Denice Merrill

Denice Merrill

Merrill Insurance Services, Inc.
Specializing in Medicare Plan Choices with over
12 Years Experience.
She can reached by calling
949-388-7332
CA LIC# 0D99790

If you are turning 65, Happy Birthday!

This Special Edition will take you through the process and explain simply what you need to do.  You are not alone if you’ve received stacks of advertising and official looking documents and not sure where to start.  A little Overwhelmed?


Be wary of misleading mailers that suggest you fill out a form and mail it in, or indicate that they are your new Medicare agent….This is a sales lead generator that will place you on a call list that is almost impossible to get off of!
OK, Here are the basics ~

Original Medicare (Parts A and B)

Medicare was started in July of 1965. It is provided by the government and pays fees for your care directly to the doctors and hospitals you visit. Part A helps with hospital cost and Part B helps with doctor and outpatient care. In 2005, the government added part D and this helps pay for prescription drug costs.

Medicare Part A (Hospital Coverage)

Part A helps with the cost of your inpatient hospital stays and skilled nursing care after a hospital stay. Medicare Part A is free to you so long as you have worked 40 Quarters/10 years in this country. Although the monthly premium is free, the deductibles and copays are not. This can leave you with a big financial exposure. The deductible is $1316 this year. If you are in the hospital longer than 60 days, the you will have a share in the financial responsibility. This is why you would choose to have a supplemental insurance plan in place.

Medicare Part B (Doctor Visits)

Part B helps with the cost of doctor visits including outpatient care, clinics, labs, etc. There is a monthly cost by activating Part B. Most people this year will pay $134 per month, but if you’re single making more than $85,000, or married and making over $170,000, you will pay a higher monthly premium.

You will have a deductible of $183 for Part B services, then Part B picks up 80% of your doctors fees, and you are responsible for the remaining 20%…There is NOT a ceiling on your 20% financial responsibility. This is why a supplemental insurance policy is important to protect you.

Medicare Part D (Prescription Drugs)

Part D helps with the cost of prescription drugs. This is not a part of Original Medicare and must be purchased. Part D plans are sold by private companies and can range in costs from $15/month to beyond $100/month. This is optional, but you will incur a penalty if this is not satisfied by enrollment into a plan or have a Medicare plan that includes “creditable” drug coverage. This penalty stays with you for life. Even if you do not currently take medications, you must satisfy this requirement.

As you have read above, Original Medicare Does NOT cover everything.

Original Medicare helps, but leaves holes in your Medical coverage, leaving you with a potential financial burden. Most people enroll in additional coverage to help them pay for the cost and benefits that aren’t covered by Original Medicare Parts A & B. And you must have Prescription drug coverage in place so as not to incur the penalties.

How do you fill in the HOLES of Original Medicare? With all the mailings you’ve received, likely you are seeing a new language called Medicare Supplemental Plans, or Medicare Advantage Plans…

Medicare Advantage Plans (Medicare Part C- Think of C for Combination)

Medicare Advantage plans are run by private companies. Here in Orange County, you’ve probably heard of companies like ~ Aetna, Anthem, Blue Shield, Humana, Scan, or AARP/United Healthcare, and there are more. These are all companies that offer Medicare Advantage plans you can choose from.

They combine coverage for certain hospital costs, doctor visits, and most include the required Part D (drug) coverage at no additional cost. In most plans you choose a primary doctor and your doctor has access to specialists within their group. Most plans offer additional benefits not offered by Original Medicare for example, Dental, Vision, Hearing, and Gym Memberships. Many Advantage plans here is Orange County have $0 monthly costs. The Advantage plans offer Out-of-pocket limits which is your financial protection.

YOU MUST CONTINUE TO PAY YOUR ORIGINAL PART B MONTHLY PREMIUMS.

Medicare Supplement Plans (Medi-Gap)

Medi-Gap plans do what the name implies, they fill in the Gaps of Medical Coverage that are not covered by Original Medicare A & B. This type of plan works along with your Original Medicare A & B. This can protect you against big financial exposure.

Medi-Gap plans are like a PPO, but more choices. You can see any doctor throughout the U.S. as long as the doctor participates with Original Medicare A & B. This solution does not require a referral from a doctor. There is a monthly cost for a supplemental plan and YOU MUST CONTINUE TO PAY YOUR ORIGINAL PART B MONTHLY PREMIUMS. Unlike the Advantage plans, on a Medi-Gap plan, you are required to enroll with a separate Part D (Prescription drug) plan. Medi-Gap plans offer greater Freedom, but it comes with a monthly cost.


