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If you are in the process of considering your Medicare options, out-of-pocket costs may have become a potential factor in your final decision. Medicare Part A and Part B do not have an out-of-pocket maximum. However, this does not apply to the Medicare Advantage plans, which do have an out-of-pocket maximum. We’ve compiled a list of what you need to know when it comes to out-of-pocket maximums and how they affect the Medicare options available to you.  

General Medicare Out-of-Pocket Maximum 

As mentioned previously, there is no current out-of-pocket maximum under the Original Medicare which can lead to other costs instead. If you are under the Original Medicare, you are responsible for the Part B annual deductible, a Part A deductible for each benefit period (a new benefit period can be started every 60 days, leading to multiple benefits in a year), and your coinsurance and copayment amounts.  

Medicare Advantage Plans 

Original Medicare and Medicare Advantage plans work differently from each other. Medicare Advantage plans are offered solely from private insurance companies that are approved by Medicare. This means that these private insurance companies are meeting the standards and requirements in place by Medicare. In addition to this, as soon as these companies meet the minimum requirements for coverage under Medicare rules, the companies now have the ability to set their own premiums, benefits, and cost-sharing structures. Typically, Medicare Advantage plans will utilize a network of proffered providers, which means that your direct out-of-pocket costs will be lower when you use the providers listed in the network selected. This doesn’t mean that you can’t use other providers. Some of these plans allow you to continue receiving care from any provider outside of the network that is listed to accept your plan. The catch to this option is that these services are considered out-of-network and can lead to a higher out-of-pocket cost if you do decide to go that route.  

As of 2021, the Medicare out-of-pocket maximum for Medicare Advantage plans is $7,550 for in-network expenses and $11,300 for combined in-network and out-of-network expenses. Once you and your family have reached the out-of-pocket maximum, your plan will then pay 100% of the expenses on covered medical services for the remainder of the year.  

Want to learn more about out-of-pocket maximums with Medicare? Reach out to your local agent today for more information. 

One of the top proven ways to prevent chronic disease, premature death, and improve health and immune function is by daily physical activity. There have been countless studies that show those who do some sort of regular exercise feel better, live longer, and have a much better quality of life. In addition to the benefits of physical activity, exercising outdoors around nature, breathing in the fresh air and soaking up the sunshine provides even more protection to your mind and body.   

Walking 

When we think of exercising, running is something that comes to mind fairly quickly, but walking is a form of exercise that is just as valuable. Walking is less intensive, but it can be just as beneficial for your health while providing unique benefits of its own such as boosting your immune system. Walking is known to be one of the easier exercises to implement into your daily life without causing inconvenience to your time management. By walking around 30 minutes a day, you are helping prevent arthritis from developing, burning calories, discouraging weight gain, and making improvements to your mood. Due to these daily developments, daily walks assist in reducing how often you can get sick and will also assist in making those nasty colds shorter and milder. As a plus side, take those walks outside in a park! The scenic views will do wonders for stress release and allow for a bit of relaxation. 

Swimming 

Swimming is known to be one of the most popular, if not the most popular, recreational outdoor activity. Not only is it fun, but it’s also one of the most effective forms of full-body aerobic exercise out there! Since you are submerged in water, more effort needs to be exerted to move around, but the water creates less stress on joints and weight-bearing parts of the body. This exercise is considered a perfect one for those who have arthritis or are currently in rehab for an injury. Like with running, this form of exercise can boost mood, improve overall health, and encourages a longer life. Swimming is considered a very enjoyable activity and provides structure for your respiratory muscles and a sense of tranquility while in the water.  

Hiking 

If you are one who enjoys being around nature and all of its glory, hiking is the perfect exercise to add to your lifestyle. Did you know that hiking is great for strengthening your muscles, improving bone density, and lowering the chances you have of developing osteoporosis? Hiking mainly focuses on working your leg muscles but can work other areas of your body, such as the core and lower back if you are carrying a bag with you. Additional perks to hiking are results of lower blood pressure, lower cholesterol, and body fat while enhancing your flexibility and coordination. 

Interested in seeing what types of insurance fit your health needs? Reach out to your local agent today for more information. 

