How To Maximize Your Medicare Budget

How To Maximize Your Medicare Budget text overlaying image of someone writing medicare on a white board Medicare is an essential program for seniors over 65, however, many of its benefits are underutilized or misunderstood. Consider the annual “wellness” visit. During which a physician will assess your health risks, take your blood pressure and other routine measurements, test for cognitive impairment, and provide personalized health advice. It’s Free! Nonetheless, a surprising number of people do not take advantage of this benefit. This isn’t the only benefit that has gone under the radar. Many healthy seniors ignore a variety of free preventive services, ranging from bone density screening to cancer detection. Other benefits such as home health care, are also frequently unused due to their strict eligibility requirements. Below you’ll find all the ways to make sure you’re using all of your benefits and getting your money’s worth.

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Choose The Right Doctor

It is important to choose a doctor who accepts Medicare assignments in order to save money. If a doctor accepts a Medicare assignment, they accept Medicare-approved amounts as full payment, and you cannot be charged more. Most physicians who treat Medicare patients will accept Medicare assignments. Providers who don’t participate fall into two categories:

 

  • Non participating providers – These providers can charge up to 15% more than the Medicare approved amount for covered services and leave you responsible for the additional costs
  • Opt-out providers – These providers can charge whatever they want which is outlined in a private contract with the patient.

To locate physicians in your area who accept assignment, visit Medicare.gov to find doctors and other health professionals section. The search tool displays which physicians accept Medicare payments.

 

If you have a Medicare Advantage plan, check your plan’s provider directory or website to ensure you’re choosing doctors in the network. Keeping in mind that doctors may be added or removed at any time. Generally, you will pay more to see non-network providers. Make sure that you research different doctors. Confirm that they accept Medicare and are willing to educate you on what is and is not covered so that you are not overcharged.

Understand Your Policy

Medicare provides coverage for skilled services such as nursing, speech therapy, and physical therapy, but there are eligibility requirements. To qualify for these services, you must be homebound. Meaning you are unable to leave your home without assistance or because of a medical condition. Many seniors mistakenly believe that they are covered for these services, only to receive a hefty bill in the end. Before assuming something is covered, carefully read your policy’s guidelines.

Look Into Medicare Advantage

Medicare Advantage plans are offered by private insurance companies and offer the convenience of having Part A, Part B, and Part D services all bundled into one plan. Whereas traditional Medicare has you sign up for each plan individually. Medicare advantage plans may also include coverage for routine dental, vision, and hearing exams. Which are not available under Original Medicare. However, the biggest benefit of Medicare Advantage is the annual out-of-pocket maximums for seniors excluding 

prescription drug plans. Which as of 2023 is $8,300. With Original Medicare, there are no annual out-of-pocket maximums. 

 

However, you should also be aware of the disadvantages of Medicare Advantage. Original Medicare is widely accepted by physicians and hospitals all over the country. Whereas a Medicare Advantage plan will have a smaller network of providers. So, it’s possible that your doctor isn’t in their network. Next, you may be required to get a referral before seeing a specialist. Which is not the case for Original Medicare enrollees. There are also certain covered services that Parts A and B that may have a high copayment under a Medicare Advantage plan. Meaning you would have higher out-of-pocket costs with Medicare Advantage than you would with Original Medicare.

Consider Medicare Supplement Plans

If you have a chronic or serious health condition and will likely visit the doctor frequently, you may want to consider a Medicare Supplement Plan. Medicare covers the majority of eligible medical expenses for seniors, but you are still responsible for 20%-25% of the total cost of care. Medicare Supplement Plans were designed to help cover a substantial portion of the medical expenses that come from having Medicare Part A and B, that you would otherwise be responsible for.

 

As with Part D, private insurers offer Medicare Supplement Plans and with Part D, there are a variety of plans to choose from. So you should shop around carefully to find the plan that fits you best. While yes, Medicare Supplement Plans do have premiums and can increase your monthly expenses, the additional coverage could give you peace of mind and eliminate some of the uncertainty that comes with your out-of-pocket Medicare costs.

