Medicare, COBRA & Individual Health Insurance

My name is Ryan McCostlin, and I'm the Bernard team member responsible for directing retail operations. Prior to Bernard, I was at Sears Holdings Corporation where I worked on ecommerce and online strategy.  Previously, I was a consultant at Stockamp & Associates, a boutique healthcare consulting firm focused on financial and operations consulting for American hospitals.  

I'm excited about our mission at Bernard Health.  We aim to be the world's most trusted advisor when it comes to helping people plan for expected and unexpected healthcare expenses... no short order. I'm also excited about returning to Nashville.  After five fantastic years up and down the East Coast, it's good to be back.  

Here at Bernard, we have two editions of the Woof Street Journal.  If you have questions about individual health insurance, click here for more content.  If you're looking for information about employer (group) health insurance, click here.  If you're just interested in what I have to say, you're in the right place. 

Most people are accustomed to filing taxes every spring.  Likewise, there is a window each year when Medicare beneficiaries can evaluate their Medicare options and, when appropriate, switch plans.  This window is called the Medicare Annual Enrollment Period.  In 2011, the Annual Enrollment Period runs from October 15 – December 7.  

Though rare, there are times when enrolling in Medicare Part A may not be the best strategy even though the benefits are often free.  If you want to disenroll from Medicare Part A, you can fill out CMS Form 1763 (available by contacting Bernard Health) and mail it to your local Social Security Administration office. 

To disenroll after turning 65, you are required to pay back all of the money you may have received from Social Security as well as any Medicare benefits paid.  You can re-enroll at any time by calling Social Security at 1-800-772-1213 or by visiting your local Social Security Administration office.

If you turn down Medicare Part B when you’re first eligible and don’t have other coverage through an employer, but later decide you want Part B coverage, you can only enroll during from January 1 – March 31 of the following year. 

Your Part B benefits will not be effective until July 1 of that year.  You may also be required to pay a late enrollment penalty of 10% of the current Part B premium for each 12 month period you delayed in enrollment.

 

The list of prescription drugs covered by a Medicare Part D plan can vary from plan to plan.  However, every therapeutic category of prescription drugs will be covered by any one plan.  Medicare Part D plans must cover the following types of drugs: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatment), immunosuppressants, and anticancer.

Within those categories, Medicare Part D plans establish their own lists of approved drugs.  These lists are called formularies.  Most Medicare Part D plan formularies are divided into four or five tiers, and each tier is assigned a different copay amount. 

Some types of prescription drugs are excluded from Medicare Part D.  They include certain types of anti-anxiety and anti-seizure drugs, Barbiturates, Benzodiazepines, prescription vitamins and minerals, and prescription drugs used for anorexia, weight loss or weight gain, fertility, cosmetic purposes or hair growth, and relief of cold symptoms. 

If you don’t join a Medicare drug plan when you are first eligible for Part A, and you go without  prescription drug coverage* for 63 continuous days or more, you may have to pay a late-enrollment penalty to join a plan later.  The penalty amount changes each year, and you will have to pay it for as long as you have Medicare prescription drug coverage.

Now, we realize that no one likes to pay a penalty, but if you find out that you do owe a penalty, know that the penalty for late enrollment in 2012 will be ~$.40 per month for each month that enrollment was delayed.  For example, if you delayed Part D enrollment by 10 months, you would owe an extra ~$4.00 each month, or $48 each year.

*Even if you have prescription drug coverage through your employer, you’ll want to make sure that the prescription benefit counts as “creditable”.  If it doesn’t, be sure to sign up for a Part D plan to avoid a late enrollment penalty! 

Medicare Advantage Plans are health plan options that are part of the Medicare program.  If you join one of these plans, you generally get all of your Medicare-covered healthcare through that plan.  This coverage can include prescription drug coverage.  Medicare Advantage Plans include:

This varies from state to state.  If you are under 65 and receive Medicare benefits due to disability or end-stage renal disease, you may not be able to buy a Medigap plan until you turn 65.  Federal law does not require insurance companies to sell Medigap plans to people under age 65, however, some states require insurance companies to sell you a policy, at certain times, even if you are under age 65. In Tennessee, Medicare beneficiaries who are under 65 are able to enroll in a Medigap Plan as of January 1, 2011.

During the first six months after you turn age 65 and are enrolled in Medicare Part B, you can sign up for a Medigap plan without undergoing medical underwriting. 

