Welcome to your comprehensive guide to choosing and changing Medicare supplemental insurance plans in Missouri.

My name is Drew and I’m a licensed insurance under the Missouri Department of Insurance with a primary focus on Missouri Medicare benefits.

Today I will share some insight about Medicare Supplements that you’ve likely never heard as insurance companies and licensed agents do not take the time to explain.  And, these elements are incredibly important for you to know!

We’re located in St. Louis, MO, just outside of St. Charles and deeply understand the Medicare plans available in St. Louis and surrounding cities and counties in Missouri.  Regardless of where you live, this guide will help you!

If you landed here it’s because you’re likely looking for information to learn how to choose the best Medicare supplemental insurance plan that is competitive in your area, regardless of the state you live in.  I’ll use some examples through out from Missouri because it’s where I’m from, but we have licensed agents in every state to help you navigate this process.

We understand your pain, the only thing in abundance during your hunt for Medicare supplemental insurance is a bunch of direct mail and sales pitches.

Rarely can you find somebody willing to take the time to educate you on the critical decision factors you should consider before enrolling in a Medicare Supplement or Medicare Advantage plan.  Seniors tell us all the time that they feel invisible when they reach Medicare age because it’s so difficult to find the right person and resources to learn what they should or shouldn’t be doing.

I’m going to share some simple concepts you should know about choosing Medicare supplemental insurance as well as address some common questions.  After reading this guide in full you will have a much stronger understanding of the questions you should be asking, what your agent should be telling you, and the types of plans that may be best fit for your situation.

Guide to Choosing and Changing Your Medicare Supplement Plan Includes:

• Upcoming Medicare Changes
• What is Medicare supplemental insurance?
• A Rated Medicare Supplement insurance plans.
• What is the best Medicare Supplement plan in St. Louis for 2022?
• How much does Medicare supplemental insurance cost?
• Most common Medicare Supplement plans and the differences.
• How to predict when Medicare Supplement plans will have rate increases.
• Switching Medicare Supplement plans outside of the Annual Election Period.
• What are the Top 10 Rated Medicare Supplement Carriers for 2022
• Other Common Medicare Supplement plan questions

Let’s get started.

2022 Medicare Changes: What You Should Know

Centers for Medicare & Medicaid Services (CMS, the entity responsible for the federal Medicare program) has announced Medicare Advantage and Part D 2022 Rate Announcement and Call Letter.

This is the last update on policy changes for the upcoming 2022 calendar year.

Here is the full report on the upcoming Medicare changes in 2022.

What are the options when I become eligible for Medicare?

There are 3 main options, 2 we suggest and 1 we definitely advise against.

1. Medicare Supplement (Medigap policy or medigap insurance) and a Part D. This is a very common health plan solution for those looking to close the 20% gap from original Medicare which creates the need to cover out of pocket costs such as outpatient procedures.  Medicare supplements are standardized plans which means every plan must offer the same plan options.  For example, a plan G from AARP is the same as a Mutual of Omaha Medicare supplement plan G.  This option is for those who want to have the peace of mind they will not have to worry about copays for every visit and procedure.  In most cases all of your copays and coinsurance are covered when using a Medicare supplement and Part D (Medicare prescription drug plan).  It’s a very predictable way to manage your monthly expenses.
2. Medicare Advantage Plan. Medicare Advantage (Part C) is a health plan offered by private companies such as United Health Care, Aetna, Humana, and many others that must offer the same benefits as original Medicare coverage (Medicare parts a and b), and sometimes more.  These plans require you to have Part A and Part B to enroll and each have a copay schedule for your doctors and hospital visits as well as some added benefits such as dental, vision, hearing, and wellness.  These plans are typically an HMO or PPO which is a form of doctor network that you must remain in network to receive in network benefits.  Many of the Medicare Advantage plans are zero premium which means you only pay when you’re using the plan.  These plans are most commonly available during the open enrollment period.
3. Original Medicare only: This is option is extremely risky.  When you’re on original Medicare only (Part A and Part B), you are subject to 20% plus deductibles with no cap on your payments.  This is why it’s wise to choose 1 of 2 options listed above to help mitigate your risk of the 20% and the deductibles.  Rarely do folks we meet with only have original Medicare, but it’s certainly happened and they are much better off after being educated on what they may qualify for in terms of supplemental coverage.

