The Ins and Outs of Medicare Supplemental Insurance

If you’re approaching the age of 65 or have just turned 65-years old, you have no doubt been pelted with various literature advising you to enroll in Medicare Advantage and/or choose a Medicare supplemental insurance plan. Navigating the seas of Medicare Advantage and Medicare supplemental insurance can seem rather overwhelming, but with the following simple pointers you’ll be able to choose the right plan, and sail off into your golden years well-prepared and worry-free. Remember, you’re never too young to start researching your Medicare supplemental insurance options.

When searching for Medicare supplement insurance for seniors, it is important to keep in mind there are hundreds of options to choose from, and with many seniors living on fixed budgets, costs can really matter. While Medicare supplemental plans are standardized and regulated by the federal government, there are some variations that occur due to additional state’s regulations.

Double- and Triple-Check for the Best Deal

It may seem easy to just reach out and sign up for the first supplemental Medicare insurance plan you find, but trust me, patience will pay off here. It is nearly impossible to over-stress how important it is to compare Medicare supplement plans before choosing the best one for you. There are quite a few resources readily available both on the Internet and in person. One major resource that is used is where you can find information regarding all aspects of Medicare. On another site there is even a nifty tool to assist in the planning of long-term care. The good thing about databases like these is that they contain a wealth of information. The not-so-good thing about databases is that they sometimes contain so much information it can sometimes take a little while to find the answer to your exact question. In circumstances like this, our next tip is essential.

When in Doubt, Give a Person a Shout

In addition to online databases, there is a wide variety of human resources just a phone call or email away. In order to get the best answer to your question it is recommended that you consult with one of the national groups that specialize in Medicare insurance. An excellent resource is the Senior Advisors Group. This insurance agency deals exclusively with Medicare supplemental, Medicare Part D and Medicare Advantage plans. Because of their expertise, this agency as well as others quickly and (more importantly!) correctly answer any query whether it’s about Medicare Advantage, choosing the best Medicare supplemental insurance plan, or even questions about Medicare Part D (Medicare’s prescription plan). So next time you’re confused about your options, just pick up the phone and make a call!

Do I Really Need Medicare Supplemental Insurance?

Yes! So how does this relate to Medicare’s coverage? There is a general rule of thumb that is called the “80/20 rule.” Outside of some of the preventative items like mammograms, colorectal screenings, and some psychiatric care, Medicare covers the first 80 percent of medical bills, leaving you to cover the last 20 percent. Medicare will also cover certain medically-necessary pieces of equipment like seat lift mechanisms and diabetic shoes (fitted by a specialist, of course). It doesn’t seem so bad at first, especially if you’re a healthy individual, but if something happens that requires you to need urgent medical care or even an operation, you may have to spend tens- to hundreds-of-thousands of dollars. A June 2011 report from the Kaiser Family Foundation predicted that by the year 2020 the median out-of-pocket spending for seniors with Medicare is projected to reach 26 percent of all income, with the most money being spent in the last five years of their life. This is why supplemental Medicare insurance is a necessity for every senior. Not only do you really need Medicare supplemental insurance, you need it before something happens to you, and you likely won’t use it much until the last 5 years of life. So two points to keep in mind 1) If you wait until a procedure is needed or something unexpected happens to you, you’ve waited too long, and 2) Don’t make the mistake of cancelling your Medicare supplement policy because you’ve’ paid in more than you use. It’s health insurance and in this case it works best if it’s held to its natural end point.

So What Is the Best Medicare Supplement Plan for Me?

If you’re still wondering which Medicare supplement plan is the best Medicare supplement plan for you, the answer is: it really depends on your specific needs and preferences! This is why you need to compare Medicare supplement plans, Medicare Advantage plans and Medicare Part D plans thoroughly before making a decision. Depending on your specific needs there is a variety of choices that could fit. As they say, sometimes a good offense is to have a good defense, so don’t wait until the last minute to take care of finding a Medicare supplemental insurance plan. Pick up the phone and start to compare Medicare supplement plans today and you’ll be sure to have many happy, healthy tomorrows.

About the author: Simone is a writer and researcher who has written for various companies about Medicare supplemental insurance, home security systems, travel, and personal safety. Her opinions can be found throughout various industry forums and blogs.

3 At-A-Glance Guides for Assisted Living

There are many details involved in choosing an assisted living facility that will work for your loved one. The process involves navigating the terminology and verbiage of health insurance policies and also figuring out what a day-in-the-life would be like at a facility.

Here are three at-a-glance guides to help illustrate what long term care insurance is, clarify key insurance terms and show what a typical day at an assisted living facility should look like.

