Marketplace healthcare plans and strategies for 2020 Insurance Consumers looking for alternative options

Marketplace healthcare plans and strategies for 2020

Did you know there are numerous types of healthcare plans available to an individual family and small business. The marketplace brought to you by Obama care is not the only option in town, now that individuals and families are getting wise to how the process works many are choosing either Partial self insurance are full self insurance or picking risks that they want covered to minimize monthly expenses here are the top options for 2020

  • Ministry Health Care
  • Faith based sharing plans
  • Hospital indemnity only plans
  • Doctor or medical plans
  • Catastrophic or named condition policies
  • High deductible health plans
  • Short term health insurance plans
  • Drug only insurance plans
  • Gap insurance plans
  • Medicare supplemental insurance plans
  • Group health insurance
  • Small business health insurance
  • Vision only insurance plans
  • Strategic risk group pools
  • Non-marketplace plans a.k.a. off marketplace plans
  • Branded hospital plans, or hospitals actually have their own insurance plans in house now
  • Out of pocket insurance plans
  • Bridge to Medicare plans
  • Faith based sharing plans are designed to be risk sharing groups of the same faith to qualify for the ACA exemption but one another in the membership pool helps take care of everyone else in the group and in a Christian-based faith sharing model the body of believers will help take care of the rest of the body at the same time leveraging a system or a doctor network or hospital network to help reduce costs and be diligent with the money available to provide healthcare for the overall group. These are not insurance plans
  • Hospital indemnity only plans Are designed for hospital admittance in a hospital stays so in the event you have to go to the hospital it’s an unknown factor but it only covers hospital visits and expenses defined in the indemnity plan so this is a full insurance plan but it only pays specifically to what is listed in the policy so it’s not a full coverage plan by any means but it does help offset large risks that you may have if you have to go to the hospital and often times is used in conjunction with maybe a high deductible plan or a self insurance strategy.
  • Doctor or medical plansCan be both provided by a network of doctors or by an insurance company where there are discounts offered as a premium is paid in Lou of higher costs billed by the doctor or the network, but there are also doctors now that are starting their own doctor plans and you can pay them a monthly membership fee to have full access to them and these are often times used in place of or in conjunction with a self insurance plan or a high deductible plan.
  • Catastrophic or named condition policies can be very comforting because they traditionally cover the top five medical expenses that causes significant overall costs like heart attack, cancer, stroke and these are also full insurance plans but they’re only full insurance plans to their policy maximum and for the defined benefit or the defined condition and typically only available one time use so if you have already had a condition you may not be eligible for this type of policy however the other types of Conditions you may still qualify for. Speak with your insurance agent or insurance company about this type of plan to see if it’s a good fit for your insurance portfolio.
  • High deductible health plans have become very popular because they shift the risk to the consumer and minimize the risk to the insurance carrier while making the consumer feel like they’re spending less per month and feeling more comfortable about managing some of their smaller out-of-pocket costs. Hi deductible health plans are an entry-level self insurance plan because you are truly managing the first portion of your expenses and if done well can actually get more out of a hide adoptable plan then you might think because you can leverage the Provider network or hospital network within this type of plan to help reduce your overall cost every year. Many people opt to go with a maximum hide adoptable and then backfill with potential he a catastrophic or condition specific or accident plan. This can reduce your overall monthly premiums and give you pretty good coverage in the event of a catastrophic expense.
  • Short term health insurance plans are typically designed for six or 12 month period‘s while you’re in between plans are waiting for a plan to start and can only be renewed once or twice so I don’t think you can buy a short term plan and renew it forever because it does have renewal limitations but are good in situations where you’re waiting for a student policy to kick in, or a new job policy to kick in or often times before you retire you may be looking for some sort of coverage before you start your Medicare supplement plan. There’s also short term health insurance plans that are called bridges to Medicare which are designed specifically for individuals 62 265 waiting for Medicare and a supplement to kick in