HAVE YOU HEARD OF THE BIRTHDAY RULE?

For those of you that already understand all the basics above, here is something you may not already know…If you currently have a Medi-Gap Supplemental plan in place, during your birthday month, you can change from one company to another.

It must be “like" plans or lesser. Example from a Supplemental Plan F to another (equal plan F), or a Supplemental Plan F down to a Plan G (a slightly lower premium plan that just has a yearly deductible of $183).

Why would you do this? Well, did you get a Birthday card that wasn’t so nice indicating your new monthly costs will be higher because you are now a year older?

The great news is that you're able to make a move and not stuck with a higher payment. You do not lose ANY of your same doctors. You do not have to answer health questions. Its a simple process and worth a quick phone call during your bday month. If you wait until after your birthday, it will be too late.

Here is an example ~ If you are age 70, living in Orange County

Using the Birthday Rule, if these are lower than you are paying, you can make a change and save money.

Plan F current rate $206/month
Plan G current rate $175.91/month
Plan N current rate $136/month

Hope this was helpful.

I love helping Seniors understand and enroll with Medicare and in the plan that fits their needs. Feel free to contact me directly, or attend one of my Medicare 101 Educational meetings at Mission Hospital offered every month.

PS. Be sure to work with a local Medicare Insurance “Broker” to get a comparison on more than one company, and more than one plan in just one visit. Find someone that is familiar with doctors in your area. We get paid by the insurance companies so there is No Cost to you. We still make House calls!

In my previous editorial, I talked about why someone might want to have a relationship with their own Medicare Insurance Broker.

I remember something I read a long time ago about surrounding yourself with a team of people that you trust. Like having a CPA that you can count on to advise you through all those tax laws. Or a Financial Advisor that can help you understand where to invest your savings. Choosing a doctor that listens to you and actually has eye contact. I could keep going. But, think about it, this is the team YOU have chosen to trust. Are you missing someone to complete your trusted team?

Sometimes family members try their best to help in this Medicare analysis…You know just the medication review alone can be daunting! Mistakes can be made, and you are locked into your choice for another year.

Do you have someone that helps you narrow down options so you can make your own decision? Review your list of medications to make sure you are covered for the next year? That is what I'd personally be looking for.

How do you find a Medicare Insurance Broker? I get this question all the time, especially when I've helped someone here in CA and now they are looking to move out of state…I do believe in finding someone that lives in your area that fully understands the local plans, doctors, and hospitals to best guide you.

Here is what you can do now to prepare for your Medicare Review.….

Get your list of medications handy, list of doctors that are important to you, give us a call or attend one of our upcoming events for a group setting. Do this soon. The Medicare Season is a very busy time.

One way is to come to one of our meetings or events. Another is as a referral from a friend that has had a good experience with a local broker. Remember, all agents are not brokers, which means they may only be representing one company and not allowed to offer others. If the agent is not a broker, you will not be able to compare plans from different carriers/companies, which is important specifically when it comes to different costs on medications.

Medication costs vary from company to company, and year to year.

Come to one of our upcoming Medicare Events - Come to Learn, not be SOLD!

This is the time of year to review and make the appropriate changes for 2017.

MEDICARE PLANS
(OPEN ENROLLMENT OCT 15TH-DEC 7TH)

So, if we can specialize in our field of expertise, in this case Medicare Insurance Options. Offer not just one company, but multiple companies. Teach you about Medicare, what to look for, what the differences are from each company, then we have done our job. Helped to educate you without you feeling like there is something hidden, or that you are being "sold".

Find an Medicare Broker that fits you.

Why do I need a Medicare Insurance Broker/Agent?  I’ve already got a plan!

Many of you on Medicare may have enrolled years ago and felt that your plan has been just fine and no need to make any changes. Perhaps you initially enrolled by calling an Insurance Company directly or had an agent enroll you during the Annual Enrollment period, BUT... did you know that the person that had helped you may no longer be in this field, or were a telesales agent of which you would not hear from to do a review?

Medicare plans DO change every year! Perhaps not in an obvious way. If you have a $5 or $10 copay to see your doctor, you most likely are on an old/outdated plan. Guess what…Your friends may be seeing that same doctor at $0 copay.