1. Long Term Care Insurance

You may hear a lot about long term care insurance, but how do you know if it is the right choice for your family? Below we’ll outline the target market indicators for long term care insurance, to help give you a better sense if these types of policies would be a good fit for you.

Who needs long term care insurance?

  • People who have assets they want to protect
  • People who want to maintain their financial independence.
  • People who are concerned about having a choice in the quality of care they will receive in the future.
  • The average age of people who buy long- term care insurance is about 65.
  • Married people with assets of above $100,000 (not including a house).
  • Single people with assets above $ 50,000. Otherwise a client would probably deplete their assets before the insurance kicks in, making them eligible for Medicaid.
  • Since women live longer then men,they have a greater chance of ending up in a nursing home. According to a 1997 study by the Health Insurance Association of America, half of all women who live to age 65 will need a nursing home at least once during their life, compared to about one- third of men.

2. Key Health Insurance Terms

Insurance is a major factor in today’s eldercare system. I advise you to contact an insurance advisor who specializes in working with older adults and their families. Here are some basic terms you’ll need to be familiar with:

  • Medicare: A federally-funded health program administered by the Department of Health and Human Services. It is available to all Americans over the age of 65. It is made up of two parts.
  • Part A: This is available to everyone, and covers inpatient care and some aspects of in-home care.
  • Part B: This is optional and requires a monthly premium. It covers many outpatient services.
    Both Part A and B include deductibles and co- payments, and exclude certain services. You may choose to purchase Medigap insurance to cover the “gaps” in coverage by Medicare.
  • Medicaid: This is also known as Medical Assistance, and covers health care services for low-income Americans. Funded by federal, state and local governments; this program requires that applicants meet stringent income and asset requirements. While it covers some inpatient services in hospitals or certified institutions, it rarely covers in-home care.
  • Secondary Insurance: Purchased privately, these policies do not cover long-term health care costs, and rarely cover long-term in-home care. This insurance is designed to supplement Medicare.
  • Long-Term Care Insurance: Such a policy covers both in-home and residential services (including nursing homes) over an extended period of time. Often prohibitively expensive.

3.  A Typical Assisted Living Schedule

When you begin to tour assisted living communities, pay attention to the daily schedule of activities, as physical and mental stimulation will help keep your loved one happy and well.

Planned correctly, activities will become the cherished part of your loved one’s day. To set our frame of reference, let’s look at a typical assisted living day from the perspective of the resident:

  • 6:45 – 7:30am: Have breakfast and receive assistance for a shower from the aide that I’m already comfortable with
  • 7:30 – 9:00am: Make my way down to breakfast. An aide will assisted me to the dining room if necessary, and the medication technician will provide my medications for the day.
  • 9:30 – 10:30am: Morning exercises in the activity room include some stretches, leg lifts and rubber band exercises.
  • 10:30 – 11:30am: Choice of a scenic drive or reading a book by the fireplace. If I take the scenic drive, the van will be wheelchair-accessible.
  • 11:30 – 1:00pm: Lunch and return to my apartment to rest for a while.
  • 2:30 – 4:30pm: Different things happen on different days. During a week, I’ll usually see education presentation, musical performances or craft demonstrations. Nothing is required if I am tired.
  • 4:30 – 6:00pm: Dinner.
  • 6:00 – Bedtime: Evenings can bring visits from family and friends, outings in the community van, or quiet time at home.

Photo Credit: Jan Krömer

Finally, a Vision for Care Referrals That Will Improve Outcomes

Picture this: you’re one of millions of Americans who needs care at home either because of aging, dementia, recovery from surgery or other disabilities.  You’ve got a family—and often an unpaid caregiver who helps with your care.  They’re part of an elaborate team of caregivers, physicians, therapists and non-medical assistance.  I’ve lived this first-hand as I’ve cared for my mother, and I’ve spoken to literally hundreds of families in the same situation.

Insurance companies and other employee benefit programs often deliver these care recommendations.  They do the best they can considering maintaining these programs—and the underlying data—is not their primary business.  Unfortunately, they struggle to extend these programs across the whole company so that each member-facing group can leverage the same data to provide the best care referrals to their members. I’ve just assumed it was one of those “not-yet-solvable” situations, as healthcare technology is always a bit slower than other industries.  So we did the best we could and used what was not an ideal support system.

The Future of Care Referral Programs

I think I finally found a vision for the future.

I ran into a white paper from SNAPforSeniors that really caught my eye.  If SNAP can deliver on this vision—and if insurance companies, call centers and other providers have the vision and foresight to adopt it—it will dramatically change the outcomes of care coordination as part of the age in place movement.  More important, it will give families like mine the peace of mind that we are getting referred to the best matched providers for our care.

