The Prideaux Group

11/10/2021

We finally received our sign!! It was stuck on a container ship for over a month. The Medicare Annual Election Period is now through December 7th. Our Kiosk is at the Bloomington Walmart. Call or message me with ANY Medicare questions. 612-868-5329

08/07/2021

I am a Vet with health care coverage through the VA system. Do I need Medicare as well?

If you have coverage through the VA and are eligible for Medicare, you’re not required to enroll. But there are good reasons to do so.. The VA itself strongly recommends that veterans with VA health care also enroll in Medicare Parts A and B as soon as they become eligible (unless they have group insurance from a current employer).

The VA provides access to health coverage not insurance and VA health coverage isn’t the same for everyone. The VA assigns enrollees to different priority levels according to various factors, such as income and whether they have any medical condition that derives from their military service. Federal funding for VA health care can change. If doesn't keep pace with costs, some vets in the lower priority groups may possibly lose VA coverage entirely.

Having both Medicare and VA benefits greatly broadens your coverage options. VA coverage pays for medical services if you go to a VA hospital or doctor. If you need to go elsewhere, you'll probably end up having to pay the full cost yourself, even in emergencies (Like an Ambulance or Airlift). With Medicare, you're covered if you need to go to a non-VA provider. This is an especially important point to consider if you live some distance from the nearest VA facility or if you don’t want to spend the whole day at the VA (Think convenience). It also gives you access to Part C (Advantage) plans that are especially designed for Vets. Many of the plans are premium free (that’s right, no premium) that include generous dental, hearing and vision benefits.

You may be subject to penalties in the future. At some point, when you’re well past 65, you might lose VA coverage, or otherwise decide that you need Medicare. If you are not already signed up for Part B (and don't have insurance through an employer or other source), you'll likely have to wait a while for coverage, and you could be liable for late penalties that are permanently added to your Part B premiums.

The Medicare and VA systems are entirely separate, with no coordination of benefits between them. You would use your VA identity card at VA facilities and your Medicare card anywhere else. There are other considerations such as for those utilizing TriCare and ChampVA. As always, it’s best to consult with a competent local broker.

07/21/2021

Many people turning 65 believe they must enroll in Medicare or pay a penalty. I tell them that they most likely do not have to enroll but many have a hard time trusting my information because they have heard otherwise. It is definitely an option to enroll, at least in part A but you have to weigh the options of whether to stay on your plan at work or enroll in Medicare A, B and D. That's where a competent Medicare agent can help. Here is an article from an authoritative source about the subject.

Some people don’t need Medicare because they are still covered by an employer’s plan or their spouse’s health plan. However, if you do not join Medicare when you are first eligible and you are not covered under another health care plan, you will have a late enrollment penalty for your Medicare...

06/21/2021

Should You Buy a Medicare Plan from Joe Namath?

