It is now easier than ever before to find out what is covered on original Medicare by using a free app for your smartphone. While this app is not perfect, it is continually being updated by Medicare.
It is important to note that this application will not work for anyone on a Medicare Advantage, otherwise known as a Part C plan. Why? Because Medicare Advantage plans are not “original Medicare” but are private insurance whereby original Medicare is waived for the period that you are on the “Advantage” plan.
Medicare Advantage plans can have more restrictions and limitations and require referrals and plan approval before many procedures can be approved. So, if you are on original Medicare, or using original Medicare with a Medicare Supplement, or Medigap plan, this app will come in handy, should you wish to check to see which procedures are covered by Medicare.
At the Senior Savings Network, we help seniors with their Medicare plan choices from coast to coast with our free broker services.
If you would like help picking the best Medicare insurance plan for you, call us at 1-800-729-9590.
Try the “What’s covered” mobile app!
The app is an official program from Medicare. This website, the Senior Savings Network, and its employees, are a private organization not employed by Medicare and offer licensed advice and support for seniors in 46 states.
As my mother always said, "Sometimes you get what you pay for."
When a new carrier enters a new market, such as many of these smaller companies that you have never heard of before, they are allowed to have rates that are too low and cannot compete, over time. They are allowed to make projections on their expected losses, and those projections are just that, projections. When they are new, the state insurance departments allow them to do this, until they have real data, which takes up to 2 years.
During this timeframe, they will very often undercut the entire market with rates that are not justifiable. This means that they cannot sustain those low rates but hope, as they often to, that they will get so many customers during the first year or two, based on super-low rates, that their customers will stay with them when they spring out the REAL rates. These rate increases have been seen to be up to 15% per year, once the “honeymoon” phase has worn off with the Department of Insurance, and they need to go from “buying business” with super low rates, to actually becoming profitable by raising rates.
What is sad to see, is where a senior goes on their own rate sheet, or advice from a brand new agent who does not know better, and gets the “cheapest” plan in the market from an off-brand insurance company that has virtually no experience in the market. When they have been in the market less than 2 years, and they are offering what we call a “teaser” rate, this is a recipe for disaster.
WHY IS THIS IMPORTANT?
If you plan on being on Medicare longer than two years, the long term viability of the insurance company you pick should be very important to you. The rate stability is absolutely critical because, in most all states, you must qualify with health underwriting in order to change companies. When doing this, if you have suffered a catastrophic or progressively worsening condition that might last your entire life, as we see far too often, you are then STUCK with the insurance company you are with. Being with a “cheap” carrier right off the bat might very well mean that you are stuck with a company that:
1) Got you in with below-justified rates that they cannot sustain; and 2) Have too small an insured base to spread that risk among tens of thousands of other seniors in your state, like the larger insurance companies can do.
What happens in this case is that the small carrier can then go back to the Department of Insurance and get large, double-digit rate increases approved.
Now, if you can predict what your health will be with certainty, in the next two years – great – take that teaser rate and switch companies when you get that first massive rate increase. It is sound advice to take a slightly higher cost company from the beginning of your Medicare journey. Preferrably, one with possibly millions of covered lives throughout the entire country, not just coverage in one state or one very small region. This is how you spread your risk and have rate stability throughout your entire time on Medicare.
While no agent can predict the future and see what rate increases will come from what company with certainty, what I have experienced in 25 years of the insurance business is that experience in the industry matters. Anyone can offer a super cheap rate. What do they do after that super cheap rate is the question.
How is their customer service with a small startup insurer? How good are they at paying claims, with a small cheap company new to the market?
These are just but a few reasons why our clients are happy with our recommendations. We choose long term quality over short term cheap.
According to the internet archive, the last time the Ways and Means Committee report on AARP was available at its location on the congressional website was December 25, 2018. Some time shortly thereafter, before the new year of 2019, the file has been removed.
A Google search of the file name will show that it has been referenced in thousands of other websites and news reports, however, a click on those links, pointing back to the Ways and Means Committee website now shows, “FILE NOT FOUND.”