When you first qualify for Medicare coverage, it takes time and diligence to evaluate whether to enroll in Medicare Part A, Medicare Part B, or both.  In fact, the Medicare enrollment process can be so frustrating that many Medicare beneficiaries get through the paperwork or online enrollment, wipe their brow, and say, "Boy, I'm glad that's over with."


That's what happened with a recent Bernard Health client (let's call him David).  David first qualified for Medicare in September, 2009 due to a disability. He had some trouble filing paperwork and providing documentation to qualify for Medicare, and by the time he received approval, David was just glad to receive Medicare benefits at all. As a result, he never enrolled in a Medicare Part D plan, Medicare supplement, or Medicare Advantage plan. 

Since 2009, David's prescription drug costs continued to rise.  By the time he called Bernard for help, David was paying over $600 per month for maintenance drugs.  David met with a licensed, non-commissioned Bernard Medicare advisor over the phone.  We collected his information and analyzed all of the options available in his town in Missouri.  The advisor found David a Medicare Advantage plan that saved him over $5,000 annually on Medicare and prescription drug costs! 

If you're confused by your Medicare options, Bernard can help.  Call 615-528-3399 for more information or to schedule a free consultation. 

There's a lot of misinformation surrounding Consumer Driven Health Plan design, and if you've ever confused an HSA with an FSA, check out the chart below.  

Health Savings Accounts are a clear winner, if you ask me.  Pay special attention to the row titled "Carryover of unused funds".



Chart originally prepared by Victoria Craig Bunce, Director of Research and Policy for the Council for Affordable Health Insurance.  Link to original available here.  Keep up the good work, Tory! 

I met with a respected business leader in Nashville last week (let's call him Paul) who had recently visited his local Social Security office to opt out of Medicare Part A.  "Opt out of Medicare Part A? Why would he do that? Isn't Medicare Part A a free benefit?", you might ask.

Having done the analysis and compared his options, Paul realized he was better off forgoing Medicare benefits for the time being.  Instead, he would continue to accept tax-advantaged contributions from his employer to his Health Savings Account.  If Paul decided to enroll in Medicare, you see, he would no longer be able to accept this free HSA money. 

The representative at the Social Security office, with all the best intentions, could not understand why Paul would be giving up a "free" benefit.  After a lot of headshaking and confusion, the Social Security office representative eventually relented and proceeded with the opt out. 

When we met, Paul half-jokingly told me that if he hears "Medicare Part A is free" one more time, he might throw up. 

After dozens of hours comparing options, Paul found the best strategy for him.  At the Bernard Health retail store, we meet hundreds of people who don't quite understand how Medicare works.  By finding the right strategy, however, you could save thousands of dollars.  If you'd like to discuss your Medicare options, you can reach a licensed, non-commissioned, advisor at 615-528-3399. We'd be glad to help. 

Last week, I read a Health Affairs article titled Complex Medicare Advantage Options May Overwhelm Seniors.  With all of the health insurance options available to seniors, it's no surpise they're confused.  In the zip code of Bernard Health's world headquarters in Nashville, Tennessee, there are 52 different Medicare plans available. 52. 


Finding the right Medicare strategy is perhaps more like filing your taxes than buying car insurance. Comparing government options, employer retirement plans, private prescription drug plans, and private Medicare Advantage plans is enough to overwhelm anyone. 

If you or someone you know is entitled to Medicare benefits, you should ask three questions:

1. Should I enroll in Medicare now or later? 
2. Which of the 14 Medicare strategies is right for me?
3. Within the identified strategy, which carrier will allow me to spend the least possible without compromising access to care? 

If you'd like help, you can call 615-528-3399 to speak with a licensed, non-commissioned Medicare advisor at Bernard Health who can guide you through the process.  We're glad to help. 

Whether health reform stays in place or changes again, Health Savings Accounts can save your organization and your employees a fortune while providing more protection and more peace of mind.  If you haven't already signed up, you only have until the end of the day on Wednesday to buy tickets to Bernard's Breakfast Symposium, scheduled for 8:00 AM on September 27 in Nashville. 

Featured speakers include former George W. Bush healthcare advisor (and architect of Health Savings Account legislation) Roy Ramthun and RJ Young Co. CFO, Sam Shallenberger.  

