Medicare Supplement or Medicare Advantage?

Posted on March 15, 2012 by admin

For people turning 65 or losing group coverage after the age of 65, Medicare can be a welcome relief.  The medical benefits are much stronger (in most cases) and the premiums are relatively low.  Medicare Part A (hospital) is free and Part B (medical) is close to $100/month, depending on income.  So far, so good.  However, most people will want to supplement Medicare Part A and Part B since they still face a lot of risk for out-of-pocket expenses — both for hospitalization/medical and prescription drugs.

The options can be confusing and overwhelming!  This brief article isn’t going to address all the various options.  There are many factors to consider when making a decision.  However, one important point to consider is this:  Get advice from an independent agent who offers BOTH Medicare Supplement plans (Medigap) and Medicare Advantage plans.  Also, make sure the agent represents all the best carriers — not just two or three.  Agents who only offer Medicare Supplement tend to be overly critical of Medicare Advantage plans and vice versa.  An independent agent, offering all product lines, will be able to give unbiased advice and help you sort through all the options.  Making the right decision is very important since it might be impossible to switch to another plan (from Medicare Advantage to Medigap) after the first year.  That’s another consideration — the ability to switch plans in the future — to discuss with an agent!

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Free Prescription Drug Cards in Georgia

Posted on March 7, 2011 by admin

Most people have a major medical plan with prescription drug coverage.  So, why would someone want a free Rx card?  Well, it is becoming more common for insurance companies to exclude coverage for pre-existing conditions.  When this happens, the carrier won’t cover any doctor visits or drugs related to the pre-existing condition(s).  A lot of money can be saved by someone who has a discount Rx card in this situation. 

If someone does not have any major medical coverage, then a discount card for Rx is essential.   There are also very inexpensive discount medical cards.  So, if someone needs surgery or is hospitalized, the savings can be substantial.

Even for those who have a good major medical policy, a free discount Rx card may prove quite useful for the following reasons:  Another negative trend in health insurance is that carriers are changing their drug formularies for the worse.  Some expensive medications are no longer covered by some major carriers.  Also, there are numerous “value” plans offered by carriers for both individual and group coverage that only offer drug coverage for generics — not brand-name drugs.  This is another instance where a Rx discount card would be helpful. 

One of the more popular free discount Rx cards is offered by UNA Rx Card.  This card is recommended
by Medicare and a lot of legitimate organizations.  Over 50,000 pharmacies participate.
You can create/print your card and check drug prices at  http://unarxcard.com/index.php

I carry a vision and drug discount card in my wallet.  I printed it and then covered it with cellophane tape. The card takes up very little room and it’s nice to have available — just in case.  Of course, that is what insurance is all about.

Greg Sanders    Peachtree Insurance Advisors    678-236-1600     www.insuranceadv.com

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Never Pay More than $100 for Accidents and Injuries

Posted on February 15, 2011 by admin

As most people have discovered, a trip to the Emergency Room can be very expensive.  However, in a true emergency, most people don’t worry about the cost.  Insurance companies do worry about the cost and they discourage policyholders from going to the ER for anything other than a real emergency.  As a result,  copays are much lower for trips to an urgent care facility.   Many carriers are now charging copays from $250 to $500 for an ER visit.  The copay for a trip to an urgent care facility is closer to $75.

Trips to either an urgent care facility or Emergency Room can occur much more often in families with kids active in sports.  Sprained knees, fractured wrists, and concussions are just a few of the injuries that can happen to active kids.  In the event of a head injury, the cost to run tests such as a CT Scan and MRI can run between $1200 and $4000.  With almost all insurance policies, these costs will be considered out-of-pocket expenses and will be applied to the deductible and coinsurance.

We recommend that our clients consider an Accident/Injury policy to supplement their major medical plan, especially if they carry a high-deductible plan.  This policy will cover up to $10,000 after a $100 deductible.  Most people are very suprised to find out how little these plans cost.  

 A recent email message from my son’s flag football league alerted me to some relevant statistics:

“Most of the recent fervor surrounding concussions and sports-related brain injuries has been focused on football, but new studies suggest heading in soccer may be just as dangerous. The past 10 years have seen a disturbing trend in youth sports-a dramatic rise in the number of sports-related concussions. According to a recent report from the American Academy of Pediatrics’ sports medicine council, ER visits for children 14 to 19 years old tripled from 7,000 in 1997 to 22,000 in 2007. Visits among children 8 to 13 doubled from 3,800 to 8,000.”