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Save On Medications

Even if you have Medicare Part D prescription drug coverage, your out-of-pocket costs can be astronomical, in part because Part D does not have a limit for out-of-pocket expenses. After you reach the catastrophic coverage threshold of $7,400 (as of 2023), the majority of people will continue to have to pay 5% of the cost of covered drugs. In certain instances, you can reduce drug costs by forgoing your Part D plan and paying cash. Big-box stores such as Costco and Target offer a variety of generic prescriptions for much cheaper, whereas many Part D plans have a high standard copay to fill a prescription. The only problem with paying in cash and not using your coverage is that the expense won’t count towards your deductible. 

 

If you stick with your Medicare Part D plan’s list of “preferred” pharmacies you will typically pay less for your prescriptions. Also most Part D plans separate their drug formularies (list of covered drugs) into 5 tiers: preferred generic, generic, preferred brands, non preferred, and specialty. With preferred generics being the lowest cost-sharing tier and the most affordable for enrollees. If you find a drug that is approved for your condition on a lower tier than the one you currently take, ask your doctor if you can switch to the more affordable one.

Review Your Quarterly Summary

Your quarterly Medicare summary displays services and supplies for which Medicare was billed. This summary will also indicate whether or not any claims have been denied; if so it is important to contact the provider of the denied claim. If you believe the claim is unjust, you can appeal the claim denial by following the instructions on the summary’s final page. When admitted to the hospital, for instance, you will receive a notice outlining your Medicare rights. You may request an appeal of the decision and a review of your case if you believe you were discharged prematurely.

Use Your Preventative Care

Many Medicare recipients don’t realize that there is a long list of services that they can get for free. Medicare provides numerous screenings and annual wellness visits at no cost to you. These free preventative measures are important for detecting serious illnesses early. The screenings may include depression, cardiovascular disease, and other conditions. There are free counseling sessions for tobacco and alcohol abuse, as well as free vaccinations for flu and pneumonia. Additionally, you are eligible for a free “welcome to Medicare” preventive visit within the first 12 months of receiving Medicare Part B. During this initial appointment, you can also receive free assistance planning for end-of-life care. And your physician can help you draft an advance directive that outlines all of your wishes.

 

Utilizing these freebies can aid doctors in detecting major health problems before they worsen, thereby preserving your health. You might also have access to free wellness benefits if you have a Medicare Advantage plan. Some Advantage plans, for instance, include SilverSneakers membership at no extra charge. This program provides a basic gym membership and access to senior-specific group exercise classes.

Plan Yearly Expenses With The Out-Of-Pocket Maximum In Mind

Individuals’ Medicare costs can vary widely based on their circumstances and the type of coverage they have. Original Medicare typically covers 80% of a beneficiary’s Part A and Part B expenses. Such as doctor visits, hospital stays, and lab work. Individuals are responsible for remaining 20% of out-of-pocket costs, with no annual cap. Medicare Advantage plans offer predictable copayments and an annual limit on out-of-pocket costs. Once you reach your plan’s out-of-pocket maximum, all Medicare-covered services for the remainder of the year are covered in full. This cap can provide peace of mind if you have a sudden illness or are preparing for a major medical procedure.

Shop Around Every Year

Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), is relatively simple. There is no need to shop around for Parts A or B because they come in a universal package. Where you should shop around is your Medicare Part D plan and your Medicare Supplement Plans. Medicare contracts with private insurance companies that offer Part D and Medicare Supplement Plans to provide seniors with a variety of coverage options. Moreover, these coverage options and their costs can change from year to year. This means that the plan you have this year might not be the best for you next year. The worst thing you can do is automatically enroll in your previous year’s plan without comparing options. This could result in higher out-of-pocket costs and for Part D could mean less coverage for prescription medications.

Get Help From EZ

If you’re looking for a Medicare Supplement Plan or Medicare Advantage Plan, you must compare the costs and benefits of each. This requires extensive research. Which can be time-consuming, as you will need to contact multiple insurance companies to obtain rate quotes. However, if you work with one of EZ’s agents, you can compare prices in half the time. Working with a licensed agent provides you with access to a variety of carriers and plans. 

 

In addition to providing price comparisons, your agent can explain the differences between each plan. And explain the differences between each plan. In addition, your agent can assist you in determining which plan will be the most cost-effective for you in the long run by comparing out-of-pocket costs and premium costs. Call us today at 877-670-3601 or enter your zip code in the bar below to begin comparing.