We’ll go into more detail through out the guide, but this should give you a good idea of the basic options you have to protect yourself from the 20% gap and deductibles of original Medicare.

Back to Top

What is Medicare Supplemental Insurance?

First thing you need to know is that Medicare supplement plans are also called Medigap plans.  Yes, two names for the same thing.  If someone refers to a Medicare Supplement Plan F or a Medigap Plan F, it’s the same exact thing.

Now to the details.

Original Medicare covers 80% after deductibles have been met which creates the need to Part D and Medicare supplemental insurance to fill the remaining coverage gap.  Technically speaking, this means Medicare part a b d are the basics and the supplement covers the 20% liability.

Medicare Supplement Insurance plans are provided by private insurance companies that coordinate with benefits provided by Original Medicare.  This is the most common way most people eligible for Medicare satisfy their supplemental health insurance needs.

Medicare Supplement plans fill the gap which Original Medicare doesn’t cover, including deductibles.  Below are some of the common questions clients ask us about Medicare Supplement plans.

The key in choosing the best Medicare Supplement plan is understanding the plan differences.

Medicare Supplement plans are standardized and identified by letters A through N. This means each plan of the same type (for example, Plan N), must offer the same exact benefits.  The only difference is the price.

Back to Top

What are the different types of Medicare Supplement Plans?

There are 10 different types of Medicare supplement plans available and they are listed as letters A through N.

Types of Medicare supplement plans in 2022, those listed in bold below are the most common.

• Plan A
• Plan B
• Plan C
• Plan D
• Plan F* (no longer available for purchase as of 2020, but still available to those with current policies)
• Plan G
• Plan K
• Plan L
• Plan M
• Plan N

Which Missouri Medicare supplement plan covers the most?

While there are many types of standardized plans, there are three common Medicare supplement plans that make up the lions share of active policies.

Below are the three most common medigap policies you should review before making your decision.

Medicare Supplement Plan F

This covered the most until 2020, then it was discontinued for new medicare beneficiaries.

Plan F is the most comprehensive Medicare supplemental insurance plan available.  However, it is scheduled to discontinue in 2020.  This means if you’re turning 65 in 2020, the plan F will no longer be available to purchase.  If you already have a plan F, you will be able to keep your plan F, so there is no reason to worry about losing it.

Why choose Medicare Supplement Plan F?

This plan is fully loaded and a great option for those who want coverage to satisfy the 20% liability of Original Medicare.  Plan F benefits include the following.

• Medicare Part A coinsurance and hospital costs
• Medicare Part A hospice care coinsurance or copayment
• Medicare Part A deductibles
• Medicare Part B coinsurance or copayment
• Medicare Part B deductible
• Medicare Part B excess charges
• First three pints of blood
• Skilled nursing facility (SNF) care coinsurance
• Foreign travel emergency coverage (up to plan limits)

Medicare Supplement Plan G

Medicare supplement plan G covers the most in regards to listed benefits.

Plan G is an excellent choice for Medicare supplemental coverage and is very similar to plan F mentioned above.  The biggest difference between a Plan F and Plan G is that Plan G Medicare supplements do not cover your Part B Medicare deductible, which is only $183.

Why choose Plan G over Plan F?

The reason why people commonly choose a plan G is that the monthly premiums savings between a Plan F and Plan G is greater than paying the annual Part B deductible.

For example, if you are 65 and live in St. Charles or St. Peters, a Plan F Medicare Supplement will cost you roughly $170 per month with Transamerica while a Plan G would cost you $130.

Would you agree it’s worth paying the $183 Part B deductible in order to save $300 on your Medicare supplemental premiums?

Medicare Supplement Plan N

Plan N is another great choice for Medicare supplemental insurance plans.  Plan N covers all the same benefits as Plan F except the following:

• Medicare Part B Deductible
• Medicare Part B excess charges
• Up to $20 charge for office visits
• Up to $50 charge for emergency room visits that don’t result in an overnight stay

Why choose Plan N over Plan G?