I allow my boys to play rough.  So, I am not suggesting that we avoid all sports and activities that can result in injuries.  However, it is comforting to know that if an injury does happen (to anyone in my family), we can have all the necessary tests done and get excellent medical care  – and never pay more than $100.

There are some exclusions for very hazardous activities. Please call for more information.

Greg Sanders          Peachtree Insurance Advisors        678-236-1600                www.insuranceAdv.com

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Life Insurance Ratings Are Important

Posted on November 17, 2010 by admin

The financial stability of a life insurance company is very important.  When shopping for term life coverage, don’t just look at the lowest cost premium from an insurance company you recognize.  Make sure you look at the ratings by A.M. Best, Moody’s and other rating agencies. Consider the Comdex ranking also.  The Comdex ranking is a composite of all the ratings that a company has received relative to all other insurance companies. The Comdex ranks companies on a scale of 1 to 100. The ranking should be at least 85, preferably in the 90s.  For some life insurance products, the Comdex score should be in the mid 90s.

There is one life insurance company based in Atlanta that has very weak ratings.  I recently looked at their web site and found the following:  

A.M. Best: C+ (Marginal)   A.M. Best provides an opinion of an insurer’s ability to meet long-term obligations to its policyholders. The opinion is rendered on a comprehensive quantitative and qualitative evaluation of a company’s balance sheet strength, operating performance and business profile.    –      Ratings are current as of June 2010.  [I looked up their Comdex ranking: 32]

It’s hard to fathom that agents could sell life insurance products with the knowledge that the carrier is in such dire financial straits.

It is also important not to rely solely on the rating reports.  A life or health insurance advisor should stay current on the financial stability of the major carriers.  Recently, a major insurance company carrier had to ask for capital waivers.  They said that if they don’t receive them they may have to stop writing new business.  During their earnings release conference call it was revealed that they are not earning the cost of capital in any of their major businesses.  

Consider that the company described above is one of the leading low-cost term life insurance companies.   This information wouldn’t be available by checking the latest financial rating reports since it is “breaking news”.  

Working with an informed insurance agent is very important in these tough economic times.

Greg Sanders   Peachtree Insurance Advisors  678-236-1600   www.insuranceadv.com

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Get the Preferred BEST Life Insurance Rate with Total Cholesterol of 300

Posted on August 25, 2010 by lifeinsuranceadvice

Many people have high cholesterol levels, which can increase their risk for heart disease and strokes.   Life insurance underwriters have traditionally been unwilling to consider offering the best rates to people with high cholesterol readings.

I have had numerous clients with total cholesterol readings well above 220 (the highest acceptable level for many carriers).  Many of these clients were advised by their doctors or healthcare practioners to lower their cholesterol by diet and exercise.   They were cautioned about the potential negative side effects of cholesterol lowering medication in many cases.  However, the life insurance carriers would not look favorably on total readings above 220, even if the applicant was seeing great results with their “alternative” regimen.

The total cholesterol reading is not the only factor underwriters consider.  Traditionally, underwriters have focused on two specific measures with respect to cholesterol: total cholesterol and the cholesterol/HDL ratio. Having a high reading for either measure would often result in the client receiving a higher rate.

There are now two carriers who will look at only one measure: the cholesterol/HDL ratio, regardless of the total cholesterol number.

Individuals with cholesterol/HDL ratios up to 5.0 can potentially qualify for Preferred Best rates.  Those with ratios up to 7.0 can qualify for Preferred rates – even if they are on medication!

Even if one’s total cholesterol reading is 300, it is still possible to qualify for the Preferred Best rate!

Carriers are now more willing to look at the “entire picture” when considering applicants.  I had a client — 9 years ago — who was forced to accept a Standard Plus offer because his total cholesterol was 290.  His doctor told him it was a hereditary issue and not to worry.  This client was extremely active and healthy.  His father (French Canandian) and his grandfather had a history of high total cholesterol, but they were very healthy and never had heart disease.  Despite these facts, the life insurance underwriters wouldn’t budge from their guidelines.

Today, this client would receive a much better rate class and would save over 25% on his premium.

Greg Sanders    Peachtree Insurance Advisors   678-236-1600    www.insuranceADV.com

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Have You Been Declined for Health Insurance in Georgia?