As the original report from 2011 was newsworthy and enlightening, the Senior Savings Network has decided to post the original report here, in its entirety. See the original report:
Until it is removed, too, here is the video talking about the report, from the Ways and Means Committee’s Youtube channel:
Medicare Advantage Practics Draw Scrutiny from HHS
The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) has published the findings of an investigation into claims denials for members of Medicare Advantage Plans. The report concluded that there is a profit motive, stating specifically, “A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for MAOs to inappropriately deny access to services and payment in an attempt to increase their profits.”
Medicare Advantage plans are becoming a popular choice for seniors as they enter Medicare years (65 year’s old) and often has a monthly premium of $0. The monthly premium is subsidized by the government’s payment to private insurance companies who then manage the care the senior receives. The incentive to closely scrutinize what is approved for care is what amounts the insurer’s profit – that is, the difference between the government’s monthly pay for the senior’s care, at a fixed rate, versus the actual cost of care provided.
Most seniors joining Medicare Advantage plans are aware that there are usually network limitations and restrictions on providers where they can seek treatment. This is the most recognized trade-off for a very low, or even zero monthly premium in comparison to original Medicare and a Medicare Supplement, which pays what Medicare does not pay, typically 20% of medical costs. Unlike original Medicare, however, the restrictions put in place on most Medicare Advantage plans go beyond merely agreeing to abide by a network of contracted providers and having co-payments when services are utilized.
The OIG study found that during 2014-2016, Medicare Advantage plans overturned 75% of their own preauthorization and payment denials, overturning approximately 216,000 denials each year. Even more, denials were overturned when the beneficiaries went further into the appeals process, beyond the first stage. The report states, “The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided.”
The alarming conclusion of this study points to the fact that only 1 percent of denials were appealed to the first level during the examined period. This means that 99% of denials to beneficiaries went unchallenged and those services were just not provided. When 75% of appeals were ultimately won by the beneficiary, it would appear that most beneficiaries are not aware of the success rate or the appeals process at all.
At the Senior Savings Network, seniors are shown the options available to them when they are joining Medicare. These options include original Medicare and a Supplement, which offers the freedom of choice to visit any doctor and any hospital that accepts Medicare; or a Medicare Advantage program with its inherently unique set of network and procedure conditions. The Medicare Supplement route means that the senior can travel from coast to coast, without restriction, and there are no significant deductibles, pre-authorization procedures, or maximum out of pocket concerns when seeking the care their chosen physician feels is best for them, as long as the procedure is deemed medically necessary by Medicare.
While the Medicare Advantage network can be searched to see if the beneficiary’s doctor is within the network, that network can still change during the plan year, as doctor and hospital contracts are not always calendar-year contracts and providers can choose to leave the networks. A provider leaving the Medicare Advantage plan in the middle of the plan year does not provide the beneficiary with a Special Election Period to change plans. In that scenario, the beneficiary must stay in the plan and simply choose a different plan-authorized doctor or hospital. A recent story from the Mississippi Clarion Ledger on October 29, 2018 “Hospitals Dropping Medicare Advantage agreements leaves patients in lurch” reported, “North Mississippi Health Services CEO Shane Spees recently told the Northeast Mississippi Daily Journal that only 4 percent of his company’s patients use Humana Medicare Advantage, but they account for 85 percent of payment denials for all payers.
The benefits within a Medicare Advantage plan, as announced at the beginning of the year are fixed for the duration of the calendar year, but not beyond that one-year period. This means that a member of a specific Medicare Advantage plan who signed up for a set premium (or no premium), after finding out that their favorite doctor is in the network might find that the next year the premium, co-payments, and provider networks have changed. This is announced in their “Annual Notice of Change” received by the members in October which outline what changes will happen to their program on the next January 1.
Conversely, with original Medicare and a Medicare Supplement plan, the benefits of the Supplement are guaranteed renewable. This means that the benefits are guaranteed not to change in the future as long as the premiums for that plan continue to be paid. This provides more certainty with regard to the future benefits of their chosen plan. While the monthly premiums can change, the benefits and freedom to choose any Medicare doctor or hospital from coast-t0-coast, does not.
