Monthly Archives

April 2014

Medicare Advantage plans

By Making the Most of your Medicare No Comments

We get clients asking us all the time about $0 premium plans, which are called Medicare Advantage plans.  Below is a list of the major issues with Medicare Advantage plans –          Advantage plans limit the number of doctors and hospitals you have access to. We suggest you call all your providers before enrolling in a plan. –          Medicare Advantage plans utilize something called Prior Authorization, which means that the provider must get approval from the insurer before a service is covered.  If the insurance company disagrees with the doctor, a service may not be covered. –          If you are a diabetic you may be paying 20% for your supplies. –          The plans are not guaranteed renewable, meaning they can leave you without coverage if they decide not to renew in the future. Medicare Advantage Plans only sign an annual contract with the government, which is subject to federal funding.  If the…

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What are my Obamacare options in the Saint Charles area?

By Understanding Health Care Reform No Comments

A common question I get from clients who are looking for individual health insurance is, “What plans are available to me under Obamacare?”  “Which plans have my doctor or hospital in network?”  “How do I pick between my options?” If you are in the market for individual health insurance in the Saint Louis/Saint Charles area, I can help.  Our agency handles every aspect of the Affordable Care Act, including walking you through the www.healthcare.gov subsidy process (the only way to get lower premiums).  Give us a call at 636-561-5060 for guidance.  We do not charge any fees for our assistance.  Ultimately, you will have 3 specific options to choose as of 2014.  They are:  Anthem Blue Cross and Blue Shield CoventryOne PPO CoventryOne Carelink  Any policy you purchase as an individual should come from one of these insurers.  What are the differences?  Anthem Blue Cross and Blue Shield  Anthem’s plans…

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How to avoid paying a copay for diabetic supplies when you are on Medicare

By Making the Most of your Medicare No Comments

Why do I keep getting a copay for my monthly diabetic supplies when my Insurance agent said it would be covered at 100%? The way it should work When you get your Diabetic supplies filled each month at the pharmacy, the pharmacy should be billing Medicare Part B. Your Medicare supplement will then pick up the balance. When they are billed this way, the diabetic supplies are covered at 100%.  Unfortunately for the pharmacy, when they bill Medicare Part B they are reimbursed considerably less than if they bill Medicare Part D. Why I get a copay The reason people on original Medicare and a Supplement get these $20 to $50 a month copays for diabetic supplies is quite simple. When you present all of your cards to your pharmacy they are generally not billing Medicare Part B, but instead billing your Medicare Part D carrier. When a pharmacy does…

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Obamacare plans offered in the greater Saint Louis area

By Making the Most of your Medicare No Comments

A common question I get from clients who are looking for individual health insurance is, “What plans are available to me under Obamacare?”  “Which plans have my doctor or hospital in network?”  “How do I pick between my options?” If you are in the market for individual health insurance in the Saint Louis area, I can help.  Our agency handles every aspect of the ACA, including walking you through the www.healthcare.gov subsidy process (the only way to get lower premiums).  Give us a call at 636-561-5060 for guidance. Ultimately, you will have 3 specific options to choose as of 2014.  They are: 1. Anthem Blue Cross and Blue Shield 2. CoventryOne PPO 3. CoventryOne Carelink Any policy you purchase as an individual should come from one of these insurers.  What are the differences? Anthem Blue Cross and Blue Shield Anthem’s plans tend to be lower priced with lower deductibles (the…

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