You have all heard Joe Namath on the airwaves promoting his “excellent, free” Medicare plan with all of those bells and whistles that he, himself was being offered as a Medicare beneficiary! Call this 800 number and you can have one, too.
If you listen carefully to each of his words, as I have, the language is technically correct. But the language may describe the features of a range of plans and not just one. Will the average Medicare beneficiary be able to suss that out?
Not a chance.
I get plenty of questions asking, “Is it really true?”
Yes, it can be to a certain extent. But, let’s talk through the parts of the commercial that were left out.
There are two choices when it comes to Medicare coverage: Medicare Advantage plans, also known as “Part C,” and Medicare supplements, which are also referred to as Medigap plans.
What is Medicare Advantage? It is the plan that Joe is talking about.
The Centers for Medicare and Medicaid services defines Medicare Advantage plans as an “all-in-one” alternative to original Medicare. These bundled plans typically include Part A (Hospital), Part B (Doctor/Outpatient), and part D (Prescription Drugs). Medicare Advantage plans are often called Part C, MAPD (which is Medicare Advantage Prescription Drug plans), zero-premium plans, the private Medicare alternative etc.
Medicare Advantage plans work similar to employer and individual health insurance plans you may be accustomed to before starting Medicare. Advantage plans consist of HMO and PPO plans and will likely require you to utilize a specific network of doctors and hospitals.
With the Medicare Advantage plan, the three parts to Medicare (A, B and D) are then bundled into one package that is provided by a private insurance company. This is why it is sometimes referred to as “Part C,” even though Advantage plans are not a part of original Medicare. Many, many national and local insurance carriers offer Medicare Advantage plans.
How can these plans cost zero per month?
Private insurers are able to offer these plans because the federal government actually pays them to offer Medicare Advantage plans to beneficiaries. These companies receive $1,000/month (or more) per enrollee from the government. In exchange, they administer and manage the health coverage for individuals that sign up for their plan.
What the insurance companies do a little differently than the government is they also provide some additional benefits not included in original Medicare. Many of these additional benefits come built into the plan at no additional monthly cost. As Joe said, “You can get more benefits and save money” with one simple call.
Some of the extra benefits that you may be familiar with is that many Advantage plans include coverage for routine dental, vision and hearing care. Original Medicare does not provide any coverage for these services.
Remember that when enrolling into a Medicare Advantage plan, you still have to pay your monthly premiums to the government for Medicare Part B. Most Medicare beneficiaries will pay $148.50/month for their Part B coverage in 2021. This will be paid on top of the “zero” premium paid to the carrier.
When Joe mentions this “completely free” healthcare, people are not aware that they have to pay the basic Part B premium to Medicare. And for some people, a total of $148.50 each month added to their zero-premium plan seems like very little. To some, it is a lot. Also, depending on your income it could be a lot more
When you purchase that zero-premium plan, here’s how the costs might play out during the year. I will assume the part B premium is the base rate of $148.50/month, which would be $1,782/year. I will use a Medicare Advantage plan for this example, which has a monthly premium of $0/month, which is also $0/year.
Next, let’s assume you see your primary care physician two times during the year, each visit with a $0 co-pay. In addition to the primary care visit, I will assume you visit a specialist (like a cardiologist or dermatologist) three times during the year. Each visit comes with a co-pay of $40 and three visits add up to $120/year.
In addition to the doctor visits, I will assume someone spends two days as an inpatient in the hospital during the year. With our sample plan, a consumer would pay $325/day for the first six days you are an inpatient in the hospital. That two-day stay would result in an out-of-pocket cost of $650.
Lastly, let’s assume that they also had five physical therapy (PT) sessions throughout the year. With this Medicare Advantage plan, each PT visit costs $40, so five visits would cost an additional $200.
Add this up and you can see that, using this actual plan as an example, those out-of-pocket costs add up to $2,752/year. Is that a lot? To some folks yes, others no. Are they “free?”
Despite all of the advertisements, there are no plans that are truly “zero dollars and zero worries” annually. It’s impossible. Also, these zero premium plans in many states have very limited dental, vision and hearing benefits. This does not in any way mean that Medicare Advantage plans are a bad thing; it means you have to pay attention to all the details. Most of my clients, having been given the choice, choose Advantage Plans over Medigap Plans and most do not choose Zero Premium plans
Zero premium plans in Minnesota look very different than zero premium plans in other states. As a matter of fact, they vary county by county. Minnesota zero premium plans are typically not as rich as some other parts of the country.
Joe is being paid to advertise for the massive call centers that are robo-dialing you. These call centers are certainly not local and do not have complete local knowledge. They most certainly do not represent all the carriers in your service area. Most likely they will not take a consultative approach to helping you. There is only one way to get that. Deal with a local agent that has ALL the carriers.
Call or text me anytime with questions. 612-868-5329

04/20/2021

Which Medicare Plan Should I Choose?

If you’re like me and turning 65 this year, you’re starting to get bombarded by mailers from insurance companies and insurance agents and agencies telling you it’s time to sign up for Medicare and we have the plan for you. So how do you know which plan is right for you? It can be bewildering.
I have seen many people make their decisions based on such reasons as “My friend has Company A and she likes it so that’s the company I’m going with” or “I have been with Company B for 20 years and they have been good for me so I’m going with them”. You might get lucky and end up with a good plan for you but most likely not.
When I help someone through the decision making process there are a number of factors I take into consideration, such as:

Who is your physician?
What clinic is your physician affiliated with?
Do you use more than one clinical system?
What is your hospital preference?
What is your level of utilization of those medical providers?
Are you a veteran?
What county do you live in?
What is your medication regimen? (What drugs do you take?)
Are extra benefits like Dental, Hearing, and Vision important to you?
What is your monthly budget?
How much risk are you willing to take?

