Best Price Medicare Supplements of Texas

01/14/2024

We still have great rates!

11/02/2023

Its Annual Enrollment, let us help you with your Medicare review free of charge.

06/05/2023

Great new low prices in Texas.

04/01/2022

FUN FRIDAY 😆🐰

~~ Our Most Important Service - Serving You! ~~
Serving Texas since 1956

Don't keep us a secret, share this information with your Family and Friends!

WE CAN HELP YOU WITH YOUR MEDICARE JOURNEY...CALL US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

03/29/2022

TURNING 65?

7 Common Questions About Medicare

1. How do I enroll in Medicare? Is it automatic when I turn 65?
2. When do I have to enroll?
3. What if I’m still working and have insurance? Do I need to enroll at age 65?
4. What does Medicare cover?
5. I’m going on a cruise/overseas trip. Will Medicare cover me if I need emergency care when I’m away?
6. How do I pay for my Medicare?
7. How can I find out how much I’ve paid for Medicare services this year?

~~ Our Most Important Service - Serving You! ~~
Serving Texas since 1956

Don't keep us a secret, share this information with your Family and Friends!

WE CAN HELP YOU WITH YOUR MEDICARE JOURNEY...CALL US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

03/25/2022

FUN FRIDAY!

~~ Our Most Important Service - Serving You! ~~
Serving Texas since 1956

Don't keep us a secret, share this information with your Family and Friends!

WE CAN HELP YOU WITH YOUR MEDICARE JOURNEY...CALL US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

03/22/2022

THE DIFFERENCE BETWEEN NURSING HOMES AND SKILLED NURSING FACILITIES

Medical emergencies can reveal more than just a new or worsening medical condition. They often expose more general problems with your living situation and whether or not it will meet your current and future needs. Especially for seniors, recovering from serious emergencies often requires a short-term stay at a rehabilitation center. From there you might be discharged back home or make the decision to move to a senior living community.

Either way, the process can be very stressful, and researching your next steps can be confusing. You may have been told that you should seek care at a skilled nursing facility. If you are going to require ongoing care should you move to a nursing home or can you stay at this skilled nursing facility? What is a nursing home and what is a skilled nursing facility?

The essential difference can be summarized this way: a nursing home is more of a permanent residence for people in need of 24/7 care, while a skilled nursing facility is a temporary residence for patients undergoing medically necessary rehabilitation treatment.

Despite the distinct differences between what qualifies as a nursing home vs. a skilled nursing facility, most of the confusion comes from the medical definition of skilled nursing.

WHAT IS SKILLED NURSING AND WHAT ARE SOME EXAMPLES OF SKILLED NURSING CARE?

Skilled nursing is a high level of care requiring advanced training and certifications. Skilled nursing care must be provided by or under the direct supervision of licensed health professionals, such as registered nurses (RNs), licensed practical nurses (LPNs), speech/language pathologists, and physical/occupational therapists.

Examples of skilled nursing services include physical, occupational, and speech therapy, wound care, intravenous (IV) therapy, injections, catheter care, continual monitoring of medical signs, and the use of medical equipment to support the patient’s care needs and monitoring of vital signs and medical equipment.

It is helpful to consider that skilled nursing is a description of the type of service that is offered. Accordingly, skilled nursing is offered at both skilled nursing facilities as well as nursing homes. It can also be provided in a senior’s home as part of home health services.

WHAT IS A SKILLED NURSING FACILITY?

A skilled nursing facility (SNF) is an inpatient rehabilitation and medical treatment center. They're often utilized for care after a hospital stay following an accident, severe illness, or surgery to help a patient regain their ability to do activities of daily living such as bathing, dressing, cooking, personal hygiene, walking, and getting into/out of a bed or chair. Similar to a nursing home, SNFs provide 24/7 care.

It should be noted that the need for skilled nursing services does not automatically mean that you need a stay in an SNF since skilled nursing is available in a variety of settings including a senior’s private home. A number of factors will go into the decision about where to receive skilled nursing care, including your living situation, whether there is someone at home who can help you while you recover, the severity of your illness, and the types of rehab services you require.