The reason some people choose a plan N is because they will try to forecast our their doctor visits for the year to determine if it makes sense to choose a lower premium plan.

Let’s use the example listed above for a 65 year old living in St. Charles, MO.  You can get a plan F for $170 from Transamerica or you can get a Plan N for $113 from Pekin Life Insurance Company.

Put yourself in this hypothetical client’s shoes.  Would you be willing to potentially have the costs associated with a Plan N if you knew it might save you nearly $700 per year in Medicare Supplement premium costs?

As you can see, the differences in Medicare Supplement plans are negligible and based on your current health history, you can choose the best Medicare Supplement plan that fits your lifestyle.  You just have to take the time to understand the moving parts and whether or not they will financially impact you.

Back to Top

How Medicare Part D Works with a Supplement

There are two ways to sign up for a Part D Prescription Drug coverage plan:

1. Enrolling in a standalone Part D plan (PDP)
2. Enrolling in a Medicare Advantage with Prescription Drug coverage.

Most Medicare Advantage plans include part D coverage.  If you are purchasing a Medicare Supplement, then you need to make sure an also purchase a Part D drug plan.

Enrolling in Part D by Selecting a Standalone Plan

If you are already enrolled in either Medicare part A or Medicare part B, you are eligible for a standalone Prescription Drug Plan.  If you don’t elect a drug plan during your eligibility period, you will be subject to a monthly penalty.

The best way to get a Medicare Part D plan is by using the Medicare Part D plan finder on Medicare’s website.  There you will enter your drug information and find the best plan that fits your situation. It’s extremely important that you go through this process to best determine the plan that is going to be more comprehensive in coverage and cost effective.

Back to Top

Best Missouri Medicare Supplement

This is one of the most common questions we hear when talking to individuals and families about their Medicare supplement.   St. Charles, MO and St. Louis, MO have very competitive options, which makes our job as Medicare brokers easy.

The best answer to this question is to remember that all Medicare Supplement plans are standardized.

What does it mean that all Missouri Medicare Supplement plans are standardized?

Regardless of the company, all plans must offer the same benefits.  For example, a Medicare Plan F with Transamerica by law must offer the same benefits as a Plan F from AARP Medicare supplemental insurance.  The only difference is the price you pay each month.

This should give you the confidence that regardless of the type of Plan F, Plan G or Plan N you choose, all the benefits and available doctors will be the same.

Below is a list of many of the A rated Medicare plans:

• AARP United Health Care
• American Continental Insurance Company (Aetna)
• Cigna Health and Life Insurance Company
• Combined Insurance Company of America
• Essence Healthcare
• Humana Insurance Company
• Medico Insurance Company
• Mutual of Omaha
• Oxford Life Insurance Company
• Pekin Life Insurance Company
• Transamerica Life Insurance Company
• United American Insurance Company

In case you were wondering, Plan F prices for a 65-year old individual in St. Louis range from $158 all the way up to $358.  It should be noted that all plans should be considered on a case-by-case basis to ensure you are properly educated on the best plan for you.

Back to Top

How to choose Missouri Medicare Supplement plans when monthly premiums are drastically different?

Great question.

You definitely can take some steps when shopping for a Medicare Supplement that will help you avoid getting a surprise rate increase the following year.

The best way to determine which Medicare plan to go with is by analyzing two additional key factors now that you have made your decision on the plan type you want to go with.

Medicare Supplement Rate Increase History

After you have chosen your plan, the second step is reviewing historical premium increase trends.  Since you now know the plans are standardized, you know the benefits aren’t up for debate.  It’s now all about price.

You should look at the last 3, 5 or 10 years of data and see how much premiums have increase year over year.  If the agent you are working with isn’t explaining this to you, then you should seek out a second opinion as this information is readily available.

Medicare Supplement Insurance Company Loss Ratios

Insurance company loss ratios are extremely important when looking at plans and predicting rate increases for the follow years.

The third step in choosing your Medicare supplemental insurance plan is by reviewing the insurance company loss ratios.  This is important as it will help you understand which plans are likely to experience a higher than average rate increase.