The answers to these questions are very important in making the determination of which plan and company best suits your needs. Without going through this process you could make a very costly mistake. For example, a specific drug with Company A could cost three times a much as with Company B. It's not out of the realm of possibility to save more than $1000 on medications. Another example is Company A has no comprehensive dental coverage and Company B has up to $2000 for comprehensive dental. A crown or root canal can cost north of $1500.
For the best results, employ the services of a certified Medicare broker who represents ALL the companies in your service area, not just two or three. For example, in Hennepin county there are 8 companies with 44 Advantage Plans available. I represent them all. Ask the broker how many companies he represents. If its not 6-8, find another broker. Brokers are paid by the insurance company not you. The plans are the same and the costs are the same whether you go direct to the company or use a broker so why not avail yourself of the services of a competent, unbiased broker, it's free.
A good broker can cut to the quick and make the process far less confusing and painful. You will walk away confident you made the right decision.
Please message me anytime with questions or call me at 612-868-5329

03/29/2021

The Ins and Outs of Medicare Part 4

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare.
Option 1 is enrolling in Original Medicare which includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, (I highly recommend it) you can join a separate Part D plan. Medicare does not cover everything. You still have significant exposure under both part A & B. For example, under part B, you are responsible for 20% of the cost of your care. The 20% is unlimited!
To mitigate your exposure and help pay for your costs, you can shop for a Medicare Supplement (often called a Medigap policy). These are available from private insurance companies. Medigap policies can afford you very comprehensive protection and you can use any doctor or hospital anywhere in the U.S. Supplement policies can be more expensive than other options though and do not include Dental, Hearing or Vision coverage.
Option 2 is enrolling in a Medicare Advantage plan (this is part C). Medicare Advantage is an “all in one” alternative to Original Medicare and is offered by private insurance companies. You still have to be enrolled in Parts A & B and you still have to pay your part B premium. These “bundled” Advantage plans include Part A, Part B, and usually Part D (drugs). These plans typically have lower out-of-pocket costs than Original Medicare. In most cases, you’ll need to use doctors who are in the plan’s network. Advantage plans are usually lower in premium cost than Medicare Supplements and are heavily subsidized by Medicare. Most Advantage plans offer extra benefits that Original Medicare doesn’t cover— like vision, hearing, dental, and more.
I know this is a lot to digest. Message me anytime and I’ll be happy to answer your questions.

03/10/2021

The Ins and Outs of Signing up for Medicare, Part 3

I'm still working. Do I need to sign up for Medicare?

You don’t need to enroll in Medicare at age 65 if you have creditable coverage through a qualified group health plan, and your company is larger than 20 employees. Your HR department can tell you if it is creditable. Most group insurance is. If it is creditable coverage and you are going to stay on the plan, you still may want to sign up for just Part A. Remember, if you paid Medicare taxes for 10 years Part A does not have a premium and it will coordinate with your group insurance, so there may be a benefit. The caveat to this is if you are contributing to a Health Savings Account. Then you would continue to delay part A as enrolling in Part A disqualifies you from making HSA contributions.

As far as enrolling in both Parts A & B, doing so might make sense if your plan isn’t heavily subsidized by your employer. Figure out what you’re paying for group health coverage and what your benefits look like under that plan, and then compare it to what you’ll pay under Medicare, taking into account the cost of everything from premiums to coinsurance to deductibles to copays.

Keep in mind that for comprehensive coverage under Medicare, you’ll need a Part D drug plan to accompany Parts A and B. Still, you might find that signing up for Medicare at 65 makes the most sense financially. A professional Medicare broker can help you sort this out.

Remember that if you don't have creditable coverage at work or you are retiring, you need to enroll in Medicare Parts A, B and D. Parts B and D have substantial penalties for late enrollment.

02/22/2021

The Ins and Outs of Signing up for Medicare, Part 2

This is a continuation of my previous discussion where I will attempt to start answering some questions.

When can I sign up?

For most of you, the first time you’re eligible for Medicare is when you turn 65, you can sign up during your Initial Enrollment Period. This is a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. So, if you turn 65 July 15th 2021, you can enroll in Medicare starting April 1st 2021 and have until October 31st 2021 to sign up. Your Medicare coverage will start July 1st 2021, the first day of your birth month. If you plan on applying for Medicare when you turn 65, do it as early as possible. That would be April 1st in the illustration above. Sometimes it takes Medicare a while to process your enrollment.

How much does Medicare cost?