Whether you moved recently or your former doctor changed practices, you may be searching for a new general practitioner. This process might seem daunting, but you already have a great resource at your fingertips – your insurance agent and provider! Here, we outline four steps to help you find the right professional for your healthcare needs. 

Start by speaking with your insurance.

Your provider often negotiates the best rate with specific physicians in your area. This is referred to as “in-network” care. If you do not know where to begin, the best initial step is to call your insurance agent. Many times, he or she will be able to refer you to a list of providers based on criteria such as location, hours of operation, specialties, and more. In-network providers will be more cost-effective for you, but your provider can also provide you with names of doctors who are outside your network. If you would like to see these practitioners, you would most likely need to pay out-of-pocket and pay a higher price. 

Next, ask friends and colleagues for referrals. 

The best way to ensure you find a doctor who fits your medical needs and personality preferences is by speaking to those you know and trust. If you receive insurance from your employer, ask your co-workers which doctors they have seen locally. Ask them about the doctor’s bedside manner, attention to detail, and willingness to listen. If you are retired, self-employed, or receive insurance from another source, talk to friends and family members. They may even be able to refer you to other quality practitioners within your network that you may not have considered. 

Contact a few offices. 

After speaking with your insurance agent and friends, create a shortlist of your top two to four choices. Contact each doctor’s office to confirm they are still within your network, charge a visit fee that is within your budget, accepting new patients, and offer a free or low-cost consultation visit. You are the best advocate for your own personal health, so do not be afraid to ask questions. During the consultation, consider asking the doctor if they have experience or specialize in any pre-existing medical conditions you have, how far in advance do their schedules fill up, how long does an appointment typically take, and if you will only see them or others in their practice.

Make your choice.

Once you are able to select the best doctor for your needs and personality, you can move forward by scheduling your first formal appointment. Your insurance provider can walk you through all the services that will be covered, which can help you know what to expect in advance of your visit. The first visit is a great time to determine if the provider has delivered on the things that were discussed in your consultation, and you can also have a better understanding of his or her bedside manner. If this doctor is a great fit after your first appointment, congratulations! If not, know that you can always reach back out to your insurance agent for further support in locating a new provider.

When it comes to planning your retirement, a lot of agents will highly recommend that you invest in a permanent life insurance policy. In truth, this may not be the best move for you. The permanent life insurance policy is intended for individuals who have obtained a net worth of at least $11.7 million threshold as of 2021, in which federal estate taxes will kick in after death. Most individuals looking into a life insurance policy while planning for retirement should consider buying a simple term life policy with a death benefit and investment in any other disposable income in tax-advantaged retirement accounts. 

Organize an Emergency Fund 

Building an emergency fund is the first way to put savings from term life insurance to work. This emergency fund should be equal to three to six months’ worth of living expenses. Having this emergency fund is crucial to help cover any big, unexpected bills that may come along. With those potential obstacles curved by the emergency fund, you will now confidently be able to keep regular retirement contributions on track. Did you know that disability insurance can help protect your income (and retirement savings) if you are unable to work? 

Invest in Long-Term Disability Insurance 

We just mentioned that disability insurance can help protect your income, including your retirement savings, if you cannot work. Disability insurance has the main focus of replacing lost income if the individual cannot work. When it comes to life insurance, many people may have some form of disability coverage as an employee benefits, but that doesn’t always mean it is a great benefit. One other form of disability insurance is Social Security Disability Insurance (SSDI), although the benefits are modest and can be difficult to qualify for. One last alternative is acquiring a disability policy from private insurers. There are a variety of life insurance policies out there such as an own-occupation and an any-occupation policy. An own-occupation policy covers someone who can no longer work in their previous field due to a disability, while an any-occupation policy covers someone who can no longer work at all.  

