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Mar 25

Medicare Explained in 10 Minutes!

Posted on Wednesday, March 25, 2020 in Uncategorized

As of this post, March 25th, 2020 it is not likely I will be seeing people face to face to explain Medicare and the options you have with it. Normally I WOULD see you face to face at your home, a restaurant, library, my house or wherever. Until I can do that I again I will talk to you on the phone or skype, or communicate via e-mail and text. But just to get things started, this is pretty much my explanation of how it all works as you go ON Medicare. As mentioned, I do have my cheat sheet, which I normally leave with people after explaining things, as it helps you “see” how it all works. Again, this is just a starting point, to help you start to understand the wonderful and confusing world of Medicare.

CLICK ON THE VIDEO

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Medicare Explained in 10 Minutes

 

Jan 2

Had Enough of Joe Namath Yet?

Posted on Thursday, January 2, 2020 in Uncategorized

Namath2WOW! There was probably a million TV commercials about Medicare during Open Enrollment this past Fall, and I think Broadway Joe was in half of them!

You probably saw more than I did, as I was working 15 hour days in October, November and December, but I heard about it at appointment after appointment.                            You may have wondered, “What is he talking about? You don’t get all this stuff for free!” And you weren’t about to call an 800 number to find out!

He was referring to Medicare Advantage Plans. Medicare Advantage is Part C of Medicare. It can be considered somewhat of a replacement for Original Medicare, as Medicare itself does not process your claims, the INSURANCE company you signed up with does. As such, the insurance company decides what your out of pocket costs  for hospital and medical services will be. Rather than deductibles and co-insurance, like Original Medicare, many Advantage plans have fixed costs for services in the form of co-pays.

“But Joe says everything is FREE!”

I think the idea behind the ads was to get the specific attention of those whose income is low enough to qualify for a particular segment of Medicare Advantage Plans, ones geared for those on Medicaid as well as Medicare. Those with incomes below the Federal Poverty Level for their household size may be eligible for a “Dual Eligible” plan, in which case, many services are at no cost. This may include a fair amount of dental, vision and hearing coverage at little or no cost as well. I’ve been told that only half of the individuals who would qualify for such a plan, actually have one…so the insurance companies are aggressively reaching out to this segment of the Medicare population.

By calling the 800 number to see, “IF YOU QUALIFY,” it opens the door for the agent on the other end of the line to not only see if you fit the strict guidelines for a Dual Eligible plan, it allows them to offer many, many other options to you IF YOU DON’T QUALIFY.

I have nearly 900 clients on a Medicare Advantage Plan. And it’s true, most do not pay a premium for their plan. (probably 90% of my Advantage plan clients pay ZERO premium). They still have to pay for Part B of Medicare, which is $144.60 a month in 2020, but no additional cost for the plan.

Medicare Advantage is one of the main “paths” to take when you are on Medicare. The other main path being Medigap, the insurance that supplements Original Medicare. When I meet with clients, we talk about both approaches. There is no single “right path” that fits everyone. But which one is right for you? I don’t know! That’s why we get together and figure it out!

I don’t have an 800 Number. I have a local number. (717) 468-0130.

And the only thing I can promise you for FREE…is my time. You’ll never pay me anything. And I come to see you. Plus I’ve done it probably 4000 times, so I can’t guarantee a Super Bowl victory, but I feel safe guaranteeing I know what I’m talking about, and a safe bet I know more than Joe Namath!

 

Apr 19

Did You Google Me?

Posted on Thursday, April 19, 2018 in Uncategorized

What’s one of the first things you do when you want to learn more about a person, place or thing? Go to the internet and see what you can find out!If you were expecting a super duper slick and fancy website, sorry! I’m just a simple guy who does one thing, all day, every day…meet with people to explain Medicare itself, and the options that are available with it. I use this blog to introduce myself, give a little bit of info about Medicare, and just try to show you I’m a regular sort of guy.

 

Apr 8

Good Bye Good Boy

Posted on Sunday, April 8, 2018 in Uncategorized

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In the Fall of 2010, my daughter Kate, then a 6th grader, wrote the greatest essay of her life.  The topic?  Why she deserves to have a dog!