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7 Reasons Seniors Should Try Fasting

Intermittent fasting is a hot trend. Going 16-18 hours a day without consuming any calories does not sound that easy, but it can be. Recent studies show that there are long-term benefits to intermittent fasting, such as lowering belly fat, boosting brain function, and helping you live longer by reducing your risk for conditions such as diabetes and heart disease. But is this a safe practice for seniors? Absolutely!

smooth for fasting with seniors
As long as you’re getting your daily calories and nutrients, you should be safe to fast.

1.Reduced Insulin Resistance

During the fasting period, lower insulin levels improve fat burning in the body. Not only will it improve fat burning, but the lowered insulin levels will help encourage muscle growth. Studies show that fasting reduces insulin by 20-31%.

2.Detox The Body

When you fast, your body removes toxins. One way this occurs is from shedding weight. When you intermittent fast, your body will burn fat, using it for the energy it’s not getting from food. The fat cells are the usual culprits for toxin storage, keeping it from what we eat and breathe.

When you cleanse your body from toxins, you will find that you have more energy, stamina, clear skin, better brain function, and restful sleep patterns. 

3.Lose Weight

Because your body lowers it’s insulin levels, your body burns\ the fat for fuel, and it no longer receives the signal to store extra calories as fat. Intermittent fasting can increase norepinephrine, a hormone and neurotransmitter that can boost your metabolism! That way, your body will burn calories throughout the day.

4.Improved Gut Health & Mood

Not only does your body burn more, but your gut health improves. Your mood and mental health go hand in hand with your gut microbiome. So, when your gut reboots due to intermittent fasting, your stomach and your mood are overall happier.

5.Heart Function

At least one study indicates that people who follow a fasting diet may have better heart health than people who don’t. When you fast, your levels of hemoglobin, red blood cell count are affected, in a good way. This improves heart health. 

senior woman feeling better from fasting
Feel good about yourself no matter what your age! What you eat plays a huge part in your energy levels.

6.Autophagy

The process of cells eating themselves to get rid of damaged cells, and recycle into better, more youthful ones is called autophagy. Viruses, bacteria, and other pathogens are destroyed in this process. The simple way to activate this is by fasting. Damaged cells are removed, and cellular and tissue rejuvenation occur.

7.Brain Function

Your body will burn glucose reserved in your blood and liver when you are fasting. The liver will turn the fat into ketones and use them for fuel. Your brain prefers ketones over glucose, and in turn, will work better and increase your ability to learn and think.

As you’ve read, intermittent fasting has many great benefits, even for those who are over 50 years old. The important thing to note is that what you eat still matters. 

When you are done fasting, remember to stick to nutritional foods that will fuel our body and mind. Stick to vegetables, fruits, and protein. If you feel weak, or light-headed, then stop fasting and seek advice from your doctor. If you have chronic conditions such as heart problems, or diabetes, contact your doctor before beginning intermittent fasting. If done right, there can be many benefits obtained from fasting, including living a longer healthier life.

Changes To Medicare Advantage in 2018

Medicare Advantage Plans have become very popular over the years, and like other insurance plans, changes occur every year. The most common changes are the list of drugs that are covered, how much your insurance company charges for them, premiums, and the percentage the plan pays towards your medical expenses. Changes can leave customers confused and with fewer options so it is important to look out for changes in the year ahead in order to get the proper care you need.

Changes in existing plan

Insurance companies will notify customers of changes in their existing Medicare Advantage plan occurring the following year. It is important to look over the changes of your current plan, and determine if these changes will cover your needs next year.

Loss of State Health Insurance Assistance Programs

State Health Insurance Assistance Programs, also known as SHIPS, aim to assist people with their Medicare options and compare Medicare Advantage plans. They provide counseling in every state, which is useful when trying to pick a Medicare plan for the year. These programs are funded by the federal government, but due to the Trump Administration’s budget cuts, it can be discontinued. The budget will eliminate funding of these state assistance programs by 94%, possibly eliminating them. However, EZ.Insure will continue to assist people with their Medicare and Medicare Advantage options even after these programs are gone. EZ.Insure always provides constant counseling, and help seeking the most ideal plan.

Network coverage

Insurance companies are constantly looking for doctors, hospitals, and other healthcare providers with cheaper rates to save money. The insurers negotiate with these providers to find the lowest cost each year, which is why plans change their network coverage every year. In the past couple of years, the network of providers has gotten smaller, with fewer specialists. It is important to make sure that your physician or specialists are included in your network year to year.