For example, AARP Medicare supplemental insurance plans in St. Louis have average a 2.1% rate increase over the last 6 years and historically maintain an 80% loss ratio which is considered acceptable.

This means their risk pool isn’t completely filled with unhealthy members, which keeps their claims within acceptable ranges.

The better a company can control their risk pool (annual claims), the more money they can keep in their reserves and the more stable they will keep your premiums year over year.

Back to Top

Switching Your Medicare Supplement:  Two Choices

One of the common misconceptions about Medicare Supplements is that you can only switch your plan during the Medicare Annual Election Period (AEP).  This time frame occurs every year from October 15^th-December 7^th.

This is not true.

Medicare Supplement enrollments are not tied to Medicare’s annual election period.  The only plans that are mandated to be changed (if you choose to change) during the Annual Election Period are Medicare Advantage Plans (MA-PD) and Medicare Part D prescription drug plans.

Medicare Supplements are not under those same rules and can be changed throughout the year.

Below are the two common scenarios that impact your ability to switch your Medicare Supplement plan.

Option 1: Change my Medicare Supplemental Insurance without Health Questions

Missouri is one of the few states that allows you to change your Medicare supplement plan with out additional underwriting, but only during a select time through out the year.

If you are within 30 days before or after your current Medicare Supplement anniversary period you can switch your plan without having to go through any underwriting questions.  This is a unique rule to the state of MO.  This means that regardless of your health, if your premiums increase on your Medicare Supplement plan and you are a resident of the state of MO, you can switch to a lower cost plan with the same benefits without being penalized for pre-existing conditions.  MO is one of the only states that offers this benefit to Medicare Supplement policy holders.

For example, if your Plan F policy anniversary date is October 1^st, that means you can switch your Medicare supplement to another Plan F from September 1^st through November 1^st regardless of your health.

California and Oregon have similar rules commonly referred to as the birthday rule vs. the anniversary period.

Option 2: Switch Your Medicare Supplemental insurance anytime (health questions required)

The other scenario for switching your Medicare Supplement plan is when you’re outside of your anniversary period.  You can still switch, but you will have to complete the health questions again.

Most people who live in St. Louis make it a habit to review their Medicare supplemental insurance every year around their anniversary period to make sure they are in the most cost effective and financially stable option.

If you do this year over year, you can be sure you will not over spend on your Medicare supplemental insurance plan.

Back to Top

How Can I Compare Medicare Supplement Plans?

The best way to compare medicare supplemental insurance plans is by working with an independent agent. The reason why is because an independent agent doesn’t have an exclusive agreement with any specific insurance company.

This means they can shop the market for you and show you the price variations, financial ratings and claims history.

For example, the cheapest medicare supplement plan F in St. Louis is $158 and the most expensive Medicare supplement plan F in St. Louis is $385.  The least expensive company hasn’t yet been rated by AM Best and the most expensive plan is B rated.

If all plans offer the same benefits, does it make sense to pay an additional $227 per month for your Medicare supplement plan? NO.

Does it make sense to sign up with a B rated company that is more expensive than an A rated company? NO

Now this may be a lot of work to properly review, but we highly suggest you take the time to review the best medicare supplements plans by working with an independent agent.

Back to Top

What if I Want to Cancel My Medicare Supplement?

Cancelling your medicare supplement is possible, but can come with some challenges.  You should definitely speak with someone before cancelling so you’re not put into a tough situation.  Below are a couple scenarios you should consider before making any decision to cancel your plan.

Cancel My Medicare Supplement:  Switching to Another Supplement

It’s June (outside of annual enrollment) and you decide you want to cancel your medicare supplement. You can certainly do that as long as you’re healthy enough to go through underwriting again (answer all the health questions).  This is pretty straight forward and not really an issue and happens all the time.

We most often find people cancelling their medicare supplemental insurance because they found another plan which offers the same benefits for a lower price.

Cancel My Medicare Supplement:  Switching to Medicare Advantage

Now, here’s where things get a little tricky, and you need to pay attention.

Earlier we talked about the annual enrollment period which happens between October 15^th and December 7^th.  If you decide you want to cancel your medicare supplemental insurance plan outside of the annual enrollment period, you are going to put yourself in a bad position.