Frequently Lori and I lovingly referenced Willie, our gargantuan golden retriever that we had when Kate was just a baby.  But we also said it’s a lot of responsibility to have a dog, a lot of work, a lot of money, yada yada yada textbook Parentspeak any Mom or Dad can spew by reflex.

Kate was determined. She wanted a dog! She promised to walk it, feed it, love it yada yada yada, you know, hollow promise Kidspeak. And she wasn’t having the, “We can’t afford it!” speech.  She said SHE would pay for it, and pay for his food and toys and whatever else dogs need.  She had money saved from working every Saturday at Uncle Davey’s Diner.

We gave in! 

At the time my long time NYC soul sister Connie worked for the City coordinating the transport of rescued animals to various shelters through the Tri-State area and beyond.  She’d send pictures and background stories on various critters.  The younger the better, to enjoy the whole puppy experience.

After a few failed attempts at adoption, a couple of pups had been shipped to PA, probably no more than 9 or 10 weeks old.  Two white males with patches of yellow or tan, possibly labs mixed with pit bulls.  “Are they pit bulls???” Lori suspiciously inquired. “I don’t think so.” I shrugged unconvincingly.

A week before Christmas, in Bethlehem no less, we went to see the 2 pups rescued off the streets of Harlem. They were now nicknamed Butterscotch and Creamsicle!  Kate picked the one that was getting pestered by his brother, and named him Oliver. Ollie! I think we brought him home in a medium sized piece of Tupperware with a blanket inside.  Waiting at home was all the goodies we had waiting, purchased under the supervision of suzi que, legendary local dog Mom

It was great having a dog again! Puppy moments! Tearing ass from room to room spontaneously for no good reason. Chowing food. Chewing toys. Crying in his crate.

Kate was true to her word, mostly.  She paid the $150 adoption fee, bought him toys and food and whatever else dogs need.  The walking and feeding and cleaning up after it, not so much.

Puppies stay puppies in spirit, but blow up as fast as a clown balloons.  80 pounds of muscle in a matter of months.  His stocky build and short snout were all pitty, his webbed feet and taller frame were Lab.  His ears were the tie breaker, and he could adjust down or back to keep you guessing.

Barks like a watchdog, cuddles like a lap dog. Beware of Dog! You’ll either be licked to death or take 40 lashes with a wagging tail!

I know, you’re nodding your head.  Same for your fur friends too, no matter the size or the breed.

And I’ll bet you know where I’m going with this…something’s wrong.

Starting in February, he just wasn’t himself. Lack of appetite, not interested in walks, sleeping all the time, looking sad.

It’s cancer. Leukemia. We tried to treat it. But the white blood cells were off the chart, and now the red ones barely show up. He’s got no energy. Rather than seek other avenues of treatment, we wanna love him to death.

We’re nearly blind from balling our eyes out.

We’re looking at pics and playing rewind in our mind for all the happy times and bad ones too.  The farting, the ball-licking, the nail chomping, the snoring. Eating documents (and homework!) and socks and underwear, and kindles and gaming devices. Barking like we are under attack from terrorists when it’s just the garage door opening!

I guess we’ll have to finish DQ blizzards all by ourselves now. Crinkling a plastic grocery bag won’t have him skipping into the kitchen, ready for a walk. No more races to the stairs when it’s time for bed.  No more trembling in fear when it’s time for a “tubby”.

Oh Oliver, you’ve meant so much to all of us. Such comfort, such joy. When no one believes in you, when you don’t believe in yourself, your 4-legged family member lifts you up, makes you smile, let’s you know everything’s gonna be all right.

We’ve arranged for Lap of Love to come Thursday afternoon and do what they do. We don’t want to say goodbye. We don’t. But we know it’s the right thing to do.

Times were tough in Williams house when Oliver came along.  It makes me wonder, “Who rescued Who?”

Nov 12

What is the Donut Hole???

Posted on Sunday, November 12, 2017 in Uncategorized

I am frequently asked 3 questions about a mysterious and misunderstood segment of Medicare Prescription Drug (Part D) coverage:

1. What is the Donut Hole?
2. How do I get in the Donut Hole??
3. How do I get out of the Donut Hole???

Whether your Medicare Prescription Drug Coverage is a “stand alone” Prescription Drug Plan or included in your Medicare Advantage Plan, it has the dreaded Donut Hole.