  • Drug only insurance plans are designed to help reduce the overall cost of your prescription expenses and typically part of a more comprehensive plan but are available individually for premium however most will find that getting just a discount prescription card will help the overall out-of-pocket cost for prescriptions for the majority of Americans. However if you’re on a cocktail or a class a drug you may really benefit from a prescription plan, the key is making sure that you have the plan in place before you need the drugs because onceYou have a require need you may no longer qualify for a prescription drug only plan.
  • Gap insurance plans Cover exactly what they say the gap between one plan or type in another they are usually condition specific and also named so they have a maximum coverage and are defined and very limited but are good to cover a specific gap.
  • Medicare supplemental insurance plans are designed to help offset Medicare covered expenses that are typically paid up to about 80% and then the Medicare supplement plan kicks in however you need to understand if Medicare part a and Medicare part B do not cover the first 80% of the supplemental plan is not going to kick in leaving you exposed to uncovered Medicare expenses. Medicare supplemental insurance plans or Medigap plans traditionally start within six months of your Medicare part B because there is a window that is allowed A specific amount of time where the insured does not have to go through underwriting to qualify for the Medicare supplemental insurance plan but if you wait past this window you may have to go through medical underwriting and often times because of your age have conditions that will preclude you from getting a Medicare supplement plan so it is very important to make sure you know the timelines of when you can purchase your Medicare supplemental insurance plan especially if you have medical conditions already.
  • Group health insurance is a benefit provided by your employer typically of companies that have W-2 employees 50 or more and often times is a group self-insured plan and then destroyed by a insurance company or is a insurance company provided plan paid for by your employer and often times available for your spouse independence. These plans are typically subsidized by the employer making the monthly expense to the employee seem more reasonable and in today’s market are veryMuch included as part of the overall benefit package or employment package because a group plan with a family of five maybe under 1000 Where as in the open market place for that same plan could be upwards of $3000 so essentially that’s a $24,000 a year income increase exchange. Now many groups are moving to Moore high deductible plans putting some of the risk back into the employees side of the equation but still offering a great benefit compared to what’s available in the open market place today. You can use some of the self insurance strategies with a high deductible plan if that will help your overall out of pocket cost per year
  • Small business health insurance is typically for three or more employees and can be a cost savings but have specific requirements and the plans are typically not as robust as available to the groups of 50 and higher making them beneficial but not as robust as the ones in the larger companies. They may save overall monthly expenses especially if you’re a family operation and have multiple family members in the business if you’re paying them a W-2 income but the underwriting will probably be based on that small
  • Vision only insurance plans         Are typically for glasses and prescriptions and contacts and not usually for cataracts an eye surgery because that’s going to be generally picked up by your medical plan and covered under your major medical.
  • Strategic risk group pools are groups or organizations that have created an affinity group or an affiliate group that is able to share in the risk and either a sharing pool or working in conjunction with a health carrier or a health insurance company to provide a group coverage for that association or that defined group of individuals similar to a business group insurance plan and typically offer reduced rates to the association or members of the group in Lou of commissions being paid
  • Non-marketplace plans a.k.a. off marketplace plans
  • Branded hospital plans, or hospitals actually have their own insurance plans in house now
  • Out of pocket insurance plans
  • Bridge to Medicare plans