Your Funds Always Have a Home 

The end goal in mind is reaching retirement with a comfortable insurance policy and fund. If you are already planning for your retirement, a tax-advantaged retirement account, such as a traditional or Roth IRA is usually recommended by financial advisors. This is also assuming that you are meeting the income limits are other requirements set by these two IRAs.  Another potential way to increase your retirement funding is by maxing out your 401(k) or a plan that is similar at your place of work if you aren’t already doing so. If you are unable to qualify for these types of accounts, don’t worry as you can always look into investing outside of a retirement account with the lack of tax benefits. One last option for you could be an index fund from a mutual fund company or brokerage firm. 

If you have any questions or need more information on preparing yourself to plan for retirement, contact your local agent today. 

We have all heard the saying, “an apple a day keeps the doctor away.” However, when it comes to obtaining the best plans and rates for your insurance, there is more than just one health factor to consider. Your insurance agent can help you determine the correct policies, but here are a few things to keep in mind before you meet with your agent.

Life Insurance: Do you want term or whole insurance? 

Term insurance offers a lower monthly premium, but there is an end date for the coverage. Your health won’t be considered as rigorously as well. Selecting whole insurance means you’ll be covered for your entire life, but it can have a higher premium. The ideal way to ensure this premium is the best possible price is by staying healthy and active. Most companies require a brief screening that will assess your risk for specific health concerns, and these will affect how much you pay. Those with multiple high-risk results may be required to pay more or be denied coverage altogether. 

Some factors can be controlled by you and monitored to help keep your rates low. 

Diet

The first step towards the best possible rate is maintaining a nutritious diet and appropriate body-mass index. Diet and nutrition can affect multiple areas of health, not just weight. These can include cholesterol, risk of diabetes or heart disease, and the function of vital organs. While it is completely acceptable to indulge on occasion, moderation is key. Should you maintain a poor diet with low nutrition, your risk for certain diseases will increase. These aspects could be revealed in your medical screening, and it could cause you to pay a higher premium due to your health conditions. 

Not Smoking

Whether you smoke occasionally or regularly, you are putting yourself at risk for cancer and disease. According to the American Lung Association, lung cancer is the most common and deadly result of smoking. In fact, more people die from lung cancer than any other type of cancer. Of those diagnosed, only one in five will still be alive five years after their diagnosis. For this reason, smokers are often guaranteed to receive a higher premium for life insurance than non-smokers, simply because of the high risk associated. However, smoking also leads to other harmful health conditions such as COPD, heart disease, stroke, asthma, diabetes, and even blindness or partial vision loss. By not using tobacco products, including smokeless and vapor products, you will most likely receive a more advantageous life insurance plan that can ensure your family is cared for. 

Hobbies & Driving 

Your personal hobbies, driving record, and other lifestyle choices can also affect your ability to find a preferred life insurance policy. If you are a frequent skydiver, have been in multiple accidents or received numerous speeding tickets, or even just own a fast sports car, you may face higher premiums or less desirable coverage. Life insurance providers will take these factors into account, as they may be indicative of thrill-seeking behavior. These activities often place you at risk for injury, or even early death should an accident occur. While this is not to say that you are completely guaranteed to receive an increased premium or limited coverage, you should speak with your agent to determine if any of your common activities could affect your policy. 

These are just a few of the factors that you can control in order to receive the coverage you want in order to protect and provide for your loved ones. While other factors like age, gender, and hereditary conditions may be out of your control, your agent can help guide you towards the best life insurance policy for your own unique needs.

If you have both Medicare and another insurance policy, you may have to follow certain rules when it comes to which insurance is primary and which is secondary. Medicare will leave it up to you to know these “coordination of benefits” rules and which cases they apply to. When Medicare is the primary payer, this means that the medical expenses incurred will be submitted to Medicare for payment first, up to its coverage limits. In this case, the secondary insurance will only pay if there are costs Medicare did not cover. 

Below, we will highlight the rules and how to know when Medicare is the primary or secondary payer. 

When Medicare is Primary

• You are age 65 or older and your current employer that provides your additional insurance has fewer than 20 employees
  Group health coverage at small companies can often have very costly premiums. Provided that you have already enrolled in both parts of Medicare, it will pay first before your employer insurance. This is a common occurrence, but you will want to check with your insurance agent to compare quotes in case Medicare is significantly more cost effective than your small employer’s group policy.