What is the Donut Hole?  Technically it is the “Coverage Gap” in Medicare, just one segment of the 4 Part D Coverage stages:

• Deductible: If your plan has a deductible, you will pay the “Full Cost” of the drug until you meet the annual deductible, though some plans exclude some “tiers” from deductible.
• Initial Coverage: After the deductible has been met, you generally have fixed amounts to pay for your drugs—Co-pays or Co-insurance (percentage of the cost)
• Coverage Gap (Donut Hole)
• Catastrophic Coverage

How Do I Get IN the Donut Hole??

Part D Prescription Drug Coverage works on a calendar year basis, January 1st through December 31st. As you fill prescriptions throughout the year, your plan is keeping track of the “Full Cost” of your drugs. For example you may pay $3, $20 and $47 dollars for three different drugs that actually cost $11.55, $66.23 and $454.81 dollars.
If the FULL COST of your drugs added together in the calendar year reach a certain threshold, (which changes each year), it is $3750.00 in 2018…YOU ARE IN THE DONUT HOLE!!

All Plans have the Donut Hole, and what you pay for drugs changes to a percentage of the “Full Cost” your Part D Plan has for your prescriptions. In 2018 the costs are 44% on Generic drugs and 35% of Brand drugs. (the percentages change each year)

How Do I Get OUT of the Donut Hole???

Stay with me here! Your “True Out Of Pocket” (TROOP) costs must reach $5000.00 in 2018. The 5000 really has nothing to do with the 3750, it is 2 different calculations! The TROOP of 5000 is reached by adding up what YOU actually paid initially, this includes deductible if any, then co-pays/co-insurances in Initial Coverage plus the 44% on generics/35% on brands in the Donut Hole, AND the drug manufacturer of your Brand name drugs contributes 50% of the cost of the Brand drug. If this adds up 5000, then…YOU ARE OUT OF THE DONUT HOLE!!!

Now you are in Catastrophic Coverage. Costs generally go down. For 2018, you will pay the greater of 5% of the full cost of your drugs, or $3.35 for generics, $8.35 for brands. This will continue to the end of the year, and it starts all over again from the beginning on January 1st!

Pretty easy, right? LOL!

Oct 1

Do You Have the Right Part D Plan for 2018?

Posted on Sunday, October 1, 2017 in Uncategorized

A good way to compare Rx costs on your current Part D plan for 2018 is on the official U.S. government site for Medicare:

• Go to www.medicare.gov
• Select the green tab for Find Health and Drug plans
• Enter zip code
• Step 1 Enter Information (about your current type of Medicare coverage)
• Select Current “Drug Plan” (Find your 2017 plan)
• Step 2 of 4. Enter Your Drugs. When finished click “My drug list is complete”
• Step 3 of 4. Select Your Pharmacies. You must select 1, but no more than 2
• On the next page, Step 4, Refine Your Plan Results, the choices are:

o Prescription Drug Plans (with Original Medicare)
o Medicare Health Plans with drug Coverage (aka Medicare Advantage)
o Medicare Health Plans without drug Coverage

Select “Prescription Drug Plans” and it will sort the choices in order for the projected lowest overall costs for all of 2018. “Overall” is the combined total of monthly premiums for the plan, plus the costs to fill prescriptions for all of next year. It will show prescription costs if purchased at a retail pharmacy, as well as through mail order. 2018 data should be on-line as of 10/1/17.

You will receive an Annual Notice of Change (ANOC) from your current plan provider every year at this time. This tells you about any changes for 2018.

Common Reasons for Changing Part D
• Formulary Change: The formulary is the list of drugs your plan covers. Make sure all of your drugs will be covered next year. If they are dropping any of the drugs you take, you would have to pay full price for them next year!
• Changes in the Pharmacy Network: Just because your favorite drug store accepts your plan this year, doesn’t automatically mean they will next year.
• You Now Take Brand Name Drugs: Your Rx list of will change throughout your life. Your current plan may cover your brand, but it may be cheaper on another plan.
• Drug Tier Change: Prescriptions are categorized into “tiers”. Many plans have a 5 tier system that looks like this:
1. Tier 1: Preferred Generic
2. Tier 2: Generic
3. Tier 3: Preferred Brand
4. Tier 4: Non-Preferred Drug
5. Tier 5: “Specialty” Drugs
If some of your drugs have switched tiers, you may pay more for them next year.
• Big Increase in Plan Premium: How much is too much? It’s up to you, but it makes sense to check and see if another plan is significantly more cost effective.