I know this vision may not concern some of you, but I highly recommend you check it out.  These types of ideas are the ones that are going to make the biggest impact. If you think your family would benefit from your insurer adopting programs like this, you should let them know.

Here’s the link to the paper –

Long Term Care Series – Part 3: Gambling on LTC

In the third part of our series on long-term care (LTC) insurance, Patrick Cloyd shares with us a real-world example of the gamble one takes by not having long-term care insurance.

Here’s Patrick’s article:

Gambling on Long-Term Care:
Study shows many not prepared for likely need

Patrick Cloyd
State Farm® agent

(410) 766-4488

A 48-year-old father of two is left with permanent injuries after an auto accident. A 66-year-old recent retiree suffers a serious stroke. An otherwise healthy 75-year-old grandfather falls and breaks his hip. These people have one thing in common. Quite unexpectedly they’re each likely to need some form of long-term care, through nursing care at home, in a nursing home or at an assisted living facility.

[Read more...]

Long Term Care Series – Part 2: Costly Misconceptions

As you all know, I’ve been running a survey to investigate, among other things, assisted living preparedness.  One of the most frequently cited issues is that of long-term care insurance and the ability to afford assisted living.

Most People Mistakenly Believe Long-Term Care is Covered

In the second part of our series on long-term care (LTC), my good friend Patrick Cloyd has shared a number of misconceptions about LTC.  While the statistics may be startling, I’m glad he’s shared these common misconceptions so we can address them with proper coverage.

Here’s Patrick’s article in its entirety:

Costly Misconceptions:
Most People Mistakenly Believe Long-Term Care is Covered

By Patrick Cloyd, State Farm® agent
(410) 766-4488
Have you failed to get insurance for long term care in a nursing home because you think you already have coverage? If so, you’re like a lot of other people, according to a Roper survey of Americans 45 years of age and over, recently released by the American Society on Aging (ASA).

That misconception can become costly when you consider long-term care in a nursing home currently averages $56,000(i) a year, according to the US Government, and is expected to quadruple by 2030(ii). People could easily find their assets depleted, their choices limited and their independence gone if they need long-term care but have made no plans to pay for it.
And chances are good they will need long-term care. Statistics released by the Health Insurance Association of America say that after age 65, Americans have more than a 70 percent chance of needing some form of long-term care, whether it’s an aide coming to their home, a stay in an assisted care facility or an extended stay in a nursing home.(iii) Younger people may also need long-term care if they’ve had a stroke, for example, or been in an accident.
“This survey confirms that Americans need to wake-up to the realities of long-term care,” said Jim Emerman, senior vice president of the ASA. “All it takes is a phone call to a financial services professional to find out the truth behind the misconceptions so many have about long-term care.”
Some of the common misconceptions uncovered in the Roper study(iv) are these:

  • Forty-two percent were not aware
  • Medicare only covers long-term care expenses for a short time, and only after someone is released from the hospital.
  • Thirty percent were not aware Medicaid coverage for long-term care is only available after someone’s financial resources are exhausted.
  • Almost half (46 percent) are under the impression their health insurance will automatically cover long-term care.

It’s dangerous to assume you’re covered for long-term care. When the need for a nursing home stay or other long-term care arises, you may discover you’re not covered and have waited too long to buy insurance. Long-term care insurance is an important part of a financial plan. I urge people to speak with a financial services professional about their need for long-term care insurance now, before it’s too late to get coverage.

(i) Estimates from: Health Care Financing Administration, Office of the Actuary, National Health Statistics Group. As presented in, “Nursing Homes.” AARP Public Policy Institute Fact Sheet. February 2001: pg. 3.
(ii) Can Aging Baby Boomers Avoid the Nursing Home? Long-term Care Insurance for Aging in Place.” American Council of Life Insurers. March 2000: pg. 15.
(iii) Lewin Group estimates based on the Brookings-ICF Long-term Care Financing Model, 1992. As cited in, “Long-term Care: Knowing the Risk, Paying the Price.” Health Insurance Association of America (HIAA). 1997: pg. 12. The level of coverage provided by long-term care insurance depends on the type of policy you purchase. Some types of care received may not be covered by long-term care insurance.
(iv) Study conducted by Roper ASW, August 2002. Released by State Farm Mutual Automobile Insurance Company and the American Society on Agency (ASA), April 2003.
State Farm Mutual Automobile Insurance Company Home Office: Bloomington, Illinois –®. The American Society on Aging is not an affiliate of State Farm®. The Long-Term Care Insurance policy 97058 is underwritten by State Farm Mutual Automobile Insurance Company.