Medigap Insurance, also called Medicare Supplemental Insurance was designed to cover expenses that are not covered by Medicare.

There are lots of questions by individuals on Medicare about what it covers and how it is covered.  In addition, in light of recent issues in Congress trying to sort out the Medicare situation, people are quite confused about coverage.

Medigap insurance is supposed to keep you out of trouble by paying those things that might otherwise come out of your pocket.  Some of those expenses include skilled nursing care and hospital deductibles, co payments and other charges, such as extended stays in hospitals after the Medicare stops paying because coverage stops.

There are also some gaps when it comes to other products and services for outpatient care including doctors , certain medical devices and some treatments that are partially covered or not covered by basic Medicare benefits.

This is where the gaps are and where Medigap insurance comes in.
This is also where it is important for you to research which coverage will be the best for your situation and which company offers the most competitive rates.  Many insurance companies overcharge or charge more for the exact same coverage that you can get from other companies, so it is very important that you compare well.

There are also programs available to help with premiums and other payments in the event that you qualify as far as income limits and finances.  If you are on a limited income, you might qualify.

To ask questions or get accurate information, you can call 1-800-MEDICARE or go online to research the Medicare website at either www.Medicare.gov or www.cms.gov.

Things are tough all over.  They are toughest on individuals with low incomes and fixed incomes, especially seniors.  When you consider the cost of the basics, it becomes very difficult for seniors to afford much more.  Medicine – or even a movie – has become a luxury.  This is a dilemma in the U.S. because too many elderly who believed in the American dream and the American way and worked hard, sometimes waiting to retire, are the very individuals having issues with Medicare. 

The unfortunate thing is that the plans that the most seniors are using for Prescription Drug Coverage have raised their premiums approximately 16% over the past year.  At the same time premiums for Medicare Part B, which covers doctor’s visits has only risen an average of 3%.

Seniors are the largest and possibly the most important group of voters in the country, so it seems interesting that there has not been more said about them in the campaigns, however; the rise in prescription costs will hopefully push Congress to engage in stronger negotiations and Democrats to create stronger proposals to create a situation where Medicare and the pharmaceutical industry sit down and negotiate prices until they come to a win-win situation for all – especially seniors.

Medicare officials feel certain that seniors can shop around for better deals and better coverage during open enrollment season from November 15th to December 31st later this year.  Seniors are encouraged to begin looking in advance and get help from individuals they know will be unbiased about what company they choose and more concerned with the best coverage.

For questions and information, seniors can go to www.medicare.gov  or www.senioreducators.com

Many older Americans are enrolled in Medicare and have chosen the Medicare Advantage Plan as a supplement in order for them to be able to go to their own doctors.  It is estimated that about 20% of Medicare recipients are enrolled in Medicare Advantage, and an organization named the Public Insight Network is working to find out your opinions of the Medicare Advantage plan.

Public Insight Network is affiliated with Minnesota Public Radio, one of the most respected public radio organizations in the country.  They are working together with Public Insight Network to find out what experience individuals that are enrolled in Medicare Advantage are having. 

This is an opportunity for you to let them know what you like and what you don’t like about the plan.  You can also let them know why you signed up – what are the services that made you feel that this would be the right plan for you.

The information you give will be used to help others – and Medicare Advantage – get the information to keep the plan doing well in areas where enrollees already like it and make changes in the plan where possible in areas where enrollees are unhappy with the coverage, products or services.

The site is designed for individuals and their families who are enrolled in the plan or who have considered it.  In addition, Insurance Agents can use the site to give their opinions and feedback from their clients.

If you are interested in giving your opinion, you can find the information on the Minnesota Public Radio website at www.publicradio.org/public_insight_network
Or you can simply go to the website at www.publicradio.org and look for the Public Insight Network section.  All information about the Medicare Advantage opinion collection is included on the page, included that guarantees that no personal information will be shared.

If you have opinions about your Medicare Advantage Plans, you now have the opportunity to voice them.  Take the time to look at the website and decide if you would like to share information that can help you or others. 

There have been stories, one after the other, of seniors who have Medicare Part D prescription coverage, but are running into terrible financial issues once they hit the threshold where they end up having to pay over $3,200 in self-absorbed prescription charges.

I read a story about a man who is over 90 years old, worked hard, is simply trying to survive, and hit the point where he has to start paying for expensive prescriptions while continuing to keep up with his Part D premiums. 