By finding a Medicare Broker to help you each year, you would have your personal agent that is looking out for your specific needs. You might be thinking, won't that cost me something? The answer is NO. We are a resource to help guide seniors so they can make their own best decisions. You need to trust someone in this field. Start that relationship now.

A broker does not work for any one company/carrier and therefore can offer a number of different plans. Find that person that lives in your area. They will be much better equipped to know the doctors, hospitals, and plans that are local.

I personally am so pleased to announce my partnering with Bridlewood Insurance (Voted #1 Agency in San Diego) we are their Orange County Branch. We are all independent agents, but come together to help you. Feel Free to reach out to any one us…We are ALL Certified and Licensed Insurance Agents/Brokers serving the Orange County area. You might recognize some of us from your local neighborhoods.

medicare 223

You can visit www.bridlewoodinsurance.com and click on Find An Agent

You are not alone. I get these questions all the time.

Most people about to turn age 65 get tons of information mailed to them and because it is so overwhelming, they may just push it off thinking they are still working and don’t need to address this information now. Or they may decide to attend local “Medicare 101” meetings only to walk away a bit overwhelmed or in some cases with the wrong information.

I recently met with a new client that told me she had been advised that because she was still working, she was not allowed to enroll into Medicare….That was WRONG!

First off, Medicare Part A (hospital), is sent to you just prior to your 65th birthday. You earned it through your taxes paid.

Part B (doctors/services outside the hospital), does not need to be initialized until you leave your employer coverage.

BUT…You could choose to initialize/activate your Part B of Medicare and choose a Medicare option of insurance coverage instead of your employer group coverage.

Why would you do this? It may offer much better coverage and in many cases greatly reduce yours and your employers costs!

What are those costs/Options?

Example #1 in Orange County, CA

Just turning age 65
Medicare A cost $0
Medicare B $121.80/month (slightly higher rates if your household adjusted gross income is over $170,000/year.

In the above scenario, you could enroll into a Medicare Advantage Plan (HMO) and there would NOT be additional monthly premiums. So the monthly cost would only be $121.80 for multiple plans. And this includes Rx Part D.

Example #2 in Orange County, CA

Just turning age 65
Medicare A cost $0
Medicare B $121.80/month

In this scenario, you could choose to add a Supplemental PPO type solution and a separate Rx Part D

For simplicity, the Plan F will be reflected and offers PPO like options with $0 Deductible, $0 Copay for doctors (Multiple companies offer these plans)

The approximate costs for this supplemental would be under $250/month + the $121.80/month = $371.80

Could the above solutions possibly improve your current coverage with your employer? Could it save both you and your employer quite a bit of money each month? More than likely the answer is yes.
(Tear out this page for reference and discuss with your HR dept)

You may also want to consider meeting with a Medicare Insurance Broker like me!

A broker does not work for any one company/carrier and therefore can offer a number of different plans, a completely unbiased approach.

Oh, and one last thing: Medicare insurance Brokers will not cost you anything to review and does not in any way increase cost to you by enrolling. Clients love that we still make House Calls and are local. I am happy to review with you one on one, or to meet with your employer to explore options. Your employer may already have a great insurance Agent that takes care of all the group policy plans, I can work with that agent too. We do not conflict with your company’s group insurance. In many cases we can lower the over all groups plan cost. The insurance industry has changed dramatically over the last few years and we ALL have to specialize. I’ve chosen to specialize in Medicare options only (for over 10 years). You can not be the Jack of all trades. Pick your specialty and do it well.

PS. (DONT GO ONTO COBRA, YOU WILL INCUR A PENALTY IF YOU ARE ELIGIBLE FOR MEDICARE).

A Medicare Broker = A Certified Licensed Insurance Agent that represents more than one Insurance Company for the Medicare marketplace. Dedicated to supporting Seniors.

You are not alone. I get these questions all the time.

Many of you attempt to read the giant piles of information that has or will be mailed to you about 4 months before you turn age 65. Also, many of you attend Medicare 101 meetings only to walk away sometimes a bit more overwhelmed. In today’s age, insurance companies need to stay compliant for government regulations and therefore must go over every little detail of benefits so as not to mislead a senior. But, there is an alternative.

Did you know you could meet with an Independent Medicare Broker that represents many different plans in the convenience of your own home? They can simplify and help you to understand what Medicare A & B are and what that means to you.