 

 

average cost for medicare supplements

NEW: TeleHealth or TelMedicine is now being offered bu most top medicare supplement providers to help increase the quality of care. MEDICARE does not always cover thel healt visits but it is the wav of the future and is showing great success in quality of care!

 

The average cost for a medicare supplement plan F is about $150.00 a month.

This is based on a 65 year old male in Texas who just started medicare part B.

Their prices will vary based on:

  • Age
  • Zipcode
  • Plan benefits
  • Carrier

This will also depend on your medicare part B start Date as if you are out of your initial window you may have to go through underwriting and may or may not qualify.

 

Medicare Physician Fee Schedule

 Medicare Physician Fee Schedule

Today im going over information about the Medicare Physician Fee
Schedule (PFS) A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.

Medicare Part B

Medicare Part B pays for physician services based
on the Medicare Physician Fee Schedule, which lists the more than 7,400
unique covered services and their payment rates.
Physicians’ services include the following:
™ Office visits;
™ Surgical procedures;
™ Anesthesia services; and
™ A range of other diagnostic and therapeutic
services.

Payment rates for an individual

Payment rates for an individual service are based on
the following components as shown in the Medicare
PFS payment rates formula on page 3:
1) Relative Value Units (RVUs);
• Work RVU;
• Practice Expense (PE) RVU; and
• Malpractice (MP) RVU;
2) Conversion Factor (CF); and
3) Geographic Practice Cost Indices (GPCIs).

 

Free Medicare Supplement Quote

The 2016 Physician Fee Schedule final rule

The 2016 Physician Fee Schedule final rule with comment period was placed on display at the Federal Register on October 30, 2015. In addition to policies affecting the calculation of payment rates, this final rule identifies potentially misvalued codes, adds procedures to the telehealth list, and finalizes a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with Physician Fee Schedule payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov. This is the first Physician Fee Schedule final rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The calendar year 2016 Physician Fee Schedule final rule is one of the several final rules reflecting a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

more facts on PFS

More on PFS

If you would like more Information on Medicare / Medicare PSF or Medigap plans you can contact me at (475) 88CARLY  (475)-882-2759

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Medicare in Colorado

Medicare in Colorado

By the numbers

The number of Medicare beneficiaries in Colorado is right in the middle when compared to other states. However, Colorado is tied for third on the list of beneficiaries with incomes that are 200% more than the Federal Poverty level.

  • Number of Medicare beneficiaries in Colorado: 667,277
  • Percentage whose income is below the Federal Poverty Level: 14%
  • Percentage whose income is 200% above the Federal Poverty Level: 61%

Medicare Advantage Organizations and Prescription Drug Plan Sponsors must have a contract with Medicare in order to sell Medicare insurance plans (such as a Medicare HMO or a Medicare Part D Plan. Depending on the terms of the contract between the plan and Medicare, not every plan is available statewide or in all service areas. Each year, the plan must renew their contract with Medicare, so the availability of a plan in a specific service area is subject to change as a result of the annual contract renewal.

Medicare resources in Colorado

There are free resources for Colorado residents with Medicare that will provide information about their benefits and Medicare plans in Colorado.

Colorado Medicare Savings Programs: Residents with Medicare can apply for one of the savings programs in Colorado through the state’s Department of Health Care Policy and Aging. These programs help residents who need help paying their Part A or Part B premiums. Normally, in order to be accepted into one of the savings programs, your income has to be below a certain limit.

Free Medicare Supplement Quote

Colorado State Health Insurance and Assistance Programs (SHIP)The Senior Health Insurance Assistance Program (SHIP) has locations throughout Colorado to answer questions about Medicare. Trained counselors provide many different services for no charge, including individual counseling, presentations, and distribution of printed materials.

How healthy is the state of Colorado?

Colorado is the twenty-second most populous state in the U.S. and is ranked as the 9th healthiest place to live. Colorado’s strength as a healthy state is helped by its lower prevalence of obesity than all other states as well as its low prevalence of diabetes. Two challenges facing Colorado are its low use of early prenatal care as well as its low immunization coverage.

All data provided by the Kaiser Family Foundation.

Do you have more questions? Give me a call at (475) 88CARLY / (475) 882-2759

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Mutual of Omaha California Medicare supplement

Mutual of Omaha California Medicare supplement

Are you looking for Mutual of Omaha California Medicare supplement plans in your area? well we are more then happy to help you with that. here are just a few.

We offer 3 Plans in California,  

These plans are based off a Woman born in 1951 and in the zip code of 9007

We offer 3 Plans in California,

Plans for a Male smoker born in 1951 in the zip code of 9007

We offer 3 Plans in California,

Plans for a woman smoker born in 1951 in zip code 90402

Free Medicare Supplement Quote

AARP Supplement Medicare Insurance

AARP Supplement Medicare Insurance

When looking for Medicare Supplements you have to find a company that sells Medigap plans. With so many to pick for it can be overwhelming. today I’m going to tell you about AARP and AARP Supplement Medicare Insurance.