Skilled nursing is mostly regulated by the Department of Public Health and the Centers for Medicare & Medicaid Services (CMS). To be certified by CMS and the DPH, skilled nursing communities must meet strict criteria and are subject to periodic inspections to ensure quality standards are being met.

WHAT IS A NURSING HOME?

In short, nursing homes are residential centers for seniors who are medically stable but can’t be cared for at home due to chronic conditions or a lack of mobility. They are places where residents can receive the care they need in order to maintain their health.

Moving to a nursing home is typically thought of as a more permanent move, as opposed to a temporary stay in a skilled nursing facility for rehab and recovery. Nursing homes provide nursing care, assist residents with activities of daily living (also known as custodial care), and offer a calendar of activities to promote resident engagement and build community.

HOW IS A SKILLED NURSING FACILITY DIFFERENT FROM A NURSING HOME?

The biggest difference is that a SNF provides a higher level of specific care. Nursing homes are designed around providing more generalized care which doesn’t necessarily require a higher level of certification or training. Of course, facilities that offer a high level of care will have staff that received some form of professional training.

However, nursing homes can have staff with the skills and certifications that qualify under skilled nursing in order to provide general, ongoing care and medical monitoring. In other words, a nursing home has the option of employing skilled specialists while SNFs absolutely require skilled specialists.

Without the advanced training required by an SNF, nursing homes are often less equipped to deal with recovery from an acute illness, or restoring function that was lost after a hospital stay. Specialized services available at a SNF such as physical rehabilitation, cardiac care, pulmonary rehab, post-stroke recovery, wound care, and speech therapy will not likely be available in a nursing home.

Some of the same services performed at SNFs can also be done at nursing homes such as assistance with activities of daily living (bathing, feeding, etc.), dialysis, medication management, blood sugar testing, and insulin injections. Again, the difference is that nursing homes perform these services where the senior lives full-time, while SNFs perform those services in a more medically intensive, short-term setting.

ARE THERE COST DIFFERENCES BETWEEN SKILLED NURSING FACILITIES AND NURSING HOMES?

In general, nursing homes tend to be more expensive to the consumer as insurance is less likely to cover the service.

Medicare will cover a skilled nursing facility as long as there is a need for skilled service, meaning oversight by a professional medical team. Skilled nursing care provided in any setting for any duration must be ordered by a doctor to be covered by Medicare, Medicaid, the U.S. Department of Veterans Affairs, or private health insurance.

Medicare does not cover custodial care, which is what a nursing home would fall under.

Long-term health insurance can help pay for many types of long-term care, including skilled and non-skilled care. Coverage can vary greatly depending upon the provider and whether or not they cover pre-existing conditions. Some policies may cover only nursing home care, while others may include coverage for a range of services, such as assisted living, medical equipment, and informal home care.

~~ Our Most Important Service - Serving You! ~~
Serving Texas since 1956

Don't keep us a secret, share our information with your Family and Friends!

WE CAN HELP YOU WITH YOUR MEDICARE JOURNEY...CALL US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

03/18/2022

MEDICARE PART B PREMIUM

Increases in Medicare Part B and the hold harmless provisions

Each year, the Centers for Medicare & Medicaid Services (CMS) set the following
year’s Part B premium. In 2022, the Part B base premium will be $170.10. Most people will
pay this amount. A small number of people may pay a premium that is lower than the base
premium. These people are protected by the hold harmless rule.

The hold harmless rule protects you from having your previous year’s Social Security
benefit level reduced by an increase in the Part B premium so long as:

1. You are entitled to Social Security benefits for November and December of the
current year (2021);
2. The Medicare Part B premium will be or was deducted from your Social Security
benefits in November 2021 through January 2022;
3. You do not already pay higher Part B premiums because of Income-Related Monthly
Adjustment Amount (IRMAA) eligibility;
4. And, you do not receive a Cost of Living Adjustment (COLA) large enough to cover
the increased premium. COLA is additional income given to Social Security
recipients to protect against inflation decreasing the benefit’s purchasing power. The
COLA in 2022 will be 5.9% of your Social Security benefit.

