3 Vital Keys in Reviewing your Medicare Plan during Open Enrollment

Here are 3 vital things you need to know when reviewing your Medicare Plan during open enrollment:

#1: Is you Primary Physician on the Plan for 2016. If you have primary care doctors or specialists you have been using, and want to keep using, make sure they will continue to be in the network of the Medicare Advantage plan where you are enrolled. The networks, which are the lists of approved doctors and hospitals by the Medicare Advantage plan, change frequently. Ask your doctors now if they have signed up to continue in the plan for 2016. If the doctors have dropped out, you could face a big financial risk. If you go outside the network of your particular plan, you may be required to pay a much larger share of the cost, and in some, cases you may have to pay the full cost without any reimbursement from the insurer.

“Will I be able to use my doctors? Are they in the plan’s network?
Do doctors and providers I want to see in the future take new patients who have this plan?
If providers aren’t in the network, will the health plan still cover my visits if I choose to see them?
Who can I choose as my Primary Care Physician (PCP)?
Does my doctor need to get approval from the plan to admit me to a hospital?
Do I need a referral from my PCP to see a specialist?”

 

#2: Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network? Plans change form year to year. For example, in 2016 Blue Shield now has a contract with Community Memorial in Ventura, which is great news for residents of Ventura.

#3: Check your drugs for coverage under the plan. The list of approved drugs by Medicare Advantage plans, called a formulary, is constantly changing. Plans add and remove drugs, and change the co-payments and deductibles for these medications.

Check the preferred pharmacy list to make sure there is a drug store conveniently close to you. The drug prices depend on buying the medications at a pharmacy which has a contract with the health plan. Many plans are now using lists of preferred pharmacies, where the price will be cheapest. It can make a substantial difference, so you want to use a preferred pharmacy whenever possible. Make sure the plan has one located conveniently near you.

 

 

Medicare Open Enrollment

Medicare open enrollment season, which runs from October 15 to December 7 this year, is a good time to review your medical plan coverage. Making the right choices can save you thousands of dollars and minimize headaches should you need expensive medical coverage during 2016.

During open enrollment season, you can make changes to your medical plan, leave your plan entirely for a different plan or keep your current plan if you’re satisfied with the coverage. Any changes you make will take effect on Jan. 1, 2016.

Traditional Medicare or Medicare Advantage?

If you choose to change your coverage during open enrollment season, a basic choice is whether to enroll in a Medicare Advantage (MA) plan or traditional Medicare. In either case, you’ll need to pay a monthly premium for  Part B coverage, which for most retirees is $104.90 in 2015. MA plans or Medigap policies cover some medical costs not covered by Medicare.

Enrolling in a traditional Medicare plan allows you to select your own doctors, provided they accept Medicare-approved amounts as full reimbursement for covered services. If you buy a Medigap policy, it will cover a portion of expenses not covered by Medicare — deductibles and copayments should you incur medical expenses from doctors who participate in Medicare.

MA plans provide basic medical services covered by Medicare, plus some costs that would normally be paid out-of-pocket if you didn’t have any supplemental coverage. MA plans generally require you to use health care facilities, doctors and other professionals in the MA plan’s existing network, although some plans may cover out-of-network expenses. The total premiums paid for Medicare and MA plans combined are often lower than the total premiums combined of the traditional Medicare plan and supplemental Medigap plans.

If you enroll in traditional Medicare, you’ll need to buy Part D coverage (coverage for prescription drug costs) separately. Most MA plans cover the cost of prescription drugs, although some may require that you buy Part D coverage separately.

One basic tradeoff is the freedom of choice you have regarding doctors and facilities under traditional Medicare plus Medigap insurance, which also comes with generally higher total monthly premiums, versus the lower total monthly premiums of an MA plan with the resulting restriction of choice regarding doctors and health care facilities.

 

Proactive Life Planning for Seniors

Proactive Medi-Cal planning is essential to become eligible for benefits when they are needed.  AT JFW Life Planning Services, we help clients navigate the complex Medi-Cal rules and eligibility requirements, keeping in mind federal look-back periods, asset transfer penalties, and waiting periods that ultimately effect if, and when, an individual may become eligible for Medi-Cal benefits. Medi-Cal is entitled to recover for benefits paid during an individual’s lifetime. Without proper planning, this could result in a family home being lost or turned over to Medi-Cal.  However, there are effective techniques, which enable families to preserve the family home and assets. It is also important to consider the connection between eligibility for use of Veterans benefits as it relates to eligibility for Medi-Cal benefits.

Please contact me on 805 415-8449 or jim@jfwlifeplanning.com for questions or concerns.

Affording Care for Seniors

Very few families can afford more than a few months of nursing home care without depleting their entire estate. While some people purchase long-term care insurance to alleviate the cost of such care, most people will need Medi-Cal to cover the expense of nursing home, assisted living, or other long term care. Medi-Cal, California’s Medicaid program provides coverage for nursing home care and other medically necessary health care services. However, because Medi-Cal is a government-funded medical assistance program, eligibility is determined my assets and income. Medi-Cal only provides for long-term care in a skilled Nursing facility.  Therefore, it may be essential to review other funding options if you wish to receive in-home care or assisted living care.

Needing Care for a Loved One

Seniors will require some form of care during their elderly years. At JFW Life Planning Services, we understand multitude of emotions that come with preparing for this reality: parents who are afraid of being lost in the system or becoming a burden for their children; children who only want the  best for their parents, but do not know how to find such care or how such care can be afforded; families who are concerned about preserving the legacy of a loved one and are fearful of losing such legacies to nursing home costs.

We work closely with clients to discuss long –term care options and asset protection strategies, as well as Medi-Cal Planning strategies that enable clients to become eligible for government-funded services to cover nursing home and long-term care costs.

Please call us at 805 415-8449/  We are here to help you make the best decisions for your individual family situation.

Veterans Benefits for Home Care

U.S. soldiers devote their lives to protecting the safety and freedom of the United States. They deserve to be treated with honor and respect, a degree of which is demonstrated through the administration of Veterans benefits.

Benefits are available to wartime U.S. Veterans over 65 who were dishonorably discharged and their surviving spouses, provided certain income eligibility requirements are met. The money obtained from these pensions can be used for many purposes, including:

  • Paying for assisted living
  • Paying for the high cost of ongoing medical bills
  • Allowing for necessary in home care
  • Arranging for nursing home care

JFW LIfe Planning Services has in-depth knowledge of the sometimes complicated rules of Veterans benefits and other government assistance programs which can be used to protect assets while preserving eligibility for these programs.

Please contact us at 805 415-8449 for all your questions and concerns.