History

According to the group’s official history, Dr. Ethel Percy Andrus founded AARP in 1958. AARP evolved from the National Retired Teachers Association (NRTA), which Andrus had established in 1947 to promote her philosophy of productive aging, and in response to the need for health insurance for retired teachers. After ten years, Andrus opened the organization to all Americans over 50, creating AARP. Today, the NRTA is a division within AARP. Dr. Andrus founded AARP while living in Ojai, California, where she had established an innovative new retirement home named Grey Gables. Ojai served as national headquarters for AARP from 1958 until the mid-1960s. Honors to Dr. Andrus include National Teacher of the Year in 1954, induction into the Women’s Hall of Fame and, more recently, a medallion placed on the Points of Light Institute’s “Extra Mile Pathway” in downtown Washington, D.C.

AARP Supplement Medicare Insurance Plans

Here are a few of AARP Supplement Medicare Insurance that they offer.

 

There are 9 plans for Texas in zip code 75087

Rates based on:

Date of Birth:

01/02/1951

Part B Date:

01/01/2016

Plan Start Date:

02/01/2016

Customize my Rate

Plan A

Standard Rate With Enrollment Discount

$146.65

Plan pays:

• Part A hospital Co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan B

Standard Rate With Enrollment Discount

$130.55

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• Inpatient deductible for qualifying hospital stays

Plan C

Standard Rate With Enrollment Discount

$159.42

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• Inpatient deductible for qualifying hospital stays

Plan pays:

• Deductible for Part B medical insurance

Plan does not pay:

• Part B excess charges, which are charges exceeding the normal Part B limits

Plan pays:

• Co-insurance for days 21-100 after meeting Medicare’s requirements

After a $250 deductible, the plan pays 80% of eligible expenses for care beginning during the first 60 days of each trip up to $50,000-lifetime max.

Plan Select C2

Standard Rate With Enrollment Discount

$140.00

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• Inpatient deductible for qualifying hospital stays

Plan pays:

• Deductible for Part B medical insurance

Plan does not pay:

• Part B excess charges, which are charges exceeding the normal Part B limits

Plan pays:

• Co-insurance for days 21-100 after meeting Medicare’s requirements

After a $250 deductible, the plan pays 80% of eligible expenses for care beginning during the first 60 days of each trip up to $50,000-lifetime max.

Plan F

Standard Rate With Enrollment Discount

$160.30

Free Medicare Supplement Quote

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• Inpatient deductible for qualifying hospital stays

Plan pays:

• Deductible for Part B medical insurance

Plan pays:

• Part B excess charges, which are charges exceeding the normal Part B limits

Plan pays:

• Co-insurance for days 21-100 after meeting Medicare’s requirements

After a $250 deductible, the plan pays 80% of eligible expenses for care beginning during the first 60 days of each trip up to $50,000-lifetime max.

Plan Select F2

Standard Rate With Enrollment Discount

$140.87

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• Inpatient deductible for qualifying hospital stays

Plan pays:

• Deductible for Part B medical insurance

Plan pays:

• Part B excess charges, which are charges exceeding the normal Part B limits

Plan pays:

• Co-insurance for days 21-100 after meeting Medicare’s requirements

After a $250 deductible, the plan pays 80% of eligible expenses for care beginning during the first 60 days of each trip up to $50,000-lifetime max.