The COLA in 2022 is likely to cover the full Part B premium for most people. If your COLA
is large enough to cover the full amount of your increased premium, you will not be held
harmless and your premium will increase to $170.10.

The hold harmless provision does NOT protect you if:

1. You are new to Medicare in 2022. Hold harmless does not apply to you because you
have not been enrolled in Medicare Part B long enough to qualify.
2. You are subject to IRMAA.
3. You are enrolled in a Medicare Savings Program (MSP). However, the MSP should
continue paying for your full Part B premium.
4. You were enrolled in a Medicare Savings Program in 2021 but lost the program
because your income increased or you failed to recertify.

Note: If you qualify for the hold harmless provision but pay a Part B late enrollment
penalty, the penalty will not be waived, and it may increase. This is because the penalty
will be calculated based on the new, higher premium—even if you are not paying that
higher amount.

~~ Our Most Important Service - Serving You! ~~

Serving Texas since 1956



IF YOU HAVE ADDITIONAL QUESTIONS, DON'T HESITATE TO CONTACT US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

03/16/2022

3 WAYS TO AVOID THE PART D LATE ENROLLMENT PENALTY

1) Enroll in Medicare Drug coverage when you're first eligible.

Even if you don't take prescription drugs now, you should consider joining a Medicare Drug plan to avoid a penalty. You may be able to find a plan that meets your needs with very little premium.

2) ENROLL IN MEDICARE DRUG COVERAGE IF YOU LOSE OTHER CREDITABLE COVERAGE.

"CREDITABLE PRESCRIPTION DRUG COVERAGE" could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, the Department of Veterans Affairs, or individual health insurance coverage. Your plan MUST tell you each year if your non-Medicare Drug coverage is creditable coverage. If you go 63 days or more in a row without Medicare Drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare Drug coverage later.

3) KEEP RECORDS SHOWING WHEN YOU HAD OTHER CREDITABLE DRUG COVERAGE, AND TELL YOUR PLAN WHEN THEY ASK ABOUT IT.

If you don't tell your Medicare plan about your previous creditable prescription drug coverage, you may have to pay a penalty for as long as you have Medicare Drug coverage.

HOW MUCH MORE WILL I PAY FOR A LATE ENROLLMENT PENALTY?

The cost of the late enrollment penalty depends on how long you didn't have creditable prescription drug coverage. Currently, the late enrollment penalty is calculated by multiplying 1% of the "National Base Beneficiary Premium" ($33.37 in 2022) by the number of FULL, uncovered months that you were eligible BUT didn't enroll in Medicare Drug coverage and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $0.10 and added to your monthly prescription drug plan premium. Since the "National Base Beneficiary Premium" may increase each year, the penalty amount may also increase each year. After you enroll in Medicare Drug coverage, the plan will tell you if you owe a penalty and what your premium will be.

*****This is not a temporary penalty for however long you went without coverage. This is a lifetime Medicare Part D penalty.

~~ Our Most Important Service - Serving You! ~~
Serving Texas since 1956

IF YOU HAVE ADDITIONAL QUESTIONS, DON'T HESITATE TO CONTACT US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

03/15/2022

Did you know? Interesting topic you can share over some coffee or while having lunch with some friends.

If you have questions about the different prescription plans in your area, feel free to contact us, Donnelly-Bay Insurance Services, at 979-885-3557 or 713-209-0400

~~ Our Most Important Service - Serving You! ~~

Commonly seen on doctor’s prescription pads and signs in pharmacies, Rx is the symbol for a medical prescription. According to most sources, Rx is derived from

03/14/2022

WHAT IS MEDICAL UNDERWRITING?

