Mutsko Insurance

Part 2 of a series on Long Term Care. 

 Nearly three quarters of the population over 65 will require some form of long-term care during their lifetimes. When help is needed, what steps should you take to find the right company to fit your needs?

 Once you have determined that your family member is able to stay in their home with some extra support for daily activities, a few choices for in home care are possible. Homemaker services companies help those who need assistance with household duties such as cooking, cleaning and running errands. A home health aide can provide more extensive personal care, including bathing, dressing, eating and transferring among other support.

 In any case, someone you don’t know will be coming into their home regularly and caring for someone you love. Finding the right person or company takes lots of research and many questions. Here are a some questions to get you started:

-  Is the agency licensed by the state, certified by Medicare, bonded and insured?

-  Can the agency provide references from doctors, discharge planners, clients and their families?

-  Will you get to interview the people who will be providing care prior to them starting?

-  What if you don’t feel comfortable with the assigned caregiver?

-  How do supervisors monitor and evaluate the quality of care provided by the caregiver?

-  What are the hiring practices of the agency?

-  Do they do thorough background checks on all employees?

-  How do they find their employees?

-  Can the care provider provide reference?

-  Are the caregivers licensed and insured?

-  How does the agency train caregivers?

-  Are they certified in CPR and first aid?

-  How does the agency handle billing?

 Long term care insurance can help keep you in your home by covering the cost of in-home care and services when you need them.  But it must be purchased before a need arises. A good time to purchase long term care insurance is when you are in your 50′s. Call me today at 440-255-5700 to learn more about the unique features and options available to you through long-term care insurance.

Anthem Blue Cross and Blue Shield recently announced that atorvastatin, a new generic for the brand name Lipitor, had been added to their covered drug list. Since the generic is less expensive and just as safe and effective as Lipitor, beginning April 1, 2012, Lipitor will no longer be covered. Atorvastatin will continue to be covered.

This change impacts all commercial and individual business in all states covered under Anthem Blue Cross and Blue Shield plans. ASO groups that have chosen to participate in the “clinically equivalent” coverage strategy are also included.

The coverage change does not apply to local groups that do not have the “clinically equivalent” benefit exclusion in place, but prior authorization will be needed. Medicare Part D and state-sponsored business are not impacted. 

This article applies to: Ohio, Wisconsin, Nevada, New Hampshire, Missouri, Maine, Kentucky, Indiana, Connecticut, and Colorado

The Medicare Advantage Disenrollment Period (MADP) runs from January 1 – February 14, of each year.  The purpose of the MADP is to give Medicare Advantage members an opportunity to return to Original Medicare. 

The MADP will allow members to enroll in a standalone prescription drug plan. However, disenrolling in a Medicare Advantage Plan and enrolling into a standalone prescription drug plan means you will not have additional coverage for any medical claims other than the 80% that Medicare pays for.  Those members may choose to purchase a Medicare Supplement providing they qualify under the terms of the policy they wish to purchase.  Using the MADP to disenroll in a Medicare Advantage Plan does not result in Guaranteed Issue of Medicare Supplement insurance. 

Make sure you qualify for the supplement before you disenroll from your Advantage Plan.

Part 1 of a series on Long Term Care.

Nearly three quarters of the population over 65 will require some form of long-term care during their lifetimes. More than 40% of them will need care in a nursing home according to the Department of Health and Human Services. While family and friends will usually try to meet the needs of their loved ones, in most cases a professional caregiver will be needed as a part of the long-term care plan.

What is long-term care?
Long-term care is care provided for a wide range of personal, medical and social services for an extended period of time. Determining the need for long-term care is often done by a health professional who can assess the disability and recommend the level and duration of care needed.

Assessing the need
The first step is to determine the appropriate level of care. Observe the daily activities that the person is involved with and see which ones they are struggling to accomplish. A doctor, nurse, geriatric care manager or a hospital discharge planner may be helpful.

Once you have determined which daily activities need support, a few choices for care are possible. Family and friends can pitch in to cover certain needs while a homemaker service or a home health aide can come in and offer support in other areas.

As you weigh your options for care, consider these costs:

National Average costs for long term care in 2010*

Homemaker Services    $18/hour
Home Health Aid Services   $19/hour
Assisted Living Facility (single)              $3185/month
Nursing Home (semi-private room)              $185/day
Nursing Home (private room)                       $206/day

A common misconception is that health insurance will pay for long term care expenses. The fact is long term care is generally not considered medical care. Because of this health insurance plans will not pay for long term care expenses. Medicare will generally cover skilled care assuming you have been in the hospital for at least 3 days. However, it will not provide care for an extended period of time (e.g. more than 100 days). Also, it usually does not cover home or personal care services.

Long term care insurance can provide you and your family with protection, but it must be purchased before a need arises.  A good time to purchase long term care insurance is when you are in your 50′s. Call me today to learn more about the unique features and options available to you through long-term care insurance.