With prescription prices at an all-time high, and many seniors on specialized medication that does not include generics yet, Imagine having to pay $3200 – even divided into a monthly payment (which is not always possible for certain medications), the monthly amount would be about $270 extra dollars per month!  That’s quite staggering to a senior on a minimal income.  When you think of a senior on Social Security and little else, their income may be an average of $800 per month.  After rent, Part D premiums, food and utilities without any frills, that should totally obliterate the $800, even without the advent of the extra $270 for unpaid for medication.

Congress has designed the Part D plan with a whole in it that needs to be filled.  It is essential that the next Congress looks at this situation and deals with it in a way that affords our oldest and most vulnerable citizens who have usually worked hard all their lives, supposedly ensuring that their benefits would be waiting for them. Unfortunately, with this donut hole to fill the security they were relying upon is not really there.

We need to take a hard look at a solution to filling the donut hole so seniors can enjoy the dignity of life they deserve

There has been much discussion about low income individuals having to choose between their prescriptions and food, often taking lower doses of the prescription drugs, thus allowing their health conditions to get worse.

There is – and has been – a remedy for the situation, only few doctors or Medicare recipients knew about it.  The remedy is a State Government Subsidy backed by the federal government for low-income patients who are usually the poorest ones.

There were focus groups conducted that included doctors, pharmacists and Medicare beneficiaries in an effort to find out what low income beneficiaries needed the most.  It turns out that more pharmacists knew about this assistance than doctors or Medicare enrollees.

The assistance either pays some or all of Medicare Part D drug coverage, depending on the individual’s income.  This enables individuals to get the medications that they need even if they are unable to afford to pay the part D premiums. 

The program is also making an effort to make physicians aware of ways to help their patients – especially by asking every patient if they can afford their medications and coming up with effective and efficient solutions if the patients cannot.

There are places you can go to find information on whether you qualify and how to apply for the program.  AARP (AARP. Org) has a program that will help you determine what programs – including this particular low-income program – will be able to accept and assist you.

The American Medical Association also has information at www.accesstobenefits.org. 

In addition, AARP and other organizations are pushing to raise the asset limit so that those who are struggling to afford their prescriptions and qualify for this particular program and any others available, will not have to lose everything and spend every cent they have just to get medicine.

It is no secret that there are many Medicare beneficiaries who have very low incomes and cannot afford prescriptions, nor can they afford the coverage that would pay for them.

The Center for Medicare and Medicaid Services (CMS) is aware of this and is being proactive in trying to deal with the issue.

CMS has launched a $12 million outreach program to reach low income Medicare recipients and help them enroll in the prescription drug assistance program.  The outreach program will continue through July of this year and target specific areas. 

Part of the program will include an evaluation of what types of marketing and outreach work the best in reaching the low-income population that is eligible for the program and could use the assistance. 

$7.5 million in federal funds will be given to state health insurance programs to run the program and conduct the majority of the outreach., which will be conducted through the use of mailers, phone messages, cold calls from experts, as well as radio and TV spots.  CMS will evaluate which types of outreach work the best.

The outreach program will allow low income individuals to enroll in the drug program at any time. 

In addition to the outreach program, various senators, including the Senate Finance Committee Chair, Max Baucus, a Democratic Senator from Montana, are working on legislation that will delay the 10.6% payment cut to physicians that Medicare has been working to pass through the current administration.  Baucus is also working on a provision that would change the asset limits for the drug benefit for low-income recipients.  As it stands, one cannot qualify or current beneficiaries can lose their benefits if they have very much in the way of assets.

There are many questions about what Medigap or supplemental insurance covers and why it is necessary.  With so much information around, it can be a confusing subject. 

There are some definite and basic areas that are important gaps in coverage and that Medigap/supplemental insurance can cover.  Some of these areas are hospital deductibles.  For example, though Medicare Part A covers hospital stays, skilled nursing home stays, home health and hospice services, there are areas that are not covered, such as hospital deductibles, co-payments, so-insurance, payments for stays beyond 150 days, skilled nursing facility co-payments, home health services which are more than part time, skilled nursing facility stays of over 100 days, and more.

These are gaps that need to be covered by some sort of supplemental plan. There are various plans available and it is important to explore what plans are available and the prices that are charged, plus what the plans cover.

There are also gaps for Part B (Supplemental Medicare Insurance) also has some gaps.  Part B covers outpatient care, such as physicians, medical devices and prosthetic devices.  There are deductibles, co-insurance and co-payments and payments for portions of treatments or devices that are not totally covered.  These are items that can be covered by a Medigap plan.

There are also various plans called Qualified Medicare Beneficiary plans (QMB) that some people qualify for.  QMB covers Medicare premiums, co-insurance and deductibles, as long as the individuals qualify financially or the coverage.