Loss of insurers

Reports from the Kaiser Family Foundation found that as of 2017, 147 counties across 14 states do not have Medicare Advantage plans. Some rural counties have been left with either only one or no insurers to choose from. If a Medicare Advantage plan is not an option, some people should consider a Medicare Supplement plan.

With all the changes occurring in the upcoming year, and loss of network coverage, it can be difficult to find a plan. At EZ Insure, we are dedicated to helping you compare and find a plan in your region. Contact us through email, replies@ez.insure, or enter your zip code in the link above to receive a quote. We make it that easy.

Medicare Part B Rates Fluctuating In 2018

The fourth quarter is when senior citizens learn about their social security benefits and Medicare. They find out if they will receive higher social security, and how much, also how much monthly premiums will be for Medicare. Most people with Medicare will face higher premiums in 2018.

Medicare Part B insurance covers outpatient care, preventative services, ambulance services, laboratory tests, and durable medical equipment.

The Part B premium increases will not only will this affect older adults who were stable due to their social security benefits, but it will affect a large number of low-income seniors who struggle on a fixed income.

“Hold Harmless”

In order to protect senior citizens living on fixed incomes, a federal law provision, “hold harmless,” prevents Medicare from raising Part B premiums more than their annual cost-of-living adjustment (COLA) from Social Security. The premiums are being automatically deducted from their Social Security checks. About 70 percent of Medicare enrollees are protected by the “hold harmless” rule.

In 2016, there was no Social Security COLA, so those under “hold harmless,” did not have their Part B premiums rise that year. Last year, Social Security gave enrollees .03 percent COLA, raising premiums from 104.90 to $109 for the hold harmless group. But, Medicare enrollees not in the group (30%) had to pay the full raise in premium, $134.

The Changes

In 2018, the cost-of-living adjustment will go up 2%, which is the highest raise in six years that senior citizens have received. This year, the Medicare Part B premium has remained unchanged from last year’s $134 a month. Because of the premium remaining unchanged, majority of seniors that were protected by the hold harmless provision will be get hit with a major increase in their premium. They will be expected to go from paying $109 a month, to $134 a month, a $25 a month increase. The $25 these senior citizens will be paying leaves them will little to no money for expenses.

Enrollees who are not part of the group, about 30 percent, will not see any additional costs because they already took the hit the previous year.

For high-income enrollees, the more you have the more you pay. Their Part B premiums will increase depending on their income, rising anywhere from $187.50 to $428.60.

Income (adjusted gross income plus tax-exempt interest income):
Single tax returnMarried filing jointlyMonthly Part B premium (per person)
$85,000 or less$170,000 or less$134 (may be less if covered by the hold-harmless provision)
$85,001 to $107,000$170,001 to $214,000$187.50
$107,001 to $133,500$214,001 to $267,000$267.90
$133,501 to $160,000$267,001 to $320,000$348.30
More than $160,000More than $320,000$428.60

Other Alternatives

Head of the Centers for Medicare and Medicaid Services, Seema Verma said in a news release, “We encourage Medicare beneficiaries to explore their options to make an informed choice between original Medicare and Medicare Advantage before open enrollment ends on Dec. 7.”

It is a good time to begin exploring other options, to avoid the large financial hit from the increase of Part B premiums. Medicare Advantage plans, Part C, have become popular, offering all that Medicare offers, sometimes cheaper. Instead of having to enroll in Part A, and Part B, and buying a separate Part D (prescription drug plan), Medicare Advantage has all of these under one plan. Medicare Advantage also offers an annual out-of-pocket limit, meaning once you have reached this limit, you will have no more out of pocket expenses.

Another option to consider helping pay for Part B premiums is a Medicare Supplement plan. These plans help pay the 20% that Medicare leaves up to the individual to pay.

It may be confusing comparing plans and figuring out which will tailor your needs, on a budget. EZ.Insure ensures finding you the best Medicare Advantage or Medicare Supplement plan in your region, within your financial plan. Get a quote by entering your zip code in the bar above. You can also call 888-753-7207, or email replies@ez.insure.You will be assigned your own highly trained agent to fulfill your needs.