the insured may be able to work at another position as defined by the insurance carrier. If so they would not be considered 100 % disabled but rather partially disabled. The amount of payout would be adjusted to offset the income earned by the secondary occupation. Own Occ is considered to be a feature that is most desirable which obviously makes it more expensive.

3. Benefit Period. Period of time that an insured receives a payout. For STD disability the benefit period is usually 13, 26 or 52 weeks. For LTD insurance the benefit period can be 2, 5, and 10 years or up to age 65.

4. Cost of Living Allowance (COLA). Increases the monthly payout as a percentage usually 3%, 5% or Consumer Price Index (CPI).

5. Insurability Purchase. An option for the insured for an increased premium to have the right to purchase additional disability insurance in the future for pre-specified limits at the future cost without having to go through medical underwriting.

6. Social Security Income (SSI) provision. Social Security pays a disability benefit without regard to whether or not the individual has private disability coverage. If the insured receives a Social Security disability payout the private carrier off-sets the total disability payout with the amount that Social Security pays.

Accidental Insurance

Accidental Insurance Benefits

Winder, GA Accidental Insurance

Accident Insurance is coverage that pays out only in the event of an accident and is paid out to the insured and not the hospital, clinic or doctor. AI pays out an amount up to a pre-determined maximum. AI is a great compliment to health insurance that has a high deductible. The premium savings on a high deductible plan can allow you to purchase an Accident plan that will reduce your risk exposure while saving you on overall monthly premium costs.

Cancer Insurance

Cancer Insurance Benefits

Winder, GA Cancer Insurance

Cancer Insurance pays out in the event of diagnosis of cancer. An attractive feature of cancer insurance is that there is only one underwriting question and that is, have you ever had cancer? If the answer is no you can get cancer insurance no matter how prevalent it is in your family. One in three women and one in two men will be diagnosed with cancer during their life time.

Critical Illness Insurance

Critical Illness Insurance Benefits

Winder, GA Critical Illness Insurance

Critical Illness Insurance is similar to cancer insurance and includes cancer as a claim to benefit but also includes other illnesses like heart attack, coronary bypass surgery, loss of limbs, terminal illness, heart valve replacement, stroke, major organ transplant, paralysis, Alzheimers Disease and major burns. The benefit is paid directly to the insured. CI insurance, like accident and cancer insurance compliments health insurance as well.

Travel Insurance

Travel Insurance Benefits

Winder, GA Travel Insurance

Travel Health Insurance is something most people don’t realize they need. Many do not realize that most health insurance carriers do not cover most of the health care expenses that might be needed while traveling overseas. Travelers health insurance is very inexpensive. A 35 year old male could have a one-time premium of $15 – $25 that would give you health care if needed while overseas.


Winder, GA Employee Benefits and Insurance Information

Employee and Group Health Insurance Benefits
Click on the heading below to expand each topic. Here you will find info on Life Insurance, Health Insurance, Dental Insurance, Accident Insurance, Cancer Insurance, Critical Insurance Insurance, and Illness Insurance.
Within each category is detailed information about the services offered for each. Get all the information you need to make informed decisions about your insurance coverage.

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.

Group Health Insurance

Group Health Insurance Benefits

Winder, GA Group Health Insurance

Group health insurance is simply health insurance offered by an employer with the main purpose of attracting and retaining good employees. 70% of Americans receive their health insurance through their employer. The idea of employer sponsored health care is a concept whose time has passed and is going to be obsolete in the next 5 to 10 years in my opinion. Group health insurance comes in many forms from self-insured plans as well as HMO, POS, PPO and indemnity plans. While somewhat larger companies (over 1,000 employees) will find true group coverage still viable, smaller companies under 100 employees will find a better solution.

Self Funded Plans

Self Funded Health Insurance Plans

Winder, GA Self–Funded Plans

Self–Funded Plans is self-funded health care provided by larger employers that medically insure their employees with its own funds. The employer takes on the risk for the health care of the employees. Most employer’s contract stop loss coverage from a carrier that covers in the event of a catastrophic loss thereby easing the overall financial risk for the employer. The employer does not pay premiums to an insurance carrier (except of course for the stop loss coverage) but instead simply pays the medical expenses for the employee as the expenses is incurred. Obviously, if the employee has no medical expenses the company saves money.

Fully Funded Plans

Fully Funded Insurance Plans

Winder, GA Fully Funded Plans

Fully Funded Plans is the traditional arrangement in which an employer contracts with an insurance carrier and for a premium the carrier will provide health care for the employee. Fully funded plans can be an HMO, POS, PPO or indemnity plans.

HMO (Health Maintenance Organization)

HMO Insurance Benefits

Winder, GA HMO (Health Maintenance Organization)

HMO (Health Maintenance Organization) is a specific type of health care plan which sets out guidelines under which doctors can operate. Typically, health care coverage through the use of an HMO is less expensive than comparable justified by the restrictions and price controls which limits the range of treatments available. An HMO does this by contracting with various providers of health care and dealing with large quantities of patients, the HMO is able to negotiate for discounted rates than the patient coming off the street would receive. Also, the HMO eliminates treatments that are unnecessary according to the HMO and rather focuses on preventative health care with the goal of achieving good long-term health of their members.

A member chooses a primary care physician when becoming part of an HMO. This primary care doctor determines what treatments the patient does and does not need. If the primary care doctor decides that the patient needs additional care beyond what they can do they refer to a specialist that can address the member’s needs.