Officially, the event is titled Health Reform and Health Savings Accounts, and you can register here. 

"I'd like to provide health insurance for my employees, but the margins in my business are too slim.  I just can't afford it." 

Many employers have told us that they'd like to have a health insurance program in place, but comprehensive group health insurance is just too expensive.  That's why Bernard Health created a health insurance program used as a recruitment and retention tool that costs ~70% less than comprehensive coverage. 

Short answer: Sometimes. 

Medicare Supplements (also called Medigap plans) have certain enrollment periods during which you can sign up without answering any medical questions or facing the possibility of having pre-existing conditions exluded. There are two types of enrollment periods during which approval is automatic. They are Open Enrolllment and Guaranteed Issue Enrollment. 

Open Enrollment
The open enrollment period for Medicare supplements begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B.  Once that period begins, you have a 6 month period when insurance companies are not allowed to refuse you Medicare supplement coverage for any reason. 

Guaranteed Issue Enrollment
Outside of your open enrollment period, there are other circumstances that allow you to enroll in a Medicare supplement without underwriting.  Those circumstances may include:

• Losing employer coverage due to retirement or death of a spouse
• Losing a Medicare Advantage plan
• Moving to a new state out of a Medicare Advantage plan area

When these situations occur, you typically have 63 days to sign up for a Medicare supplement without having to answer any medical questions or risking being denied coverage for pre-existing conditions.  

If you have questions, you can contact one of Bernard Health's licensed, non-comissioned Medicare advisors by calling (615) 479-2196.  

At Bernard Health, we regularly meet clients with dozens of Medicare questions.  Transitioning to Medicare can be overwhelming, and it can be difficult to know which is best.  By finding the right strategy, however, one can save thousands of dollars in Medicare related premiums and other costs.

Today, Bernard Health announced the release of its web-based benefits enrollment system, the BerniePortal.

Developed over the last 4 years, the BerniePortal was originally utilized by Bernard’s group benefits brokerage clients to take their benefits administration process online. Now, with thousands of users, clients cite four benefits to using it:

1. Save money: moves complex paper business processes online

2. Save time: cuts down on mistakes and time-intensive effort of filling out paperwork

3. Peace of mind: eliminates liability associated with paperwork errors

4. Happier employees: no one likes filling out insurance paperwork

Prior to the BerniePortal, employers were faced with mountains of paperwork every time they had a new hire, and then again at annual benefits enrollment. While most larger employers moved this business process online a long time ago, small to medium sized employers (30 to 400 employees) generally have not been able to do so.

With the BerniePortal, these employers now have access to an affordable, easy-to-use, web-based benefits enrollment system that has extremely low upfront costs and no contractual obligation. Set-up takes about an hour, employee sign-up just 5 minutes. Furthermore, employers can keep the same health insurance broker they have always had.

At a fundraiser in Nashville last week, I met a nurse practitioner who works at one of Nashville's most well-respected medical practices.  Let's call her Sarah.  As a nurse practioner, Sarah understood the impact of misaligned incentives in healthcare.  In fact, she witnessed them every day.  

During our converstion, Sarah gave me a firsthand account of some of the most oft-cited and maligned practices that contribute to uncontrollable healthcare costs.  At her medical practice, managing physicians instruct nurse practitioners to order ultrasounds for every patient that visits, regardless of evidence-based medical necessity.  Why would such a practice be implemented? Defensive medicine? Exploitation of fee-for-service reimbursement models? 


From January 2010 to January 2011, Health Savings Account enrollment grew from 10 million to 11.4 million in the US.  Though not a panacaea, I like to think that a patient with a Health Savings Account based health insurance plan would push back and ask questions about why certain tests and procedures were being ordered, maybe even saving some money in the process.

Many of our clients at Bernard Health have had the experience of receiving a medical bill that included some kind of error.  According to a story in yesterday's Washington Post, patients have a 50% chance of overturning a health insurance company's medical bill payment decision when they appropriately file an appeal.   The key is appealing correctly. 

If you've had a medical claim denied by your health insurance carrier, the appropriate next step might be to ask your physician and insurer to cross-reference your treatment with your diagnosis to make sure they're in sync. 

You may be able to complete the appeals process yourself, but if you'd prefer to consult with a licensed, non-commissioned medical bill expert, you can contact a Bernard advisor at 615-479-2196. We'd be glad to help.