Plan K

Standard Rate With Enrollment Discount

$47.95

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• 50% of Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• 50% of the inpatient deductible for qualifying hospital stays

Plan pays:

• 50% co-insurance for days 21-100 after meeting Medicare’s requirements

Plan L

Standard Rate With Enrollment Discount

$91.52

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• 75% of Part B co-insurance (generally 20% of Medicare-approved expenses)

Plan pays:

• 75% of inpatient deductible for qualifying hospital stays

Plan pays:

• 75% of co-insurance for days 21-100 after meeting Medicare’s requirements

Plan N

Standard Rate With Enrollment Discount

$115.85

Plan pays:

• Part A hospital co-insurance plus coverage for 365 additional days after Medicare benefits end

• Part A Hospice Care Co-insurance

• First 3 pints of blood

• Part B co-insurance3(generally 20% of Medicare-approved expenses)

Plan pays:

• Inpatient deductible for qualifying hospital stays

Plan pays:

• Co-insurance for days 21-100 after meeting Medicare’s requirements

After a $250 deductible, the plan pays 80% of eligible expenses for care beginning during the first 60 days of each trip up to $50,000-lifetime max.

Have more questions about AARP or Medicare? Or maybe you are looking for a Supplement. Give me a call at (475) 88CARLY / (475) 882-2759

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Medicare Health Insurance

Medicare Health Insurance

  1. There are two main ways to get Medicare.

    • Original Medicare (Parts A and B) which is provided by the federal government
    • A Medicare Advantage plan (Part C) offered by a private insurance company
  2. With Original Medicare, you may pay a share of the cost.

    • You contributed to Medicare by paying taxes. That’s why you’re eligible for Medicare when you turn 65.
    • Original Medicare may not pay for everything. You may pay a share of the cost of monthly premiums and copays.
  3. Medicare supplement insurance helps with some out-of-pocket costs.

  4. Prescription drug coverage may help limit drug costs.

    • Original Medicare does not include prescription drug coverage. However as a Medicare member, you can get Medicare Part D prescription drug coverage.
    • Prescription drug plans, also known as PDP, and Medicare Advantage plans are offered by private insurance companies.
    • You can enroll in a stand-alone Part D plan to go with your Original Medicare coverage.
    • You can enroll in a Medicare Advantage plan that includes prescription drug coverage.
  5. Coverage choices vary by plan type and state.

    • Original Medicare (Parts A and B) is the same across the United States.
    • Medicare Advantage (Part C) and prescription drug (Part D) plans are offered by private insurance companies and may be available only in certain counties, states or regions.
    • Medicare supplement plans travel with you nationwide. The plans are standardized, but the availability may vary by state.

Looking for more information? tomorrow there will be a follow-up radical stay tuned for more. If you have any questions Call me at (475) 88CARLY / (475) 882-2759

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Do you need Medicare Supplement insurance?

Do you need Medicare Supplement insurance?

I get a lot of people asking if they really need Medicare Supplement insurance. Well there really isn’t a right or wrong answer to that question. If you are ok with paying the 20% that Medicare doesn’t pay for then you don’t have to get one. But if you are on a fixed budget and it’s easier for you to know what you are going to have to pay each time you go to the doctor or if you have to pay anything at all. Then yes I would say you should want to get Medicare Supplement insurance.

Most of my clients tell me that they would rather pay a monthly premium and know what they are going to be paying. They tell me that instead of going to the doctor and not knowing what you will be charged for they would rather have a plan.

Now everyone is different and there are a variety of different plans out there that you can choose from. Depending on if you have a lot a health conditions, if you have maybe one small health condition, or if you are completely healthy at the time you sign up. So depending on what kind of condition you are in would be what you might go by when signing up for a plan.

Free Medicare Supplement Quote

There are 10 different plans that you can choose from so it is up to you on which plan you want to go with. With Medicare Supplement plans it doesn’t matter what insurance company you go with. Because the plan benefits will stay the same no matter what. The only thing that is going to be different is the pricing. Different insurance companies charge different rates for each plan. So all you have to do is decide which plan you want to go with, and then find out who is offering it the cheapest.

 

If you are ready to get signed up for Medicare Supplement insurance then feel free to give me a call directly at 901-KORTNI8. I’m a Licensed Broker, which means I can look at multiple companies to see who if offering the cheapest rate for those plans.