There are policies from B through L and they cover various things.  It is important to research on the Medicare website www.Medicare.com, www.cms.com or can call 1-800-MEDICARE to get specific information on each plan to get help determining what pans would work best for them.

There are many options available to make sure you are covered the best way possible.  It is important to research all plans and decide what plan you need.

We continue to hear more and more about unethical sales people pressuring Medicare recipients to purchase various Medicare supplemental policies that offer more coverage or different coverage for prescriptions and other products and services.  Throughout the country, Medicare recipients are getting calls from people trying to get them to buy additional coverage, drop their current coverage and change to new coverage and other such attempts.

In some cases these calls are legitimate and can be helpful, however, in too many cases the pressure tactics are extremely uncomfortable for individuals trying to determine the best coverage.  In addition, often the advice is not good advice.  It is not always the best idea to change policies or supplements and it is definitely not a good idea to consider making changes in coverage without consulting with individuals who have accurate information and without getting some information from the individual trying to get you to change.  It is important to try and get a name, phone number, company name, license number and mailed/written information from the individual trying to get you to change supplements.  If they are unwilling to give you any or all of this information, something is wrong.  Legitimate sales people and agents are almost always willing to provide information so that you will feel comfortable with them and with any choices they try to get you to make.

Congress will soon be working on ways to create uniform regulations that will protect Medicare recipients and make insurance companies who sell supplemental policies tow the line.  Once this process takes place it will make it more difficult for people trying to take advantage of Medicare recipients.  This may take some time to create and implement these protective measures, but states are working on the problem and trying to determine ways to keep Medicare recipients safe from predators and leave them with peace of mind.

Let’s say that you are a retiree whose old employer has just dropped your prescription coverage and you hastily enrolled in a Medicare HMO thinking that you would be well covered.  Now you have many doubts.  How do you determine if you made a wise choice in your Medicare HMO coverage?

This is a question that many people are asking these days and have been asking as they have experienced this type of change in their medical coverage.  It is important to look into the HMO – hopefully before you enroll – to see how much coverage you have and how and where it covers you.  For instance, many HMOs only cover you close to home, particularly in nearby counties, or within your state, except for emergencies.

Usually your HMO will cover what your old policy covered, but not always. If you are not sure about this, there are places to ask questions.  First of all, you can always get in touch with the Centers for Medicaid and Medicare Services (CMS).  They have information on plans being offered, as well as comparisons of coverage.  You can also contact an organization called SHINE – Serving Health Insurance Needs of Elders, a program of trained volunteers working in the state of Florida Department of Elder Affairs and other agencies on aging. 

These volunteers are qualified to give information about Medicare health pan choices, eligibility, enrollment and coverage; supplemental (Medigap) insurance and the issues attached to it, appeal rights, long term care and prescription assistance, including Medicare prescription plans.

Having informed and trained individuals to talk to about benefits that can protect your income and assets, as well as your health, is a very important and vital opportunity.  If an individual can make informed choices and feel comfortable with those choices, it is essential, and it will help people put themselves into a position where it is easier to stay healthy because they understand – and can access – services they are entitled to. 

Most states have some type of organization providing information.  To get the contact information, contact CMS at 1-800-MEDICARE, AARP, or call SHINE in Florida at 1-800-262-2243 or 1-800-963-5337.  Get the accurate information yu need to make the choices that are necessary.

Medicare Part D covers prescription drugs.  The coverage can be purchased through many companies and are difficult and confusing to sort out for many seniors.  Overall costs are supposed to – and often do – lower overall costs and give you better coverage, but your retail prescription expenses must be up to $2,250 per year, and you need to be sure that the plan covers the actual medication you take.

It is important to research Medicare part D.  You can do so by talking to several insurance agents.  Be sure to find honest agents that you can trust, perhaps by getting referrals from friends, family and neighbors.    Don’t just talk with one agent, talk to a few, and take notes.  Make sure they give you quotes and information in writing.  If you don’t feel comfortable meeting alone, bring someone you trust with you.

Depending on how much you usually spend on prescriptions each year, you could save hundreds of dollars with a Medicare drug plan that fits your situation.
Medicare Part D can save you money.  The premiums are usually reasonable and cost from $12 to $30 and can save you a lot.  If your medicine costs over the year are above $2,250, you probably need to purchase a more expensive plan that will cover more of the costs associated with your prescriptions.

