Medicare is complex. You have options. Here are the three options you have to get benefits and avoid penalties. Let’s start by defining a few terms.
Medicare Part A is the benefit for hospitals and other inpatient health services. If you have paid into Medicare for the required amount of time, you are eligible to get Part A at no cost. If not, there may be a premium for Medicare Part A.
Health Insurance is complicated. There are so many words that have industry specific meaning. That can lead to confusion. Many will choose a plan based on premium costs alone. Here are the basics that can be used to compare plans and save you money.
Thinking of retiring early? There are so many things to consider. Here are some options for health insurance. If you’re retired and need health coverage, you can use the Marketplace to buy an insurance plan. If you have retiree health coverage, you have different choices to consider.
Consider these things when deciding between Original Medicare and a Medicare Advantage Plan for your health coverage:
Original Medicare
You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
Medicare Advantage
In many cases, you can only use doctors and other providers who are in the plan’s network and service area (for non-emergency care). You may need to get a referral to see a specialist.
Medicare is making huge changes to things for 2025. More is being required of carriers financially and this will make changes to Prescription Drug and Medicare Advantage Plans.
There are, of course, pros and cons of concierge medicine. concierge the concierge medicine definitions, benefits, as well as its drawbacks.
What is Concierge Medicine?
A concierge medical practice provides direct access and personalized care to patients. Physicians operating a concierge medical practice will typically form their own boutique medical practice consisting of a small number of qualified physicians. Patient lists are smaller, which minimizes paperwork and bureaucracy. This means patients get to build trusted relationships with their physicians. Patients pay an annual fee for their care and insurance is not billed for the physician’s services.
Can’t get insurance? You have options. Let’s talk about some of them.Under 65? There are several options for health insurance.You can apply for an insurance subsidy through the Health Insurance Marketplace and even get help paying for your private insurance.
Medicare Advantage Plans aren’t for everyone. They do, however, have distinct advantages and disadvantages. Here are a few:
Convenient coverage options
With a Medicare Advantage plan, all your coverage options are in one convenient plan. This list includes Medical, prescription drug coverage and extra benefits like dental, vision and hearing coverage.
In 2025, Medicare will have a new program allowing Medicare beneficiaries to spread payments out for expensive medications over the entire year. The program is called the Medicare Prescription Payment Plan (M3P). This will allow beneficiaries taking expensive medications to pay $0 at the pharmacy and make payments to the Prescription Drug Plan over the remainder of the year. This is one of the changes Medicare has made to make medications affordable for beneficiaries. Below are questions from the Medicare M3P Fact Sheet.
How Is the Medicare Part D Benefit Changing in 2025?
Changes in 2025 include a new $2,000 out-of-pocket spending cap, signaling the end of the coverage gap phase. This will include a change in the plan stages from Deductible, Inisital, Coverage Gap and Catastrophic stages to having only the Deductible, Initial and Catastrophic stages.
Understanding Healthcare sometime feels like slogging through a rainforest. There are vines, tree limbs and a variety of creatures. As a purchaser of health insurance, here are some of your rights:
Companies can’t put dollar limits on your care.
Insurance companies cannot limit the dollar amount paid out for your healthcare. Instead, there is often a maximum out of pocket limit for what YOU might pay for your healthcare.
Under Obamacare or the Affordable Care Act (ACA), Marketplace health plans must cover the same 10 Essential Health Benefits.
This can save you money because you will have more coverage. It can also save you time due to it being easier to compare health insurance plans. Below are the 10 benefits insurance companies are required to offer if selling plans on the Health Insurance Marketplace.
You’ve probably gotten a spam call or two (or more if we’re being honest!) within your lifetime. Between bad actors in the Marketplace switching consumers from plan to plan and the rise of AI assisted attacks, you are at risk of having your coverage compromised any time you pick up the phone. Knowing these risks could save you from having your coverage switched after what seems like an innocent phone call.
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1. A Medigap policy is different from a Medicare Advantage Plan, and policies don’t cover prescription drugs. Medicare Advantage Plans bundle your Hospital (Part A), Medical (Part B), and usually drug coverage (Part D) into one plan. Most Medicare Advantage Plans also offer extra benefits that Medicare doesn’t cover, like vision, hearing, dental, and more.
A Medigap policy helps lower your share of costs for approved Part A and Part B services when you have Original Medicare. To get drug coverage, you can buy a Drug Plan (Part D) in addition to buying a Medigap policy.
