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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.

 

Mar 21

My Favorite Medicare Myth!

Posted on Wednesday, March 21, 2018 in Medicare

There are many myths about Medicare, or maybe just misunderstandings.  My favorite, or probably just the one I hear most of all is:

“You have to sign up for Medicare 3 months before your 65th birthday, or you get penalized!”

Oh boy, where do I begin to debunk this myth? As long as you have “creditable” coverage elsewhere, typically from your own employment or your spouse’s employment, there will never be a penalty for signing up for Medicare later, even well past your 65th birthday. So, you do not have to sign up for Medicare. Not even Part A, the “free” part.

When you are approaching the age of 65, you’re mailbox gets stuffed with promotional offers about Medicare Insurance Plans, like Medigap Supplemental Insurance, Medicare Advantage Plans and Prescription Drug Plans. (None are as informative, clever and humorous as mine, of course) The funny thing is, none of these mailings are from Medicare, unless you are already collecting Social Security.  That’s right!  If you are not yet collecting your monthly retirement benefit from Social Security, you will not receive a single thing in the mail from the Government, telling you what you have to do (or don’t have to do) regarding Medicare! Weird, right?

Myths are widely held beliefs, or false ideas.  Medicare has been around for over 50 years.  I don’t know who started this one, but it’s spread around for decades, “You have to sign up for Medicare 3 months before your 65th birthday, or you get penalized!”  There CAN be a penalty, it’s just that few people end up owing it.  If you wait to enroll in Medicare past age 65, for every 12 month period you did not have Part B, and did not have creditable coverage, you will pay 10%  more for Part B for the rest of your life. But, as previously stated, the likely reason to delay taking Part B, is because you DO have creditable coverage.

And…NO…you do NOT have to let Social Security or Medicare know that you are NOT going on Medicare at 65.

If you are still puzzled by what you HAVE to do with Medicare as you are nearing 65, call me (717) 468-0130, call Medicare (1-800-MEDICARE) or call Social Security (1-800-772-1213).

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!

Mar 2

Did You Get A Letter From Me?

Posted on Thursday, March 2, 2017 in Medicare

Brian Weems Williams Letters About Medicare

Feb 21

The Joy of a Colonoscopy!

Posted on Tuesday, February 21, 2012 in Family

Oh what a blast it is turning 50! I hit the big 5-oh back in December.  Three days after my birthday I had foot surgery to remove a planters wart from the ball of my left foot.  Now, 6-7 weeks later it finally feels as good as new. This ends nearly 6 months of nagging pain with this stupid wart. But that’s another story.

One of the things recommended for anyone turning 50 is to have a preventive colonoscopy.  I had a sigmoidoscopy done about 10 years ago, and that’s a completely different violation of the human body which can only be experienced to fully understand.  There is no pain with the colonoscopy, the discomfort is in the “prep”.  And I might also add, a liquid diet the day before the procedure no party, even though I could have milkshakes all day!

The day before your procedure and the morning of your procedure, you must chug a quart of liquid that tastes like, and has the thickness of, lemon fresh Joy dishwashing liquid. My brand was called MoviPrep. It is almost comic in its efficiency. About 45 minutes after the first 8oz gulp of this goop you think a volcano is going to erupt in your belly. And it does. Many times over the next hour. Then peace reigns, until assault part 2 begins the next morning!

After part 2, your colon is picked cleaner than Cindy Lou Who’s house on Christmas Eve after the Grinch got done with it! By the time I  was in Ephrata Hospital ready to be wheeled into the OR, I couldn’t wait to be put under by the anasthesia, because I was  so insanely hungry I pondered eating my own fingers!

God only knows what kind of jokes the doctor and staff are cracking while the roto rooter is trolling your intestines, because you are OUT. I remember rolling over on my side and then waking up in recovery about an hour later.

They found polyps, as they did 10 years ago. Almost 4 weeks since my colonoscopy and I haven’t heard anything about the diagnostics on the polyps. I’m mildy concerned about the polyps themselves, more concerned about the bill! Because I checked with my insurance carrier before the procedure. As a “screening” it’s at no cost as a provision of health care reform. However, if they find polyps, it’s diagnostic and the free part is thrown out the window. Or so I’m told, we’ll see.  I will report on it when I see it.

Did I mention I got my AARP card?