• You have retiree insurance or COBRA (Consolidated Omnibus Budget Reconciliation) insurance
  If your former employer provides retiree insurance coverage, Medicare will still remain your primary provider. The retiree or COBRA insurance will cover you as a secondary provider. Be sure to check with your secondary policy to determine if you have prescription drug coverage, as this may mean you do not need to enroll in Part D of Medicare.

• You are on social security disability insurance (SSDI) before reaching age 65 and your current employer that provides your additional insurance has 100 or fewer employees
  In some cases, you may be eligible for Medicare before age 65 due to a disability. If you are already enrolled in SSDI, you will be automatically enrolled in Parts A and B of Medicare as well after 24 months. Medicare will become your primary payer, and you will want to notify your employer of this change. 

• You have Veterans Administration (VA) benefits and receive care from a non-VA facility
  All care provided at a VA hospital is covered under VA insurance. However, should you also be enrolled in Medicare and receive any medical treatment from a traditional non-VA healthcare center, Medicare would be the primary payer.

• You have End-Stage Renal Disease (ESRD) for more than 30 months
  For the first 30 months of being diagnosed with ESRD, your employer or non-Medicare plan would be the primary payer for all claims. After the 30th month mark, you would be automatically enrolled in Medicare, regardless of your age, and it would become the primary payer. It is important to note that 36 months after receiving a kidney transplant, you will be transitioned out of Medicare and return to your other insurance. If you become eligible again due to age or disability, you will need to re-enroll. 

• You have Medicaid
  Medicaid, which provides medical expense assistance to people with low incomes, will always be secondary to Medicare. Not all providers who accept Medicare also accept Medicaid, so it is important to ask if they participate in Medicaid. If the provider does not accept Medicare, you may be responsible for the costs that Medicaid does not cover. 

When Medicare is Secondary

• You are age 65 or older and your current employer that provides your additional insurance has 20 or more employees
  If you work for a large organization, it may be more cost-effective to delay Medicare enrollment and continue using your group policy as your primary and only coverage. Be sure to speak with your insurance agent who has experience in Medicare before finalizing this decision. They will be able to walk you through the process and make sure it’s right for you.

• You have filed a Worker’s Compensation claim
  In this case, any medical visits or services relating to the Worker’s Compensation claim would not utilize Medicare as the primary payer. 

Even after considering these rules, you may find that Medicare will pay a claim that goes against these rules if your primary insurance provider does not provide payment within 120 days. Even though Medicare was the first to pay the hospital, it would still be considered the secondary payer and contact you later to recover the funds. It is always a good idea to speak with your insurance agent when you become eligible for Medicare due to age or disability, as they can help provide you with detailed insight into your premiums, coverage, and benefits.

Slips, trips and falls are the number 3 cause of accidental death in the United States, right behind motor vehicle accidents. No matter where you are in the world, if you are indoors or outdoors, you can experience a slip or fall. Slips and falls can naturally happen indoors when going up stairs or walking on wet hardwood or uneven flooring, but they are more common outdoors in parking lots and on sidewalks, stairs, decks, and other areas that are affected by the weather. 

Follow these tips to keep yourself safe and avoid having a dangerous slip, trip or fall. 

 Consider Your Shoe/Footwear Choices 

Depending on the weather in your city, you may need to change your plans for the day. If your area is experiencing lots of rain, opt for shoes that have traction, like tennis shoes. If it’s really muddy and slick outside, look for shoes that are fit for hiking. When it comes to footwear in the wintertime, store your steel toe boots. If you wear them too long in the cold, they could cause hypothermia in your feet. Waterproof shoes that have good traction on the bottom should be the top qualities to look for when buying your next pair of winter shoes. 

Planning an outfit that requires heels or sandals? Make sure that the weather is sunny with no chance of ice, snow, rain, and the terrain is dry – or if the weather is wet, wear better shoes until you reach indoors safely. You’ll be protecting your ankles from any potential harm. If you are climbing stairs in shoes with heels or sandals, take mind to grip the stair railing to help keep balance you don’t fall.  