The quick answer is that Medicare A covers hospitalization, and Medicare Part B covers Doctors and services outside the hospital. But the more detailed explanation will show you there are deductibles and copays and financial exposures if you relied only on A & B.

There are a variety of solutions that can help fill in the holes of Medicare A & B. Supplemental PPO “Like” plans, or HMO plans. Some include drug coverage, and some do not. Some with a monthly cost and some without a monthly cost. Thankfully here in Orange County, we have many plans available. Competition is a great thing!

Then, what about D? Well the short answer is that Medicare Part D = Drugs. This is one of the most important and the hardest areas to do your own research. Everyone’s medications are unique and must be reviewed to verify what might be the best solution each year.

Certain medications can vary greatly in costs from one plan to the next, as an example a diabetes type medication like Januvia or Glumetza on some plans could be $0 copay, and on another not covered at all or at a higher copay of $45.00.

Medications are the biggest hidden moving part - make sure you have a Medicare Broker that represents multiple plans to compare and verify your costs each year.

If you are already in the Medicare system, Oct 15 through Dec 7 is the time of year that you can start reviewing and make changes to your current solution that would become effective the beginning of each new year on January 1st.

CAN I CHANGE MY MEDICARE PLAN NOW?

Yes, is some cases you can make a change now…If you recently moved to a new area - Example moving from Palm Desert to Orange County could create the opportunity to change your plan.

Yes, if you are working, and would like to move to a plan that may save you $$... and continue working. This in many cases can save your employer $$ too.

Yes, if you are 65+, and left/lost your job.

Yes, if you are new to Medicare.

Call us now to help guide you through any of these situations - YOU DO NOT HAVE TO WAIT UNTIL OCT 15TH!

As a Medicare Broker I do not work for any one company and therefore can offer a number of different plans ~ completely unbiased approach.

Oh, and one last thing: Medicare Insurance Brokers will not cost you anything to do a review and does not in any way increase cost to you by enrolling. Clients love that we still make House Calls and are local.

I live in Orange County and many of us are still working even after the age of 65…Many people are postponing enrolling into Medicare because they are still on their employer health insurance benefits or their spouses. Below is some information that may clear up a few mysteries…

Q: What if I’m still working and on my employer group plan or my spouses employer plan?

A: Typically Part A (hospital), is sent to you prior to your 65th birthday. You earned it through your taxes paid. Part B (doctors, specialist, those services outside the hospital), does not need to be initialized until you leave your employer coverage. Once you leave you will need to initialize your Part B to not incur a penalty. Social Security (SS) will withdraw the premium from your monthly SS check, or if you delay your SS you can pay it directly on a quarterly basis. Medicare will begin the first of the month following your exit from the employer plan ~ no lapse in coverage.

Once you turn 65 you will get your Part A. If you have no other “creditable coverage” you have 3 months prior to your birthday, your birthday month and 3 months after to initialize your part B and to enroll in a supplemental plan to cover the gaps in your “Federal Medicare” plan.

Q: Can I go onto Cobra until I can fig-ure out all the Medicare Options?

A: Highly discouraged. Cobra does not qualify as “creditable health insurance coverage” and you will be given a penalty to pay a higher part B premium and Part D (drugs) that stays with you year after year! We are available to educate you on your options at no charge. You will be able to make an decision with your eyes wide open on your options.

Q: How do I sign up for Part A & Part B if I’m already on Social Security?

A: Once you turn 65 you will get your Part A. If you have no other “creditable coverage” you have 3 months prior to your birthday, your birthday month and 3 months after to initialize your part B and to enroll in a supplemental plan to cover the gaps in your “Federal Medicare” plan. If you delay signing up for additional coverage after your birthday month your coverage will be delayed.

Q: How do I sign up for Part A & Part B?

A: Contact Social Security 3 months before you turn age 65. To sign up ~ go online at www.medicare.gov, or call (800)-772-1213, or visit your local social security office in person (call first to make an appointment).

Part A (premium free) and Part B (for which you may pay a higher monthly premium based on last 2 years tax returns) As of today the minimum is $121.80/month.

For more details or questions about activating your Medicare, please call me. One Call Does It All! 949-388-7332

Please be AWARE of any emails or phone calls you get regarding soliciting the sale of a medicare policy. Medicare is a highly regulated Federal program. Phone calls and emails are not allowed unless “you” have invited the contact.