As long as you have worked at least 10 years and paid Medicare taxes in to the system, Part A has no monthly premium.

Part B has a premium each month. Most people will pay the standard premium amount, which is $148.50 in 2021. Your Medicare Part B premium is based on your income so it may be higher. Once your individual income is north of $88.000 or your joint income is north of $177.000 your premiums will start to increase progressively. This amount can change every year. You can find up-to-date premium amounts on Medicare.gov.

Not everybody is going to need or want to sign up for Medicare when they turn 65. Some may just sign up for Part A and not Part B (Yes you can sign up for Parts A and B separately). Some may not sign up for either part. I will go over this soon. Stay tuned!

02/16/2021

The Ins and Outs of Signing up for Medicare

Probably the most common questions I get from people turning 65 is “Do I need to sign up for Medicare?” “When should I sign up?” and “How do I sign up?”.

The short answer to the first question is maybe, and to the second two is it depends.
This will be the first in a series of articles to address these questions and more.

First a little backround.

Medicare is health insurance for:
■People 65 or older
■Under 65 with certain disabilities
■People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant.

Medicare Has Different Parts

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals. Part A also includes coverage in critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also covers hospice care and home health care. You must meet certain conditions to get these benefits.

Medicare Part B (Medical Insurance) helps cover medically necessary services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover. Part B also covers many preventive services.

Medicare Part D (prescription drug coverage) Medicare prescription drug coverage is available to everyone with Medicare. Private companies provide this coverage. You choose the Medicare drug plan and pay a monthly premium. Each plan can vary in cost and specific drugs covered.

Medicare Part C (also known as Medicare Advantage) essentially replaces your Part A and Part B coverage and many times offer additional benefits. Private insurance companies approved by Medicare run these plans. Medicare funds these plans. Generally, you must see doctors in the plans network. Most Medicare Advantage Plans cover prescription drugs and include Medicare Part D. You choose the Medicare Advantage Plan and may pay a monthly premium. Costs vary by plan. You are still a Medicare beneficiary when you elect Part C. Nobody is going to take Medicare away from you.

I know I didn't answer any questions yet but this is already a lot to digest. The answers are coming soon. Stay tuned!

10/14/2020

We just got our kiosk set up at the Bloomington Walmart for the Medicare Annual Election Period! It starts tomorrow (10/15) in earnest. This is my first time at this Walmart. Years ago I was approached by my Field Marketing Organization to do the Walmart gig. I was a little reticent to say the least but they persisted and I acquiesced. I was surprised by the amount of business that comes out of Walmart. It’s kind of cool that I’m 3 blocks away from the house I grew up in on 76th and 11th in Richfield.

09/29/2020

Wow I can't believe it! The 2021 Medicare Annual Enrollment Period is right around the corner! It starts 10/15. This is the time to change or review your Medicare Advantage (MAPD) or Prescription Drug Plan (PDP) options.

Here are some important things to know about this coming AEP:

The Centers for Medicare & Medicaid Services announced the Part D Senior Savings Model, a voluntary model that enables participating plans to lower Medicare beneficiaries' out-of-pocket costs for insulin to a maximum $35 copay per thirty-day supply. The lower copay applies even in the coverage gap (donut hole)! Most carriers are participating in some fashion in some or all their plans. If you are an insulin user message me and I can direct you the plans that are participating.

There are several new low-cost and Zero Premium PPO (Preferred Provider Organization) options available for 2021. Key features may include no referrals, national coverage network, dental, vision, over the counter benefits and more. I haven't seen this kind of parity in the market since cost plans were sunsetted in 2018.

There is a new MSA plan that provides an annual cash deposit, with the ability to access any Medicare provider and pay for services from your MSA account. Unused $$$ rollovers each year.

New electronic enrollment systems allow you to enroll from the comfort of your home. This is provided your agent is willing or proficient in using these systems.

Companies and agents (the sharp ones) have implemented new processes to address the current Covid environment, including:
• Phone and virtual appointments (Zoom, FB, etc.)
• Online enrollments with text-to-enroll capabilities
• In person appointments with a mask, sanitizer and disinfecting procedures in place
• Direct mail as needed

If you are happy with your current plan no action is required, the plan will continue with any changes taking effect on January 1st of 2021.

09/29/2020

I just deleted our previous posts. They were all time sensitive and quite dated. (I concede neglect) Going forward I'm going to publish information largely about medicare.