Tread Forward with Caution 

Wintertime environments are some of the most dangerous when it comes to the risk of a trip or fall due to the ice and snow that can accumulate. Another dangerous climate is one with a ton of rainfall. Rain can cause even the flattest of areas to become slick and offer up a one-way ticket to a fall. In order to protect yourself from experiencing a fall in these two dangerous climates, choose to wear shoes that are high in traction and waterproof. Another big tip is when entering or exiting buildings, do your best to avoid walking on curbs or steps if you can help it. Walk with caution and do not run in these conditions or you are increasing your chances of falling.   

Take All the Precautions You Can 

Here are a few things to be mindful of when faced with an inclement weather situation. When getting out of your vehicle, keep a hand on the vehicle to support yourself because you don’t know how slick the ground is. Did you know that putting your hands in your pockets to keep warm is more dangerous than it is worth? Keeping your hands free is necessary because by putting your hands in your pockets, you risk your balance since you’ve now lowered your center of gravity. 

What Happens If You Fall? 

The number one thing that you should do if you do happen to take a tumble is to tuck your head in towards your chest to avoid hitting your head. Keep your elbows and knees bent when you fall and try to land on your butt to help protect your body from sustaining any injury. If you’re unsure how your insurance would protect you in the event of a slip, trip or fall related injury, reach out to your local agent to make sure you’re covered for this common risk. 

February is known as Heart Month in the United States, so there is no better time to learn about cardiovascular disease. According to the American Heart Association in a 2019 study, nearly half of all adults in the United States – 48% to be exact – have some form of cardiovascular disease. The term “cardiovascular disease” is used to refer to a number of conditions, including heart disease, heart attack, stroke, heart failure, arrhythmia, and heart valve problems. Because this disease is so prevalent, it can lead to potentially serious or fatal health concerns for up to half of the members of your staff. The good news is that 80% of cardiovascular disease can be prevented by adopting healthy lifestyle choices such as not smoking, adequate exercise, proper nutrition, and maintaining a healthy weight. 

What are the types of cardiovascular disease? 

Heart Disease: 

The most commonly found type of cardiovascular disease is heart disease, which is caused by a buildup of a fatty substance called plaque in the arteries. As this plaque lining the arteries builds up over time, blood cannot flow as easily as it needs to. When the heart does not receive enough blood, or if the plaque forms a blood clot and blocks the artery entirely, this can cause a heart attack or stroke. Heart disease can be monitored and maintained if the individual makes new healthy habits. 

Heart Attack:

A heart attack occurs when a plaque buildup or blood clot in the arteries cuts off all blood flow into the heart. The cells in the muscles that make up the heart will begin to die without blood, and other parts of the body will begin to shut down as well. Although many heart attacks are not fatal when individuals receive immediate critical care, it still means lifestyle changes need to be made. The heart often remains partially damaged after, and it cannot survive multiple heart attacks. 

Stroke: 

When the arteries that carry oxygen-filled blood to the brain are blocked, a stroke can occur. If the brain cannot receive oxygen, cells will begin to die and cause symptoms such as the inability to speak or move. In many cases, patients will recover these abilities with time and the help of rehabilitation therapists. However, if enough oxygen is cut off for a prolonged time during the stroke, the damage can be irreversible. 

Heart Failure, Arrhythmia, and Heart Valve Problems: 

Unlike the first three types of cardiovascular disease, these three conditions do not mean that the body’s supply of oxygen-filled blood has been completely cut off. Instead, the heart will continue to pump blood, but it is not able to provide the body with an adequate amount. If heart failure occurs, the heart still beats but does not supply enough oxygen. If arrhythmia occurs, the heart beats at an irregular rate. It can beat too slowly and not supply enough oxygen, or it can beat too quickly and fatigue the heart muscles. When one of the heart’s valves does not open and close properly, it can cause blood to leak through. This can also cause the valves to close in the wrong direction, creating immediate circulation issues. All three conditions can grow worse over time if left untreated. 

How Can I Help My Staff Prevent Cardiovascular Disease? 