Sep 27

Yeh, I Probably DO Know Where You Live

Posted on Wednesday, September 27, 2017 in Uncategorized

Johnny Cash had a song called, “I’ve Been Everywhere,” in which he rapidly sings city after city he’s been to. Well I travel all over Lancaster, Lebanon and Berks Counties, visiting with people to explain the confusing mess of Medicare.

Just in the last 30 days I’ve been to Morgantown, Mohnton, Green Hills, Paradise, Lancaster, Ephrata, Lebanon, Palmyra, Myerstown, E-town, Exeter, Wyomissing, Refton, Willow Street, Manheim, Stevens, Landisville, East Earl, New Holland, Akron, Kempton, Millersville, Holtwood, Fredericksburg, Leola, Lititz, Ronks, Boyertown, Oley, Birdsboro, Kutztown, Columbia, Newmanstown, Mount Joy and Hamburg!

I have friends that are brokers for Medicare Insurance like I am, and they all have plush offices for people to come to. I would be bored out of my mind in an office day after day! I like going to different towns every day. I enjoy meeting clients in their home, petting their dog(s) and cat(s), seeing their family photos, and just getting a better sense of who they are.

Sep 12

How Many Phone Calls About Medicare do YOU Get???

Posted on Tuesday, September 12, 2017 in Uncategorized

If you still have a “land line” phone in your home, chances are very good that agents or telemarketers from insurance companies will call you repeatedly to pitch their Medicare Insurance product(s) to you. They call from all over the country: Texas, Oregon, Florida, etc.

They don’t leave messages. Do you know why they don’t? They know you won’t call them back!

Over 95% of the time when I meet with people to explain options with Medicare Insurance, it is in their home. I have no problem driving up to an hour from my house in Ephrata to where my clients live, typically somewhere in Lancaster, Berks or Lebanon County. It is not uncommon for such phone solicitations to happen 2 or 3 times in the hour that I am in their house!

Some people, in a moment of weakness, or purely by accident, actually answer one of these calls. Shockingly, some people, some really otherwise intelligent people, buy whatever the person on the other end of the line is selling! Now, some of these agents who solicit over the phone, may actually know what they’re talking about. Some may actually be brokers, and can offer multiple companies as options.

Some.

I feel the decisions to be made about your health insurance for the REST OF YOUR LIFE is a little too important to be made over the phone, with anyone, let alone someone on the other end of an 800 Number.

The phone IS necessary…to set up a time to get together face to face, one on one. I DO NOT SOLICIT BY PHONE, I only use the mailbox. I will certainly call you back, but you’ve got to start the ball rolling by calling me first at (717) 468-0130.

I hope to hear from you soon!

Sep 11

You Look Comfortable!

Posted on Monday, September 11, 2017 in Uncategorized

With a warm smile, that’s what a new client said to me today, “You look comfortable!”

Yes it was another sunny September day in scenic Lancaster County, 10 am, first appointment of the week and I was well rested and ready to go. However I think it had more to do with the contentment and joy in doing what I do. Perhaps some of it is being completely confident in what I do. I meet over 500 NEW people each year. I’ve met with THOUSANDS of people about Medicare insurance. The basics are the same, the presentation is the same, but the people are all different. Each person is an individual, so each time it feels brand new, and it’s fun!

Yes. I AM COMFORTABLE!

Oct 31

Ephrata Girls U12 Soccer G-Force!

Posted on Saturday, October 31, 2009 in Uncategorized

Another season of soccer has come and gone.  The “G Force” was 2-5 with a 3rd place finish in the Season ending festival.   In a show of team solidarity they all sprayed their hair with purple and gold paint and sparkles, then added some face paint with Gold E’s and their jersey number on their cheeks.  Earlier this week we had fun at our last practice by dressing up and being silly.

Ephrata Girls U12 Fall 09

Ephrata Girls U12 Fall 09Ephrata Girls U12 Funny FaceEphrata U12 Girls Soccer HalloweenEphrata Girls Soccer U12 Wacky Wednesday

Ephrata Girls U12 Funny Face
Ephrata Girls U12 Halloween Practice

Ephrata Girls U12 Halloween Practice