In their audit, the OIG recommends that the Center for Medicare & Medicare Services (CMS) “enhance their oversight of Medicare Advantage contracts, including those with extremely high overturn rates and/or low appeal rates, and take corrective action as appropriate.” It was also recommended that CMS implement strategies to communicate with beneficiaries in a clearer way about the appeals process available to them. The Medicare Advantage appeals process can be quite daunting and has various layers of complexity.
Seniors on Medicare are especially vulnerable to scammers and sometimes those doing the scamming are actually insurance agents trying to hide their identity.
Seniors can verify the identity of an insurance agent by getting the agent’s name, license number, and callback number and then verifying their license with the state’s department of insurance. The numbers for each state department of insurance can easily be found withthis link. Contact your department of insurance before giving out any personal information to someone who has contacted you by phone.
The good rule of thumb is – if they call you, you do not know who they are – regardless of what the CALLER ID says. If you contact them, you are in control of who you are talking to. So, verify who they are, then call back their legitimate number
Here is the helpful video on the topic:
Christopher Westfall, National Producer # 596926 1-800-729-9590
Medicare Supplement Plan N can be a good value, depending on your location (ZIP code), Age, and whether you’re a male or female. Meaning, all rates and rate comparisons are personalized depending on YOUR situation.
For any agent to make a complete blanket statement that ONE particular plan is the best for everybody, all the time, is simply not aware of all of the options out there. I provide very personalized service by pulling up all available plans and all available companies for our potential clients. As always, my service is 100{57afd372ef552335ba870edf523b8e4a4ddf98dad7cf21c72091c800f1bfac05} Free.
Plan N Medicare Supplement can be a good value, or it might not, depending on your situation. To find out whether Plan N or Plan G or Plan F is the best for you, give us a call at 1-800-729-9590. It takes less than 3 minutes to give you the breakdown of what is available.
Working with someone else? At least get a second opinion (and more options) Call me today!
Aetna was in the news this week about their pulling out of certain states in the “ObamaCare” exchanges.
This only impacts those UNDER 65 on regular health insurance, not your plan with Aetna.
This is a smart move for AETNA, as they’ve been losing money – like all insurers have, and Aetna has already lost over $400 million by participating in the “ObamaCare” exchanges.
Aetna’s Medicare plans are stronger than ever and are delivering the best value in the market right now with their below-average rate increases at renewal time. Part of the reason Aetna is able to deliver great renewals is because they recognize vulnerabilities, like the continued participation in the UNDER 65 health insurance market would continue to bring.
Thank you for allowing me and my office to help you with your Medicare Supplement plan.
Please remember that we are here to help if you have ANY questions at all about anything having to do with Medicare.
Sincerely, Christopher Westfall Senior Savings Network 1-800-729-9590
Si está considerando su primer plan de Suplemento de Medicare, o está considerando cambiar a un plan de Medicare Supplement más asequible, debe ver este video.
La mayoría de los agentes de seguros que trabajan con personas de la tercera edad presionarán a Plan F como la mejor solución. Mientras que el Plan F cubre todo, a menudo es a una prima tremenda, innecesaria. Los mismos beneficios exactos se pueden obtener con el Plan G, con el deducible pequeño, ahorrando así cientos al año. Pero, se pone mucho mejor.
Por favor, vea este video que explica los muchos beneficios del Plan G vs. Plan F:
¿Quieres ver las tarifas de TODOS los planes y todas las empresas? Podemos hacer eso, y mi servicio es 100{57afd372ef552335ba870edf523b8e4a4ddf98dad7cf21c72091c800f1bfac05} gratis. ¿Cómo? De la misma manera que su seguro de automóvil y los agentes de seguros del propietario trabajan – se les paga de las primas al transportista, que luego paga a los agentes. Trabajamos de la misma manera. No te cuesta nada.
Llámenos aquí o llame al 1-800-729-9590 las 24 horas del día. ¡Gracias por leer!