Here’s why.

Your medicare supplement isn’t mandated to follow the CMS enrollment guidelines, but your Medicare Part D prescription drug plan is.

This means that if you cancel your supplement plan, you will only be left with drug coverage and original Medicare (20% liability of all costs plus Part A and Part B deductibles).  Because Part D drugs plans follow CMS enrollment guidelines, you cannot switch it until the next AEP which in some cases can be six months or as long as 10 months depending when you cancel.

The only way to get into a Medicare Advantage plan outside of open enrollment and after cancelling your Medicare supplement is to qualify for a special election period (SEP).

Can you cancel your medicare supplement plan?  Yes.

Can you get into a new plan?  Yes.

Should you always talk to an independent agent and review your options before making a decision?  ABSOLUTELY

There are plenty of people willing to talk through your scenario and help you make the right decision.

Back to Top

If My Health Changes, What Medicare Supplement Plan Do I Need?

The good news about your Medicare supplement plan is that when your health changes, they cannot individually raise your rates.

What you need to consider is choosing the right Medicare Supplement plan when you are still healthy so you’re not put in a bad position if your health changes.

As we mentioned above, the most common medicare supplemental insurance plans are the followings.

• Medicare Supplement Plan F
• Medicare Supplement High Deductible Plan F (HDF)
• Medicare Supplement Plan G
• Medicare Supplement Plan N

Choosing one of these plans will put you in a position that you will not need to change your plan if your health takes a turn.  Each of these plans will provide you a strong level of financial security in regards to your healthcare expenses.

Back to Top

What is the Best Medicare Supplement Plan in St. Louis for 2022?

In order to answer this questions, we ran a review of the medicare supplement plans across all the zip codes in St. Louis utilizing current 2022 data from CSG actuarial.

If a company is listed in both categories below, there is a strong indication it’s a Medicare supplement plan you should consider.  Plans highlighted green are a good place to start when you are considering choosing or changing your medicare supplement plan in St. Louis.

Below you’ll find the results by financial rating and price.

Best rated Medicare supplement plans in St. Louis.

1. Transamerica Life Insurance company
2. Combined Insurance Company of America
3. United American Insurance Company
4. Companion Life Insurance Company
5. Mutual of Omaha Medicare Supplement
6. Americo Financial Life and Annuity Insurance Company
7. Cigna Health and Life Insurance Company
8. AARP – United Healthcare Insurance Company
9. American Continental Insurance Company (Aetna)
10. Gerber Life Insurance Company

Cheapest Medicare Supplement Plans in St. Louis and St. Charles

1. Combined Insurance Company of America
2. Pekin Life Insurance Company
3. Cigna Health and Life Insurance Company
4. The Manhattan Life Insurance Company
5. Renaissance Life & Health Insurance Company of America
6. American National Life Insurance Company of Texas
7. AARP – United Healthcare Insurance Company
8. Transamerica Life Insurance Company

Back to Top

Who are the Top 10 Rated Medicare Supplement Carriers for 2022?

In order to look at the top rated Medicare supplement plans for 2022, we again used data from CSG actuarial, the leading actuarial company in the Medicare space and looked specifically at 65 year old females on a Plan G.

Top Medicare Supplement Companies for 2022

We wanted to list 10, but we believe there are seven superior Medicare supplements for 2022 and have listed those below.

Combined Insurance Company of America

Combined is an A+ rated company by AM Best and has a positive outlook.  This means not only are they financially stable, but they have maintained a strong claims ratio which is a good indicator they won’t have large rate increases in 2022.

Their average rate increase is 4%.

Mutual of Omaha Medicare Supplement

Mutual of Omaha is arguably the most recognized household name in the Medicare Supplement business.  They have an A+ rating and their outlook is “Stable”.  Again, this is an indication of strong financial strength as well as good claims management to keep strong claims ratios.

They offer a 12% household discount as well which is another perk.

United American Insurance Company

AM Best reconfirmed a A+ rating and “stable outlook” for United American.  This is a testament to their dedication to continually leading the industry as one of the best medicare supplement plans in 2022.  With an average rate increase of 2.5%, there is a strong chance you can expect this to continue in 2022.

