The Value of Max (aka the Scoop on MOOP)

By Marc Manor

With the cost of healthcare and healthcare related insurance getting more expensive each year, it sometimes can be hard to find the value.  Consumers are so overwhelmed with the expense, that the value of their plans is sometimes lost on them.  If a 60-year-old is paying $600 to $800 a month for a high deductible healthcare plan, who can blame them when consider opting out; especially now that the new tax law has removed the individual mandate tax penalty for not having insurance starting in 2019.  Before you go out in the world uncovered or under-covered, let me just take this opportunity to highlight what I call the “value of max” or "the scoop on MOOP".

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Almost everyone hears of the protections for pre-existing conditions that the Affordable Care Act (ACA) health insurance plans have; however, another lesser known protection is the “maximum out of pocket” feature.  Although less well known or talked about, this feature should be of great importance to those who are sitting on the fence when it comes to their 2019 healthcare coverage.

Leaving behind calm instead of chaos

By Marc Manor

Most days for me as an insurance professional are very satisfying.  I meet new people and help them get the most out of every healthcare dollar.  These people have great stories and because many of them are seniors, they have contributed so much to our American experience; our elders are truly “the greatest generation”.  I have always admired the work ethic and family devotion I observe in many of the seniors I work with.  Their stories are fascinating, and I love to hear them tell of their life and times.  It saddens me greatly when one of our senior clients pass on; but it motivates me even more to do more to make sure their families are cared for in accordance with their wishes.  

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When this happens, I sometimes get calls from the family members trying to tie up loose ends with unpaid hospital bills and insurance claims they don’t fully understand.  I can sense their despair and frustration when trying to gather information and make countless phone calls as they try to piece together all their loved one’s affairs.  I help them as much as possible, but it never feels like enough. 

Communicate and don’t procrastinate!

Surprise! Surprise! Surprise! It’s a bill!

By Marc Manor

Those of us old enough to remember “Gomer Pyle”, can visualize the scowl on Sergeant Carter’s face when Gomer revealed his many surprises!  Surprises can be great but not when it comes to healthcare insurance claims, most of us want to our bills to be exactly what we expect – NO SURPRISES! 

Healthcare insurance claims are based on a long list of medical codes that are associated with each treatment, diagnosis, and/or medical procedure.   The codes are entered by medical data entry people to base them on a patient’s chart or doctors notes.  The codes have a variety of uses in the medical field but the codes that are probably most important to us as healthcare insurance beneficiaries are the ones correlated to our healthcare benefits.  The codes submitted to the insurance company will determine how claims will be processed.  Allow me to provide you with some examples that may help in understanding how the codes affect healthcare insurance claims:

“I received a bill for a recent lab test.  I thought lab tests associated with qualified preventive care was 100% covered!”

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Preparing for Annual Medicare and Healthcare Insurance Renewals

By Marc Manor

With Medicare Annual Enrollment Period (AEP) and Healthcare Open Enrollment right around the corner, I thought annual renewals would be a timely and appropriate subject for this week’s blog.  Many of our clients want to know what this means to them. People looking for healthcare or a change in providers want to know when and how they can make those choices when the time comes.  Because AEP and Open Enrollment  coincide with the holiday and shopping season, it’s important to have a plan before the throws of shopping and family consume us. Here are some questions to consider:

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Is my current Medicare or healthcare plan the right fit?

If your Medicare or healthcare plan is providing you with all the coverage you need, and it fits your budget, then you should likely stay with where you are.  Your provider probably already has the information they need and you have become familiar with the benefit schedule, co-payments etc.  If this is the case, you may want to just stay put and roll into next year with the same plan. 

I got a letter about “renewal” what does this mean?

Avoiding the Pain of Healthcare Privacy!

By Marc Manor

Everyone loves the Health Insurance Portability and Accountability Act of 1996 (HIPAA), right?  I say that with a little more than a tinge of sarcasm because we all know that HIPAA is a necessary evil when it comes to protecting our privacy and, in many cases, our identity.

HIPAA seems like such a necessary requirement that I am dumbfounded it was not enacted until 1996!  I clearly remember the days early in my military career when we routinely plastered our social security number on everything we owned as a means of identification!  What were we thinking?  To think of all the sophisticated computer hacking that is done to steal someone’s information these days, while for many years, all someone had to do was pick through the garbage!  But I digress! 

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HIPAA is an essential part of the healthcare industry as well as affecting everyone who uses any healthcare service.  These regulations were enacted for your protection, and they are interpreted with only the slightest variation among healthcare providers and insurance companies.  Almost all err on the side of caution and interpret HIPAA with strict adherence.  Those who fail to comply with HIPAA guidelines are subject to fines of up to $50,000 per violation with a maximum $1.5 million annual ceiling. While this measure ensures compliance, sometimes it can make it difficult to have someone else act on your behalf with doctors, hospitals, or insurance companies. 

Medicare Myth Busters: Medicare Supplement (Medigap) and PPO Plans

By Marc Manor

Welcome to a series we call “Medicare Myth Busters”!  So much of what I hear about Medicare comes from word-of-mouth.  We know from our childhood, the game “telephone” can drastically transform an original message to something completely different.  Because I hear Medicare beneficiaries talk, I would like to help separate some fact from fiction on some of the most common Medicare misconceptions that I hear. We will insert the "Medicare Myth Busters" into the regular blog on occasion as we continue to advocate for our Medicare beneficiaries.  The first myth buster in the series is:

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“My Medicare Supplement Plan F is a PPO (Preferred Provider Organization) so I can go to any doctor that accepts Medicare and I don’t need referrals.”

Setting the Course for Your Medicare Voyage

By Marc Manor

You’ve already had that milestone birthday and reached the big six-O; you survived mid-life crisis and now you can access your IRA without being penalized!  So, before you ponder that next milestone birthday at age 70; let’s talk about that big 65^th!  Sixty-Five is really something to be excited about because that is when you will likely become eligible for Medicare. 

Photo by Pineapple Supply Co. from Pexels

Now you have reached the age of eligibility and you can look forward to the Medicare benefits you have been working toward all these years with your hard-earned tax dollars!  You are enrolled in Medicare Part A and B, and you have received that nice red, white, and blue card and are all set to go, right?  Not so fast!  Low and behold there is a fork in the proverbial Medicare road!  Do you stay on Original Medicare or Medicare Advantage (otherwise known as Part C)?