Medicare Supplement plans, also known as Medigap plans, are a great way to cover the gaps in Original Medicare, but the application process can be tricky. For many people, the most difficult part is answering the health questions. This part of the application process is called Medical Underwriting, and in many cases, carriers can use this information to determine if they'll accept your application. Medical Underwriting can be stressful if you don't know what to expect, so we'll answer some of the commonly asked questions about the process.

WHAT HAPPENS DURING THE UNDERWRITING PROCESS?

The underwriting process begins with you filling out your application. Each carrier may ask for different information, but in general, you can expect questions such as:

> If you have specific health conditions on a list provided by the carrier
>If you have any surgery or similar treatments scheduled
>What medications you're currently taking or have taken in the past few years

If you have any questions about whether something applies to you, you should always ask your agent for clarification. They'll be able to help ensure that your application is accurate, which will speed up the process.

Once an underwriter from the carrier has had the time to review your application, they may call you and some follow-up questions. If you miss their phone call, you should call back to complete your phone interview as soon as possible, because they won't make their decision until they've spoken with you. As long as your application is in order and you aren't missing any paperwork, you should receive a notification of whether you've been accepted soon after your phone interview.

HOW LONG IS THE MEDICAL UNDERWRITING PROCESS?

Depending on the carrier and the time of year, the medical underwriting process can vary from a week to over a month. If you are applying for coverage during the Annual Enrollment Period (AEP), you should apply as soon as it begins (October 15) to ensure that you get an approval in a timely fashion. Outside of AEP, most carriers are able to give their response within a week or two from when you submitted your application.

CAN I AVOID THE UNDERWRITING PROCESS?

Fortunately, there are a few scenarios in which you may be able to avoid medical underwriting. This can be crucial if you have a serious health condition, because you may not be able to find a carrier that will accept you if they have a choice.

The following situations give you 'GUARANTEED ISSUE" rights, which means that you can be automatically approved for a Medigap plan.

1) YOU'RE IN YOUR MEDIGAP OPEN ENROLLMENT PERIOD

Your Medigap Open Enrollment Period starts on the month that your Medicare Part B begins, and lasts for six months. For instance, if you start Medicare in July, your Medigap Open Enrollment Period would end in December. Most carriers will also let you apply for the plan you want six months "before" your Medicare Part B start date so that your Medigap plan will be active the moment your Medicare coverage begins. During this time, you'll be able to sign up for a plan with any provider with no health questions. This is the only time most people can avoid underwriting, so it's critical you take advantage of it.

2) YOUR STATE HAS A SPECIAL RULE

Some states have special rules that allow you to avoid medical underwriting. For example:

>If you live in New York, Connecticut, Washington or Maine, you may able to change your plan year-round without answering health-related questions
>If you live in California or Oregon, you can apply for a plan of equal or lesser value around your birthday
>If you live in Missouri, you can apply for a plan of equal or lesser value around your policy's anniversary date

YOU LOST COVERAGE THROUGH NO FAULT OF YOUR OWN

The guidelines for this can vary, but if you lost coverage for a reason other than non-payment, you might be eligible for a "Guaranteed Issue" right. For instance, if you had a Medicare Advantage plan but moved out of the coverage network area, and were therefore dropped by your carrier, you would have a guaranteed issue right.

Keep in mind that most of these guaranteed issue rights situations are time-sensitive. If you believe you fall into one of these categories, or will in the future, you should work with your agent as soon as possible to figure out your timeline.

The medical underwriting process is confusing for many people, and the wait to hear if you've been approved can be stressful. In order to have some peace of mind in the meantime, you can keep your current insurance active until you hear that you've been approved. This is a process that many people applying for Medigap plans have to go through. While it may seem intimidating, you shouldn't let it deter you from applying for the coverage that you want.

IF YOU HAVE ADDITIONAL QUESTIONS, DON'T HESITATE TO CONTACT US, DONNELLY-BAY INSURANCE SERVICES, AT 979-885-3557 or 713-209-0400

~~ Our Most Important Service - Serving You! ~~