Posted on August 19, 2010 by lifeinsuranceadvice

Recently, I posted some information about the new Federal High Risk Pool.  At the time,  there wasn’t a lot of detailed information available on the government site, especially concerning rates.  Well, now the rates have been published.    Rather than parphrase what has already been written, I am providing excerpts of a letter that was sent to agents from a general insurance agency:

The Pre-Existing Condition Insurance Plan was created to make health insurance available for those that have a problem getting insurance due to a pre-existing condition.
 
Web site:  https://www.pcip.gov/
 
The ability to apply online or over the phone is available on the web site.  You can also call our office for applications and a Benefits Summary.
To be eligible for this coverage:
You must be a citizen or national of the United States or lawfully present in the United States.
You must have been uninsured for at least the last six months. This includes High Risk Pool Coverage and insurance coverage that may only exclude coverage for a pre-existing medical condition.
You must have had a problem getting insurance due to a pre-existing condition.

Pre-Existing Condition Insurance Plan: Georgia Pre-Existing Condition Insurance Plan Run by the U.S. Department of Health and Human Services in GA

PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods.
The monthly premiums for your Georgia are:
Age:    00-34        35-44         45-54       55+
             $323          $387          $495        $688

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan’s network.

If this doesn’t sound too great, then there are other options available in Georgia.   Please call us for an assessment of your situation.

Peachtree Insurance Advisors       Greg Sanders         678-236-1600    www.insuranceADV.com

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Federal High Risk Pool — Now Available in Georgia

Posted on July 1, 2010 by lifeinsuranceadvice

Over the past couple of months, several people have asked me about the new Federal High Risk Pool that was created by the new health care reform law.  For people in Georgia who have been declined coverage in the individual market and can’t qualify for the Georgia Assignment System or Enhanced Conversion option (after COBRA is exhausted), this was great news.   For someone with significant pre-existing health conditions who has been declined coverage or had certain conditions excluded, this new option could be a life saver … at least until 2014, when everything changes.

Information about this insurance program is available at www.healthcare.gov or at www.pcip.gov

Although there is still some mystery surrounding the new High Risk Pool, it is official as of today — July 1.  Yesterday, I was checking out the site and there were lots of kinks.   For example, I clicked on the application link for the Federal High Risk Pook and the Oregon application appeared.  I clicked on the Georgia option and got nowhere. 

Today, however, I clicked on Georgia and found the following:

Georgia
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a pre-existing condition.
While you can apply for the PCIP in Georgia today, the premium rates won’t be officially available until July 15. The estimated premium for a 50 year old will be between $491.00 and $600.00 in Georgia. If you apply before July 15, you will be notified by mail of the premium once your application is approved. In order for your coverage to be effective, you’ll then send in your payment
 
Yes, the premiums are quite high and yet to be precisely determined.  Also, there isn’t information available on what specifically is covered.  How high is the deductible and maximum out-of-pocket costs?  Hopefully, we will find this out soon as noted above.
For those who desperately need the insurance, I would recommend applying right away.   You can always drop the coverage after a short time if it isn’t worth the cost to you.  
Greg Sanders –  Peachtree Insurance Advisors – 678-236-1600 — www.insuranceadv.com

 

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Lowering Your Life Insurance Rates

Posted on June 26, 2010 by admin

When purchasing a life insurance policy, sometimes the desired result isn’t obtainable.  Less than 20% of all applicants qualify for the best underwriting classification.  It can be quite upsetting to find out that your rate is substantially higher than what you were originally quoted.  However, unfavorable underwriting decisions can often times be challenged — especially in borderline cases.  Find out exactly why the Underwriter decided to give you the lower rate class.  Your agent should be able to assist you in determining if the decision was borderline or based on inaccurate information.  Sometimes, taking another blood sample is necessary.  If you weren’t told how to prepare for the exam, then your results might not be accurate for very obvious reasons. 

 Unless the lab results indicate an unknown health condition such as high liver enzymes, there shouldn’t be surprises.  A knowledgeable advisor will gather all the  health history and other pertinent information before shopping the market.  Carriers have different underwriting guidelines, so one company might offer the “preferred best” rate while another only offers “preferred” for certain minor conditions. 

However, some people don’t qualify for the best rates — with any carrier — due to factors such as height/weight, tobacco use, high blood pressure, etc. 