Where does D come in?

 

You are not alone. I get these questions all the time.

 

Many of you attempt to read the giant piles of information that has or will be mailed to you about 4 months before you turn age 65. Also, many of you attend Medicare 101 meetings only to walk away sometimes a bit more overwhelmed. In today’s age, insurance companies need to stay compliant for government regulations and therefore must go over every little detail of benefits so as not to mislead a senior. But, there is an alternative.

Did you know you could meet with an Independent Medicare Broker that represents many different plans in the convenience of your own home? They can simplify and help you to understand what Medicare A & B are and what that means to you.

The quick answer is that Medicare A covers hospitalization, and Medicare Part B covers Doctors and services outside the hospital. But the more detailed explanation will show you there are deductibles and copays and financial exposures if you relied only on A & B.

There are a variety of solutions that can help fill in the holes of Medicare A & B. Supplemental PPO “Like” plans, or HMO plans. Some include drug coverage, and some do not. Some with a monthly cost and some without a monthly cost. Thankfully here in Orange County, we have many plans available. Competition is a great thing!

Then, what about D? Well the short answer is that Medicare Part D = Drugs. This is one of the most important and the hardest areas to do your own research. Everyone’s medications are unique and must be reviewed to verify what might be the best solution each year.

Certain medications can vary greatly in costs from one plan to the next, as an example a diabetes type medication like Januvia or Glumetza on some plans could be $0 copay, and on another not covered at all or at a higher copay of $45.00.

Medications are the biggest hidden moving part - make sure you have a Medicare Broker that represents multiple plans to compare and verify your costs each year.

If you are already in the Medicare system, Oct 15 through Dec 7 is the time of year that you can start reviewing and make changes to your current solution that would become effective the beginning of each new year on January 1st.

What to do now early September

Prep for your Medicare Review. If you are new to Medicare, call us now to help guide you.

A Medicare Insurance Broker does not work directly for any one company/carrier and therefore can offer a number of different plans, a completely unbiased approach.
Brokers must get certified with all of the plans they represent every year to be able to confidently and legally show more than one option. This is a true dedication and commitment to the industry.

If you have worked with an Agent that didn’t offer to review your medications to verify the plan you are on is still the best fit for you, they are probably not a Medicare Insurance Broker and you may want to consider reviewing with one this next year.

Oh, and one last thing: Medicare Insurance Brokers will not cost you anything to review and does not in any way increase cost to you by enrolling. Clients love that we still make House Calls and are local.

I live in Orange County and lots of us are still working even after the age of 65. Many people postpone enrolling into Medicare because they are still on their employer health insurance benefits or their spouses. Below is some information that may clear up a few mysteries...

Q: What if I’m still working and on my employer group plan or my spouse’s employer plan?

A: Typically Part A (hospital), is sent to you prior to your 65th birthday. You earned it through your taxes paid. Part B (doctors, specialist, those services outside the hospital), does not need to be initialized until you leave your employer coverage. Once you leave you will need to initialize your Part B to not incur a penalty. Social Security (SS) will withdraw the premium from your monthly SS check, or if you delay your SS you can pay it directly on a quarterly basis. Medicare will begin the first of the month following your exit from the employer plan ~ no lapse in coverage.


You may also choose to activate Part B and go onto a Medicare Plan and continue working. This may be a savings to both you and possibly your employer - worth finding out. Call if you would like some help doing a comparison.

Q: Can I go onto Cobra until I can figure out all the Medicare Options?

A: Highly discouraged. Cobra does not qualify as “creditable health insurance coverage” and you will incur a penalty to pay a higher part B premium and Part D (drugs) that stays with you year after year! We are available to educate you on your options at no charge. You will be able to make a decision with your eyes wide open on your options.

Once you turn 65 you will get your Part A. If you have no other “creditable coverage” you have 3 months prior to your birthday, your birthday month and 3 months after to initialize your part B and to enroll in a supplemental plan to cover the gaps in your “Federal Medicare” plan.
For more details or questions about activating your Medicare, call me direct - I’m here to help.
(No dharge-EVER)

949.388-7332

Please be AWARE of any emails or phone calls you get regarding soliciting the sale of a medicare policy. Medicare is a highly regulated Federal program. Phone calls and emails are not allowed unless “you” have invited the contact.

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