Medicare & Long Term Care Insurance: Oh my!
By Lori Cochrane, Principal Professional Fiduciary, Cochrane Support Services
When it comes to Medicare plans, long term care plans, and knowing the ins and outs, the information is overwhelming and confusing. Only professionals know what the heck they're talking about. When I need information for my clients, I get first-hand information directly from the pros.
Turning 65 brings about questions about health insurance and what to do about Medicare. As we decline and enter a phase where our long term care insurance may kick-in, we need to know how to maximize benefits.
These two insurance topics are not as straightforward as they should be. The rules are complicated. I asked Katie Fernandez from All Types Insurance to help me understand Medicare. I also asked Susan Feldman from BrightStar Care to help me understand long term care insurance. Read on to learn more...
I recently asked Katie Fernandez about the opportunities to change Medicare plans mid-stream. I was surprised at the available options. With Katie’s permission, here are snippets from our conversation along with information obtained directly from Medicare.gov. It always helps to get a better understanding of what might be available.
Meet Katie --
“My name is Katie and I have specialized in the senior health insurance market for 18 years. I’m locally available to help people navigate Medicare and answer any questions they may have. I specialize in services related to Medicare insurance products, such as Medicare Supplements, Medicare Advantage plans, and Part D (prescription drug plans). Regardless of a client’s current plan, it is always a good thing to understand and know all of your Medicare options.”
Q. When are we supposed to enroll in Medicare?
There is an Initial Enrollment Period that lasts seven months for individuals turning 65 to enroll in Medicare.
Katie says, “Anyone turning 65 years old has 3 months before, the month of, and 3 months after their 65th birthday to make their plan choice."
Q. What are our plan choices? There are three types of plans to choose from, each with a variety of enrollment periods. They include:
Straight Medicare Part A & Part B (plan D for drugs sold separately)
Supplemental, aka “Medi-gap” (plan D for drugs sold separately), and
Medicare Advantage (Includes a drug plan)
Q. When can we change plans?
You can change Medicare plans during the Annual Enrollment Period which is each year from October 15th through December 7th. This is an annual opportunity for ALL Medicare recipients to change plans of ANY KIND. This is also the allowed time frame to change prescription drug plans or enroll in one to avoid further penalties.
Supplemental is a Medicare Primary plan with a Supplement “medi-gap” (does not include a drug plan):
Open Enrollment coincides with the Annual Enrollment Period which is October 15th through December 7th, each year.
Birthday Open Enrollment -- This period lasts 30 days before and after your birthday.
Katie says, “I can shop Medicare Supplement Medi-gap plans each year, enrolling you 30 days before and up to 30 days after your birthday, to help you receive identical benefits for a lower monthly premium.”
She goes on to say, “For those who choose a Medicare Supplement, overpaying and constantly increasing costs can get frustrating. I focus on shifting my clients to the same plan for less money with no health questions asked.”
Medicare Advantage plan (includes a drug plan):
Annual Enrollment Period is October 15th through December 7th.
Open Enrollment is January 1st through March 31st, each year.
Katie adds, “I make sure you have the best advantage plan that works with your network of doctors and hospitals. Some Medicare Advantage plans I offer include dental, vision, transportation to and from doctors’ appointments, free gym, and classes as well as a monthly allowance to purchase over-the-counter supplies!”
Q. What is Special Enrollment?
Katie says, “Special enrollment periods are when you can change your plan outside of these open enrollment periods, which you may not be aware of. During this time, you can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life. Some of the qualifying events may include:
A move in or out of a service area
Moving into or out of a Long-Term Care facility
Losing an employer plan
Involuntarily losing creditable prescription drug coverage
Being affected by a weather-related disaster or a natural disaster
A change in “extra help”, for example to Medi-Cal assistance, or loss of a special needs plan
With so much more to know we recommend you ask a professional for advice about Medicare options and enrollment. The more you know, the more you save!
Katie offers a free consultation to help clients choose the right Medicare insurance policy, make policy changes and sort out claims. You can call Katie at 916-408-7665. You can find her at: All Types Insurance Agency, 805 Twelve Bridges Drive, #15, Lincoln, CA 95648.
Long Term Care Insurance: Use it or lose it!
By Guest Contributor, Susan Feldman Community Liaison, BrightStar Care
If you’ve been paying premiums on a long term care insurance policy for years and wondering “What does this policy cover?”, “When do I use it?” and “How do I use it?”, read on.
Given the choice, most people wish to age in their own home, in familiar surroundings with family, neighbors and pets. If you had the foresight to purchase a long term care policy with an “In Home Care” benefit, you’re in luck.
Locate the Policy: If you have your hands on the policy, that’s great. If you can’t find it, call the insurance company and request a copy. Make sure your adult children and/or power of attorney know you have a policy and where it is. Nothing is worse than paying into a policy and not remembering to use it.
Schedule of Benefit: This summary page states the coverage of the policy. For example, how much will the policy pay for in-home care, assisted living or nursing home care? Some even have a benefit for home modifications and fall alert devices.
Elimination or Deductible Period: This is the portion the policy holder is expected to pay before the insurance company pays. It can be 0, 30, 60, 90 or up to 100 days. How those days are defined can vary. Some are individual days of care while others are calendar days. This may be waived in certain situations.
Qualifying Need: The critical “trigger” to use the policy hinges on needing either stand-by or hands-on assistance with at least 2 of these Activities of Daily Living (ADLs); transferring, toileting, incontinence care, bathing, dressing and feeding (not meal prep).
Qualified Caregiver: While some LTCi companies allow family members to be the caregiver, most require a licensed home care agency to provide the care.
Use it or Lose it: Tapping into your LTCi policy when there is adequate need yet not waiting too long (investment wasted) simply takes evaluation. If qualified assistance is needed to help a senior stay home safely, possibly relieving a spouse or adult child of the tasks, why not investigate starting a claim. After all, that’s why you purchased the policy in the first place.
If you’d like assistance in navigating the waters of your LTCi policy, I’d be happy to meet with you, review the policy, discuss care needs and do a home safety assessment. Just email or call to set up this complimentary service.
Susan Feldman has been with BrightStar Care for over 10 years helping those with long term care insurance understand and utilize them well. She can be reached at firstname.lastname@example.org or 916-919-0063.