Simply based on the fact that 8 out of 10 Americans live with cardiovascular disease, it is likely that someone on your staff already faces some form of the disease. However, you can offer incentives to help encourage your staff to adopt healthy preventative behaviors. These can include workplace perks such as a monthly free lunch and specially designated parking, or personal perks like gift cards and fitness accessories. 

By offering high-quality medical insurance to your employees, you always have peace of mind knowing they will be cared for if a cardiac emergency occurs. If you would like to know more about medical insurance and preventative care benefits, talk with your local agent today.

A wellness visit, also known as an annual primary care visit, usually takes around 30 minutes and the cost is often covered through insurance.  These visits are important for everyone to attend because as you age, your wellness can change in an instant. As you age, your risk level rises for illnesses and diseases that begin to take effect in those later years.  

Saving Time and Money 

If you only visit a doctor when you are showing visible symptoms or if you aren’t feeling like yourself, it can end up costing you more in the long run. Did you know that regular primary care is associated with fewer hospitalizations and emergency room visits? When you visit your doctor annually you will slowly be building and establishing a relationship with them, which will make it easier for you to schedule any unexpected appointments at a time that works best for you. A downside to not maintaining your regular annual primary care appointment is that if you do have to visit the emergency room or an urgent care center, treatment might mean longer waiting periods and take more time than necessary out of your day. 

Updating Your Wellness Exam Results 

When you become an older adult, health risk assessments become a forefront of important testing that you need to get taken care of. This kind of testing is crucial to preventing issues that could be a problem as you age and includes questions regarding your health status, injury risks, and behavioral health. Reaching this age means keeping your blood pressure in a healthy range because doing so can prevent serious cardiovascular issues, which include heart disease. Once your primary care doctor has determined that you have high blood pressure, it is possible that you will be prescribed medication in order to help bring it down or you may be referred to see a cardiologist.  

Catching a Disease in the Early Stages 

It isn’t always easy to notice symptoms of a progressive disease, such as cancer, chronic obstructive pulmonary disease or heart disease until it has reached one of its final stages. An annual exam can help your doctor identify if there are any progressive diseases that are showing early in your body. Catching diseases and illnesses early is the most effective way to treat them.

In order to help protect yourself in the future, schedule your annual appointment with your local doctor.  

Medicare is one of the biggest milestones you will reach in the later stages of life. Before going down your Medicare path, there are few things you need to know. Did you know that some people are automatically approved and placed on Medicare? This isn’t always the case, as a lot of people have to sign up before getting into the program. You may have to sign up if you are 65 or close to turning 65 and not getting Social Security. If you choose to sign up for Medicare Part B when you first become eligible, you can avoid a potential penalty! There are two great upsides when it comes to getting into your Medicare program: 1) you can choose how you get your Medicare coverages and 2) there may be ways for you to have assistance on paying your Medicare costs. 

 There are time frames in which you need to sign up to be on the Medicare program. These time frames also relate to when you can change your existing Medicare coverage if need be. More information on time frames is located below. 

Initial Enrollment Period

The Initial Medicare Enrollment Period is the time in which most people sign up for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). The time period starts three months before you turn 65 and ends 3 months after. As mentioned earlier, if you are not already collecting Social Security benefits before your Initial Enrollment Period starts, you will need to sign up for Medicare via online or contacting Social Security.

General Enrollment Period 

The General Medicare Enrollment Period is available if you missed the Initial Enrollment Period. This enrollment period is between January 1st and March 31st, and if you do enroll or make any changes during this time, coverage will go into full effect on July 1st.

Special Enrollment Period 

The Special Enrollment Period (SEP) is available if you missed either of the previous two enrollment periods. This enrollment period means that you can sign up for Medicare Part A and/or Medicare Part B during an SEP if you have special circumstances. 

Overall, the best timeframe to join a Medicare or drug supplement (Part D) program is when you first turn 65. Making the effort to sign up when the opportunity first arises can help you avoid paying a lifetime Medicare Part D late enrollment penalty. If you could not get into the previously mentioned time frame, this would be your next best option. Medicare offers an Annual Open Enrollment Period which occurs from October 15th and December 7th. During this time, you have the chance to join a program, drop, or switch your coverage.  

Need more information on Medicare? Reach out to your local agent today.