Once you have Medicare Part A and Part B, you can now consider your options for additional health coverage under the Medicare system.
Traditional Medicare is sometimes preferred by Doctors and Hospitals for a couple of reasons. One is ease of use. With traditional Medicare, there are fewer pre-authorization requirements. Reimbursement rates are sometimes higher than with other Medicare plans.
Hospital Indemnity Insurance is insurance with a monthly premium. If you meet the conditions of the policy (like hospitalization or ambulance ride), the insurance pays you cash. You can use this cash to pay for things your health insurance doesn’t cover like copays, coinsurance, deductibles, living expenses while you recover,
Unlike health insurance, there are no networks. The plan pays cash to you to cover expenses.
Dental plans can be cheap, expensive, or in between. How do you know if you’re getting the best plan for your family? Below are several factors to consider before buying dental insurance.
Young adults, families with children, older adults – each situation is different and you may or may not need dental insurance. If you go to the dentist often or need expensive procedures, dental insurance might be a good idea. If you only go to get your teeth cleaned once or twice a year, a minimum of dental insurance might be best for you.
We all want to save money, especially on Health Insurance. The Health Insurance Marketplace has two ways to save money.
Ways to save on health insurance costs
There are two ways to save on the cost of health insurance:
Premium Tax Credits – Marketplace plans have set premiums. You can qualify for a discounted premium based on your income. The lower your income the more you save. This savings is called a Subsidy.
Cost Sharing Reductions – If you qualify for Cost Sharing Reductions and choose a Silver Plan, you may pay less for doctor visits, deductible and maximum out of pocket costs.
It’s that time of year. Open Enrollment is here.
It’s time to consider your options and choose a 2024 health insurance plan for your family. Here are some things to do if you are enrolling in the Health Insurance Marketplace for the first time:
Fill out an application, compare plans, and enroll in health coverage for 2024.
If you need help, talk to a licensed Health Insurance Agent. It’s a free service.
The Health Insurance Marketplace is the gateway to buying good health insurance for individuals and families.
The Marketplace decides how much discount each applicant will receive on their health insurance. This is based on zip codde, income, family size, age, and tobacco use.
Once the amount of discount is decided, you will choose your private health insurance plan based on benefits and total cost.
After COVID started in 2020, Texas Medicaid and CHIP went into “Continuous Enrollment.” Continuous enrollment allowed those already enrolled in these programs to stay enrolled. Enrollment continued regardless of circumstances. For example, if updated paperwork was requested but not turned in, enrollment would continue. Very few people were disenrolled from these programs during the Public Health Emergency/Continuous Enrollment.
Health Insurance has its own vocabulary. Here’s a vocabulary words about providers and networks:
Primary care provider (PCP) – A doctor who directly provides or coordinates a range of health care services for a patient.
Referral – A written order from your primary care doctor for you to see a specialist. In many health maintenance organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral, the plan may not pay for the services, and you will be responsible for the visit costs.
If you have health insurance at work, you can usually add your children to your plan as dependents. You can keep your children on your health plan until they turn 26. They may stay on your plan even if they’re married. But you can’t add their spouses.
The Health Insurance Marketplace is a federally managed service that helps find and compare health insurance policies. It is sometimes called the Affordable Care Act or ACA. This web site can be found at Healthcare.gov.
Whether you are enrolling yourself in a Plan or working with an agent (to make the process faster and easier), this information is needed to determine the best plan. Once you’ve chosen a plan, you’ll need this information again to sign up.
Shop smarter and avoid health insurance scams with this handy-dandy checklist. Get answers to these questions before buying. A licensed and certified agent will be able to answer each of these questions regarding health insurance. And, if it looks “too good to be true,” it probably is.
Though there are many things to consider when purchasing Health Insurance, Premiums are a top consideration. Other costs to consider are deductibles, co-pays, co-insurance and maximum out of pocket limits.
Michael and Leah have welcomed a new baby into the family. Some options for Health Insurance include adding the child to an existing Health Insurance plan, getting an individual or family plan through the Health Insurance Marketplace (sometimes called Obamacare) or they can apply for Medicaid or CHIP coverage. Once notified, Insurance companies may add a child to an existing Health Insurance policy if a child is a biological child, adopted child or stepchild. There may be an increase in premium.
Health Insurance can be complicated and a litle overwhelming. So many choices. So many people shouting. How do you know where to look or who to trust? Here are options available based on life situations.