POS Plans (Point Of Service)

POS Health Insurance Benefits

Winder, GA POS (Point of Service)

POS (Point of Service) is a type of managed health insurance plan that offers more choices than an HMO (which does not cover expenses outside the network or HMO.) POS members may seek care from in-network doctors, starting with a personal physician or out-of network providers for a higher cost. A POS plan is considered a combination of an HMO and a PPO (Preferred Provider Organization) plan. It has some of the price controls an HMO has (like going through your primary care physician before seeing a specialist.) It also offers some choice that a PPO has like the ability to go outside of the network. POS healthcare uses a network of preferred providers which patients must turn to first, receiving referrals to other providers if it is deemed necessary. Managed care ensures that patients get the medical attention they need, as long as they follow the system dictated by the insurance company.

PPO Plans (Preferred Provider Organization)

PPO Insurance Benefits

Winder, GA PPO (Preferred Provider Organization)

PPO (Preferred Provider Organization) is a type of managed-care system in which health care providers, such as doctors and hospitals, have made an agreement with the insurance companies to offer discounted fees to the members. The health insurance company gets a discount from the provider, which is passed along to the member, and in return the provider gets a much larger group of patients coming through the door.

The biggest advantage of a PPO is the amount of freedom they offer. Unlike other managed health care organizations, a PPO does not require you to maintain a primary care physician nor does it require you to use your primary care physician as a gatekeeper. This means that you can seek care from a specialist without first getting a referral. Also, you have the freedom to choose care from a provider outside of the provider network should you need it — the expenses can be substantially higher, but you at least have the option to choose any doctor or hospital you like.

Groups Less Than 50

Group Insurance Benefits for Less Than 50 Employees

Winder, GA Groups Less Than 50

The Problem With Groups Less Than 50:

1) The first insurance principal that insurance students learn is the law of large numbers. A group of 5,000 employees has a large number to avoid an adverse selection, which is to avoid an abnormal population of employees with health risks. Take a group of 10 employees. If one or two employees have a health risk such as obesity, diabetes, cancer or heart bypass surgery the premium will increase dramatically and the remaining healthy employees will bear the burden of increased costs because of the claims of the unhealthy employees.

2) When an employee is terminated, the employer is held accountable for the administration of the continued health care that the terminated employee is entitled to through HIPAA legislation. This is bad for both employer and the terminated employee. The employer must be in compliance with cobra or state continuation depending on the size of the company. The terminated employee must then pay the ex-employer from 100-102% of the premium. The new increased health premium due to cobra for the terminated employee becomes more burdensome because before termination the employee had the health premium subsidized by the employer in most cases, by at least 50% or more. The ex-employee is now without a job and finds their health coverage double in cost. In the search for new employment finding an employer that sponsors a group health plan is crucial and even more difficult to do these days. Many employers are dropping their employer sponsored health care altogether.

3) A common strategy for employers to save on costs is to have their broker shop the market for a new health insurance carrier that can compete with the rising costs of the current carrier. If a switch is made, the employer must explain to employees (and sometimes their dependents) why the female employees and dependents must find a new Gynecologist because the current doctor is not in the network. Other problems often occur by switching plans which can stir up grumbling and dissention between employees and the employer. The employer is paying a huge sum for employer sponsored health care and in addition is subsidizing the costs for the employees…and now they are grumbling because the employer is just trying to save on expenses by considering an alternative low cost plan/carrier. In the words of Dr. Phil, “how’s it working for you?”

4) Why do you want to be in the insurance business? The whole system of employer sponsored health care revolves around the employer. The employer went into business doing whatever it is that they do because they saw an open door of opportunity. They went into business because they enjoy manufacturing those widgets they love or servicing those thing-a-ma-gigs they lovingly made. Why then do you allow your employer sponsored health plan take up more and more of your time, energy and profits? If you still like your group health plan we can help you…yes, we still do them representing Blue Cross Blue Shield, Aetna, United HealthCare, Humana and others. But if you would like to “get out of the insurance business,” save on costs and still retain great benefits that your employees manage giving them more options and most importantly controlling their own health care…call us NOW!

5) Costs are astronomical! Health insurance is a crisis for employers, as well as individuals. Since 2005, General Motors has added $1,500.00 to the cost of every car it sells in order to cover the cost of health insurance for their employees. The cost of health benefits now exceeds profits for most Fortune 500 companies.

6) With more and more employees seeking coverage elsewhere, many employers are faced with participation requirements.

Cafeteria Plans

Cafeteria Insurance Benefits

Winder, GA Cafeteria Plans

Cafeteria Plans One of the most underrated and underused employee benefits available for small businesses today is outlined in section 125 of the U.S. tax code. A section 125 or “cafeteria” plan allows employees to withhold a portion of their pre-tax salary to cover certain medical or child-care expenses. Because these benefits are free from federal and state income taxes, an employee’s taxable income is reduced, which increases the percentage of their take-home pay. And because the pre-tax benefits aren’t subject to federal social security withholding taxes, employers win by not having to pay FICA–or workers’ comp premiums–on those dollars. With so many advantages, why is the plan underused? The most likely reason is that these plans don’t generate a lot of profit for benefit administration companies, and with little profits to earn, only minimal advertising is being done. That means many people are unaware the plan even exists. But utilizing the tax code for your business can be an incredible way to enhance your employee benefits package, while simultaneously boosting your margins.

There is recent legislation regarding Cafeteria Plans. Until recently, only group benefits were used in conjunction with Cafeteria Plans, but now they can be used with individual benefits. Why is this so significant? Employers can now use these plans to save money for their employees, save money for themselves and provide better benefits with none of the hassle.


Winder, GA 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

Winder, GA 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

Winder, GA 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

Winder, GA 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.
    • 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.
  • 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:

Medicare Part D (Prescription Drug Coverage)

Medicare Part D - Prescription Drug Coverage

Winder, GA 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

Winder, GA 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.