A good agent will let you know if there is any chance you can qualify for a better rate by shopping with other carriers.  When the lab results, paramed exam and doctor’s records have already been obtained, it is much easier to shop with other carriers and get firm offers from the Underwriters at those carriers.

If a better offer isn’t possible, then it is important to find out the process for lowering rates in subsequent years.  For example, if someone  receives a rate that is 20% higher due to slightly elevated cholesterol numbers, a plan for action is called for.  Many carriers will offer a better rate after one’s cholesterol is controlled for at least 6 months.  However, they might not lower the rate until the first policy anniversary.  It is also possible to get a better rate for losing weight and maintaining a lower weight for at least one year.

It can be important to find out this information prior to accepting an offer from a life insurance carrier.  Some carriers make it nearly impossible to qualify for better rates without completely reapplying.  Other carriers have a simple, streamlined process.  An experienced life insurance agent will be able to readily access this information.

One more note about unfavorable underwriting decisions.  Some people are inclined to wait until they are eligible for the better rates.   It is always best to get some insurance — even if it means shortening the term length or lowering the face amount.   If one’s health takes a turn for the worse it could result in becoming uninsurable before reapplying.

Remember — purchasing life insurance is really about protecting the ones you love. 

Greg Sanders — Peachtree Insurance Advisors — www.insuranceAdv.com — 678-236-1600

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Another Happy Client …

Posted on April 21, 2010 by lifeinsuranceadvice

Two weeks ago, I received a call from a financial advisor (CFP) who I knew during my early years in the business.  She had heard through other advisors that I was the “go to guy” for health insurance and medicare related questions. 

 This advisor had been working with a medical doctor, attempting to help her with her health insurance needs.  After spending some time preparing quotes and discussing benefits, she realized that her client needed special attention.  Like many financial advisors, she did a very limited amount of health insurance business and only represented a few carriers.  When this doctor peppered her with questions about networks, pre-existing conditions and benefits, she couldn’t adequately address her concerns and felt her client would be better served by an expert.  

After receiving a call from the advisor explaining her predicament, I then called this doctor to pick up on things.  I was able to quickly assess her situation, perform medical underwriting pre-screens, and zero in on her best options.  Since she took two generic medications to control her blood pressure and cholesterol, she wasn’t thrilled with the idea of paying additional premium to cover these conditions.  She was open to a higher deductible plan that would save her money.  Without getting into the details, suffice it to say that we found a carrier and a plan that suited her needs perfectly. 

The best part is that I was able to call her this morning (one week after she applied) and tell her that her application was approved with no exclusions and no rate-ups. I also called the financial advisor to share the good news and thank her again for the referral.   I really enjoy making those phone calls and seeing my clients happy about the decisions they made.

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Doctors often recommend unnecessary procedures

Posted on March 29, 2010 by lifeinsuranceadvice

It’s termed “defensive medicine” and doctors admit to practicing medicine in this fashion.  The main reason for this style of practice is due to medical malpractice suits. 

According to an article in Newsweek , “physicians estimate that 35 percent of diagnostic tests they ordered were to avoid lawsuits, as were 19 percent of hospitalizations, 14 percent of prescriptions, and eight percent of surgeries, which amounts to some “$650 billion in unnecessary care every year.” 

The health care reform legislation didn’t address tort reform, so this is still an area that is contributing to the extemely high costs of health care.  Overall, the health care reform legislation will do very little  to reign in medical costs.  In fact, these costs are expected to rise considerably over the next few years.  Taking charge of your health care — rather than always assuming the doctor knows best —  is very important these days.

As a policyholder, it is important to understand why certain tests are ordered.  Unless you want to get saddled with unnecessary bills, make sure your doctor explains why each test, each prescription, and each surgery is needed.  Also, if a doctor recommends a hospital stay “just to be safe”, make certain you understand the pros and cons of choosing another course of action.  It may just be easier and “safer” for the doctor, however, for you it may be an inconvenience and a HUGE expense.  Keep in mind, doctors admitted that almost 20% of hospitalizations were recommended to protect themselves — not their patients! 

We do everything we can to help our clients save money and make smart decisions about their health insurance. In addition to becoming “insurance smart”, becoming more informed about your health care will improve both your physical and financial health.

Greg Sanders — Peachtree Insurance Advisors — 678-236-1600 — www.insuranceADV.com

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