One way to figure out your annual drug costs is to talk to your pharmacist  Not only can your pharmacist tell you how much you have spent on prescriptions, he or she can also tell you which plans seem to pay the best, quickest and most reliable.  Once you have paid the $2,250 you are considered in the “donut hole” where your coverage for part D ends for all intents and purposes.  At that point you continue paying premiums, but the coverage for part D is on hold until you reach the catastrophic amount of $5,100 worth of qualified part D charges.  It is essential that you compare plans well.  Make sure you check premium prices.  Part D is part D.  It is the same coverage whether you pay $15 per month or $45 per month, so comparison shop.

If you have questions, look at the information on www.medicare.com or check the AARP website, which has a great comparison chart.

Medicare has gotten more and more complicated than it was a few years ago. There are some things that are covered better, but the costs can be staggering.  A lot of Medicare recipients are confused and overwhelmed and trying to determine what combination of plans are the best for their circumstances.

For instance, it is extremely important to find out what your supplemental premiums will be if you move – especially to another state.  There have been many Medicare recipients who have not considered their coverage a factor when moving.  As a result, there have been situation where individuals covered in one state and paying about $1200 annually, moved to another state and had to pay two to three times their previous premiums for the same exact coverage with the same exact insurance company.

It is essential to make these comparisons.  It would be difficult to get information and talk to experts before you purchase, rent or lease someplace new to live in a different state from where you live. 

Some of the factors that create the difference are included in the demographics of the area.  In areas with a large amount of senior citizens, premiums will be higher because statistics show that there are more medical issues, expenses and claims in an area like this.  In an area that is home to a majority of younger people, who offset medical expenses of older individuals, premiums would be lower because there are usually less medical expenses and claims, due to better health and less medical issues.  

In the event that you are considering a major move – perhaps to find a great place to retire – be certain to check your Medicare Supplement premiums and other medical coverage and expenses first.  If you have questions regarding any of these issues, contact www.medicare.gov or call 1-800-MEDICARE to get your questions answered.

Moving is always a huge life event.  It can be very stressful.  You can eliminate some of the stress by researching your coverage and your premiums in advance.

When we think of retirement, we often think of slowing down, taking it easy, traveling and having time for our gardens and out grandchildren.  This is something lovely to look forward to, but in order to achieve this picture or whatever the particular, personal picture you have in your mind, it is important to prepare in advance.
We include many things in our plans for retirement, such as savings accounts, life insurance, investments and other important assets.  However, many of us have not thought of the role that our health and out health care costs will play in our retirement.

It is critical that we factor in health care expenses, as they could drastically change what our retirement picture actually looks like.  It is true that Medicare is available, however to plan for the long-term we will need more than that.  We will need to supplement our basic Medicare benefits so that we can pay for health care expenses that Medicare does not cover.

For instance, in the event that you needed long term care or an operation that was considered major surgery or a short (or longer) stay in a nursing home, how much would it cost us out-of-pocket and out of our retirement dream?  It is hard to come up with specific figures, since medical costs continue to rise and there seems to be no end in sight.

Since we cannot actually calculate the cost, there is still something we can do to prepare, especially while we are still working and at least somewhat healthy.  Even if we have stopped working and are beginning or in the middle of retirement, there are still things we can do to offset the financial impact of an unforeseen accident, illness or hospital stay.  The sooner we look into this, the better.

There are excellent Medicare Supplement policies  on the market.  There are many to choose from and various companies that you can purchase them through.  It is important to investigate Long Term Care policies and Medicare Supplements – especially Part D, which covers prescriptions initially up to $2,500 – are important to compare.  Look at annuities, which can often be used to offset health care expenses.  Even one small annuity can help..

It is never too late to start, and it is essential to at least ask some questions and do some research.  It is estimated that the average retiree will spend between $150,000 and $250,000 in medical and health-related expenses, yet most people at pre-retirement have saved up less than $25,000.

Whether you are already retired, getting ready to retire, or you are still working with a few years to go, start gathering information and using it to plan.  You can begin by going to legitimate web sites, such as www.medicare.gov , www.medicaid.gov , www.ssa.gov , www.cms.gov , and the AARP website at www.AARP.org . 

Don’t be caught off guard.  Start exploring options and asking questions now.  Be prepared for your retirement so that the retirement you picture becomes a reality.

Last week we discussed some new rules to help protect Medicare recipients from being pressured and/or cheated when it comes to signing up for coverage in addition to their basic Medicare coverage.  We mentioned that there are some new rules that have been put in place to stop the practice of preying on vulnerable seniors.  At that time we explained that sales people and agents could no longer cold call, nor could they drop by or hang around at clinics and doctors’ offices to try to get people to sign up for additional benefits.

There is more protection as well.  Not only have unsolicited calls been banned, so have door-to-door visits.   Agents cannot camp out in parking lots of assisted living centers, hospitals and nursing homes.   Also, there is a limit of $15 on any gifts that agents or sales people can give potential clients.  They can no longer take potential clients out to expensive meals or treat them to other expensive gifts.  

