Out of Time, Warner?

I got a call Thursday, December 5th, at 6:30 pm.  It was Warner, and he wanted to know about Prescription Drug Coverage for those on Medicare.  So, I explained to him the out-of-pocket costs, the donut hole, and how insurance companies “tier” their medications to save money.

I also explained that if he was interested in a Prescription Drug Plan I was offering, he had to make a decision soon.  You see, December 7th was fast approaching, and that was the end of the season for making changes to Medicare coverage.  What he said next I did NOT expect.

Warner was on 16 medications – which was not too far off the reservation for an 80 year old – and has never taken out a Prescription Drug Plan since he was eligible some 5 1/2 years ago.  It was at that point my jaw dropped and I believe I no longer had clean underwear.  You see, Warner was on a Prescription Assistance Plan, aka a PAP, and was only paying $500 per year for his medications.  The good news was that this had been in place for the past 15 years – Warner’s entire time on Medicare.

The bad news: Warner had never been told of the Late Penalty for not selecting a Prescription Drug Plan once he was eligible.

I then had to break it to Warner that the drug plan we had been discussing, which covered ALL of his medication, would have an additional $34.25 added to it, just because he never had a drug plan before.  That meant that every month he would pay, in premiums alone $135.75 just to have drug coverage.  This did not include his deductible, cost-sharing, donut hole amounts, etc.

To make matters worse, time to enroll, if that is what he wanted to do, was running out.  Oh, and the Pharmacy Assistance Plan notified him that, if he did get a Prescription Drug Plan, he would be kicked off the assistance.  They would be making their decision whether to keep him on the assistance or not January 1.

This put Warner between a rock and a hard place: 1. if he took the Prescription Drug Plan, and was still eligible for the assistance, he would incur all those additional costs, and not be eligible for the assistance again 2. if he doesn’t take the drug plan, and then loses the assistance January 1, he has NO coverage, and can not get the drug plan until next year.

How do you think the story ends?

I am an Independent Insurance Agent, licensed in the state of Georgia.  If you need guidance for Life Insurance, Medicare, or Long Term Care needs, please contact me at 404-551-5339 or email me at bob@legacyfinancialpartner.com

Bob Levine
Legacy Financial Partners, LLC
404-551-5339
bob@legacyfinancialpartner.com
http://www.equilife.com/boblevine
@TheBobLevine

How Can You Tell If Nancy Pelosi Is Lying?

The answer: Her lips are moving.

Once again, the former Speaker of the House lies to the general public, and they lap it up like milk from a bowl.  On all the Sunday News Programs, in defense of Obamacare – which she refuses to call ObamaCare, instead, she insists on calling it the “Affordable Care Act” – she stated that insurance companies can kick you off a plan if you develop a pre-existing condition.

Oh, Nancy! If it were only true.

In the past, insurance companies have cancelled coverage if you have not continued to pay the monthly premium.  They can, and have, rescinded coverage, if the applicant has misrepresented information, or intentionally deleted information, on the application.  They have never, however, accepted an application with correct information, then once that person has developed a condition, refused to continue coverage, simply because of that condition.  They might have – and this has been done – raised premiums so high that the person can no longer afford to keep the coverage.  Then, at that point, they are uninsureable for future coverage anywhere else.

The insurance companies will be vilified, and the liars in Washington will get away with this fiasco.

Now, to be fair, there are no other ideas coming from the other side of the aisle.  Republicans, rather than just clapping their hands, need to submit, solid, realistic, compassionate alternatives.  Thus far, it’s been nothing but double talk from the right as to what they propose.  Nothing detailed.  Nothing showing dollars and cents.

Here are some ideas:

1. condition specific coverage to add to High Deductible Plans
2. regional coverage across state lines
3. public/private partnerships for the frailest amongst us

And, for God sake, stop comparing this to Part D Medicare coverage.  Part D is not mandatory for everyone on Medicare.

Again, can someone tell me why we are mandating that 45 year old males have Maternity coverage. Or, someone who does not have children, must have pediatric dental care?  Nancy, why not concentrate on Fraud, Waste and Abuse?

If you would like to discuss your options, please feel free to contact me at 404-551-5339 or email me any questions or concerns to bob@legacyfinancialpartner.com

“Shared Responsibility” Rule

Bottom Line: you (everyone) must have “minimal essential coverage” – MEC – or you will pay, not a penalty, not a tax, but your “shared responsibility” amount.  This, according to the MEC Rules, in Section 5000A of the Internal Revenue Code.

Officials are estimating that 36 million taxpayers will have to fill out MEC-related paperwork.  Unions and employees who are leased to PEO’s are exempt.  IRS officials also:

• Decide taxpayers should have to take responsibility for health penalties paid by any dependents, whether they live with them or not
• Suggest that, to keep things simple, people can get out of paying the penalty if they can show their dependents have coverage for at least one day per month for at least nine months out of the year.

Response from Tim Thornton, from (State withheld): I’m 44, unemployed, and on food stamps. My state did not expand Medicaid, any my income is so low, I do not qualify for subsidies.  In other words, this (ObamaCare) does not help me at all.  I’m not a female, pregnant, with an STD and on drugs.  Should I do drugs, contract an STD in order to get help?  

If you are confused, or like Tim, you feel your options are limited or ridiculous, feel free to contact me at 404-551-5339 or bob@legacyfinancialpartner.com.

The Government Shutdown & Seniors

If you are a Medicare Beneficiary, or are working with one, and you go on the Medicare.gov site to explore your options for medical coverage/prescription drug coverage for 2014, you may see, “Due to the government shutdown, information on this website may not be up to date.”

If you ARE currently working with an Independent Insurance Agent, he/she will still be able to shop around for you, by contacting each Insurance provider individually, and obtaining the information needed.

If, however, you are NOT working with an Independent agent, there are two courses of action you may take:

1. get involved with an agent in your area
2. keep on trying the Medicare.gov website until you no longer see the message

Just a note: For those Medicare Beneficiaries who currently use a Medicare Advantage Plan, you are fortunate.  The government shut down will not affect you obtaining services, or remittance of payment for services rendered.  You see, by enrolling in a Medicare Advantage Plan and/or a Prescription Drug Plan, you have opted out of Medicare, and are allowing a private insurance provider to administer and finance your health care coverage.  YOU STILL RETAIN ALL RIGHTS OFFERED TO THOSE IN MEDICARE.

To keep up to date on both Medicare and the Affordable Care Act moving forward, please stay tuned to this blog, or feel free to follow me on Twitter @TheBobLevine, as well as contacting me @ 404-551-5339.  I am a licensed Life/Health Agent, operating in the State of Georgia, and a Consultant with Legacy Financial Partners, LLC.