Hunting Down Lost Money

It’s possible that there is money waiting for you to claim. It could be a long-forgotten utility deposit or proceeds from an inheritance that never found you. While most people won’t find a small fortune, you may be surprised at what’s waiting for you!

To begin looking,  go to www.Ohio.gov and enter Treasure Hunt in the search box. It is important to start with the state entity that holds citizens’ forgotten property to avoid paying fees to a third party to reclaim your money. You can connect to other states and Canada from this website, too.

Search for unclaimed money under all variations of your name, including maiden name, nickname or alias.

Here’s a tip: If you have trouble proving that you lived at an address long ago, try to verify it with your credit report address history. It may be just what you need to prove that you are the rightful owner of long forgotten funds.

Happy hunting!

Six Steps to Smooth Your Transition to a New Plan

So, do you feel pretty good about the changes you made during Medicare’s Open Enrollment period? Perhaps you switched from one Medicare Advantage Plan to another. Or, you changed to a plan that has better coverage for your prescriptions. Congratulations on making these changes. But, there are still a few things to do before your work is done.

Here are six steps you can take now to smooth the transition to your new Plan.

Cancel your supplement coverage. Your Supplement is not automatically cancelled when you switch to an Advantage Plan. Did you cancel your Supplement coverage? Although some companies will cancel and make changes over the phone, others require a written request so ask what your insurer requires.

 Cancel your automatic withdrawals. Were your premiums being automatically withdrawn from your checking or savings account? Cancel your withdrawal with the insurance company and then follow up with your financial institution to make sure the automatic withdrawal is cancelled.

Tell your doctor. If you changed from one Advantage Plan to another, let your doctors know the first time you see them in the new year. If your doctor unknowingly files for reimbursement with the wrong insurance company, it will cause confusion and delays in payment.

Tell your pharmacy. Present your new insurance cards to your pharmacy before you need your next prescription. Don’t wait until you need a refill or have an emergency before you make this change.

Check any new requirements. Some medications require a pre-authorization from your physician. If you have needed this in the past, check your coverage and then contact your doctor before you need a prescription refill.

Questions on a Supplement Plan?  Unlike other Medicare Plans, you can make changes in your Medicare Supplement Plan outside the Open Enrollment Period. In fact, you can make changes or purchase Medicare Supplement Insurance any time during the year. Call me to help you find the best Supplement for your situation.

While you are checking on these insurance matters, take some time to review all your other insurance coverage, too. Look over your life insurance beneficiaries and make sure all other information is up to date. Do you have adequate life insurance coverage? What about disability insurance? Are you ready to look into purchasing long term care insurance? If you find some gaps, call me. I will put together a comprehensive plan that brings your coverage up to par.

Initial Coverage

Medicare Part D coverage starts with the first prescription you fill. When a member’s 2012 total drug costs exceed $2930 the member enters the coverage gap referred to as the “donut hole.’ 

Coverage Gap

When you enter the Part D coverage gap in 2012 you will pay 50% of name brand medications and 83% of generic medications. Once your total drug costs exceed $4700, you will go into the Catastrophic Coverage.

Catastrophic Coverage:

The catastrophic coverage period for 2012 begins once one exceeds $4700 in true out of pocket costs and covers 95% of a member’s drug costs.

The chart below shows your estimated prescription drug plan monthly premium based on your income. If your income is above a certain limit, you will pay an income-related monthly adjustment amount in addition to your plan premium.

If your yearly income in 2011 was

Individual Return              File Joint Return          You Pay

$   85,000 or less                  $ 170,000 or less               your Plan Premium

$   85,001 – 107,000          $ 170,000 – $214,000      $11.60 + Plan Premium

$ 107,001 – 160,000          $ 214,001 – 320,000         $29.90 + Plan Premium

$ 160,001 – 214,000          $ 320,001 – 428,000         $48.10 + Plan Premium

Above $214,000                   Above $428,000                 $66.40 + Plan Premium

Medicare deductibles and co-payments will be changing in 2012 as follow:

Part B deductible……………………………………….. $ 140/annual

Part A deductible per benefit period…………………..$ 1,156

Co-payment for hospital stay

61-90 days ……………………………………………….$ 289/day

91-150 days………………………………………………$ 578/day

Skilled nursing co-payment

21-100 days………………………………………………$ 144.50/day

Medicare Supplement plans will automatically be adjusted to cover these increased amounts.  Your Medicare Advantage co-pays will not be affected.

This year, when you sit down to review your Medicare health and drug plan choices, give some consideration to the following:

Travel Plans.  If you are planning to travel extensively in 2012 or spend part of the year in a different state, make sure you know if your coverage travels with you.

Does Your Plan Still Work at Your Pharmacy?  Even if you’re not changing plans, make sure your pharmacy will still be in your plan’s network next year. Plans can change their network pharmacies each year.

Are the Services You Need Covered? Change happens. Maybe your family situation is different this year, or you have different health concerns. Make sure you look at the services and benefits in your plan and what you may need in the coming year.

Don’t wait until the last minute. Call me today if you think you will need a different plan for 2012.