One of the tougher restrictions on agents and sales people who would try to pressure individuals into signing up for coverage just so that the agent can make a quick commission is a change in the way that the commissions will be paid.  No longer will it be easy for these insurance people to switch Medicare recipients from policy to policy each year just to get a nice commission, even if the coverage is not best for the individual.  New rules will go into effect later this year with restrictions.  This is extremely important because commissions usually average between $300 and $500 per policy, which is a large incentive for unscrupulous agents.

As we have noted, it can be very difficult for elderly individuals to compare the many combinations of policies and coverage available.  In addition, these unethical agents target the poor, just to make a quick commission, without regard to which coverage is best for them.

Congress is trying to continue making it more difficult for dishonest agents to take advantage of unsuspecting Medicare recipients.  The states are also trying to become more involved in investigating extreme cases of abuse. 

If you are a Medicare recipient and you feel you have been targeted by a dishonest agent or you have bought a policy that does not meet your needs without realizing it, contact 1-800-MEDICARE or www.CMS.com or
www.MEDICARE.com ,  

If you are a federal retiree and a Medicare recipient, you may be confused, you may be paying too much and you may be due some refunds.  The Federal Government knows this and they have sent a letter to the Center for Medicare and Medicaid Services (CMS) and to the Office of Personnel Management (OPM) telling them both that since they have not coordinated with one another, you may have overpaid and they may have to pay you back.

The letter asked CMS and OPM to provide information on the number of federal retirees enrolled in FEHBP and the Medicare prescription drug benefit.  The letter also asks for information regarding which plans each retiree is enrolled in along with an analysis of how much it has cost for duplicate coverage for both the retirees and the federal government.  This will be a big job and a large sum of money.  The letter was written by the House Oversight and Government Reform Committee headed by Henry Waxman (D-Calif.) and Representative Danny Davis (D-IL.). 

The letter stated that more than 200,000 federal retirees enrolled in both the Federal Employees Health Benefits Program and Medicare, the Medicare Part D coverage is duplicate coverage and is unnecessary.  The letter continues by saying that this has resulted in over $60 million in overcharges paid by the retirees plus over $140 million in subsidies paid by taxpayers.  This $200 million combined because excessive profits received by the private insurers that direct the drug plans.

CMS has begun to look into the situation according to the information in the letter and their spokesman has stated that they will respond to the lawmakers on the committee directly, rather than make any statements prematurely.

If you are a federal retiree and think that you might be in this situation, feel free to contact Medicare online at www.Medicare.gov , www.cms.gov , or call them at
1-800-MEDICARE for further information.

If you are a Medicare recipient, there are various supplemental plans available to you that are supposed to help pay for things that basic Medicare coverage doesn’t pay for, such as prescriptions and certain medical procedures. 

Even the basic Medicare can be very confusing, but when you start factoring in all the supplemental coverage, it can be even much more confusing.  On top of that, there are a great many agents and salespeople trying to sell you more coverage.  This can be extremely confusing, and some of these individuals who are selling supplemental insurance are not necessarily honest and they only have their best interests at heart – not yours.

Chances are that you have received lots of mail and phone calls from people trying to sell you more coverage.  They might try to “sweet-talk” you into buying or they might try to pressure you into buying from them.  When they are doing this, they might try to worry you by telling you that if you don’t get the plan they are offering, you could suffer financial ruin, and other stories like that. 

Quite often, these individuals aren’t very honest.  In addition, many of them don’t understand Medicare and can’t be sure what plan or plans would be best for you.  How can you be protected from these individuals?

The Centers for Medicare and Medicaid Services (CMS) has recently proposed stricter marketing rules to protect Medicare Advantage and Part D recipients from being taken advantage of by dishonest sales people.  Some of the proposed rules include eliminating cold calls of patients and banning sales activities at public events, such as health fairs or waiting rooms.

In addition, you can help protect yourself by:
• Having a friend or relative present at any appointment you make with a sales person
• Never giving out information such as social security number, birthday or policy numbers over the phone
• Never sign anything unless you thoroughly understand it
• Don’t allow a sales person to intimidate or pressure you into signing something right away.  If they tell you this is a one time offer and they can’t come back, something is not right

For answers to your questions, contact www.medicare.gov, or www.cms.gov, which is the official site for Medicare.  In addition, Medicare would like to hear from you if you have suggestions or complaints.  You can contact them at the web sites given or call them at 1-800-633-4227.  To report fraud or abuse, call 1-800-447-8477.