For the record, they just release their rate increase of 1% for 2022, so the pattern is looking good for United American in 2022.

Americo Financial Life and Annuity Insurance Company

AM Best awarded Americo with an A rating and “stable” outlook, but have not yet released information for 2022 or their rate increase history.  They entered the medicare supplement market as a new plan 3 years ago, so the data is still coming in.  However, their A rating and stable outlook earned them a spot on our list of best medicare supplement companies for 2022.

Cigna Health and Life Insurance Company

Like Mutual of Omaha, Cigna is another strong household name for medicare supplement insurance plans.  They have an A rating with AM Best and their outlook is “stable”

Cigna is also one of the cheapest medicare supplement plans in St. Louis as well as many other cities and states.

Renaissance Life and Health Insurance Company of America

Renaissance is a new player to the Medicare supplement market, but they are getting some attention.  They have an A rating and “stable” outlook from AM Best.  As they are a new medicare supplement plan, we were not able to access rate increase history, but will update as that information is available.

AARP – United Healthcare Insurance Company

You’re not American if you haven’t received information on AARP.  They continue to be a leader in the Medicare supplement market and are equipped with a stable A rating from AM Best.  With an average rate increase of 2.8%, they are a clear shoe in to our list of the best medicare supplement companies for 2022.

If you’re curious about other Medicare Supplement plans in 2022 and want our opinion, just ask we’ll happily pull the data and share with you.

We want to make sure you are equipped with the best information when shopping for a Medicare Supplemental insurance plan.

Back to Top

Can Medicare Supplement Insurance Be Denied?

Yes, you can be denied medicare supplement insurance, but only in one scenario.

When you first age into medicare, you have a 7 month window to choose your Medicare Supplement plan in what’s referred to as a “guaranteed issue” period.  This means that regardless of your health, you will  be accepted into the medicare supplement plan of your choice.

The most common reason people are denied coverage for Medicare Supplements is when their health has deteriorated and they live in a state that doesn’t allow them to switch to a new plan.

This is why it’s critical to do your homework ahead of time and choose a medicare supplement plan that has a strong history of stable rate increases and claims ratios.

This will give you the best chance at not needing to switch your supplement due to price down the road.

Back to Top

Does Medicare Supplemental Insurance Cover Dental or Hearing Aids?

This is one of the most common questions we receive.

No, Medicare supplements do not include dental insurance or coverage for hearing aids.  In order to get this coverage, you must get a third party plan.  These plans can be stand alone senior dental insurance or senior hearing plans, or you can get combination plans referred to as Dental, Vision, and Hearing (DVH).

Dental, vision, and hearing plans are often very affordable and while not as robust as what you may be used to before going on medicare, they can drastically impact the costs of dental work or hearing aids.

One of the most well known dental, vision, and hearing plans is offered through a company call Medico.  If you would like information, shoot us an email and we can certainly talk through you options.

Back to Top

Can I Get a Supplement That is Tax Deductible?

Yes, you can deduct your medicare supplement premiums that exceed a certain percentage of your AGI.

You should speak with your tax advisor on how to report your medicare supplemental insurance premiums as a deduction on your tax return.

Medicare Supplements for Low Income

As previously discussed, Medicare Supplements have a monthly premium, so it’s important to weigh your options when considering which medicare supplemental insurance plan to choose.  Below are two low income scenarios.

Low Income Medicare Scenario 1:  Medicaid

If you’re classified in your state as “low income”, then you may qualify for some level of Medicaid.  When this happens, it likely makes more sense to utilize a Medicare Advantage plan that coordinates with Medicaid.

These plans are called Dual Special Needs Plan (DSNPs).  This means the Medicare plan is designed for people with Medicaid and will coordinate with their services.

One of the reasons low income individuals on Medicare use dual special needs plans is to take advantage of the additional benefits not offered through Medicare or Medicaid such as hearing aids, silver sneakers, and some limited dental work.

Low Income Medicare Scenario 2:  Medicare Supplement

Low income doesn’t always mean Medicaid, but may just mean you’re retired and living on a fixed income.  This scenario certainly creates the instance where you need to be cost conscious with your healthcare plan.

Medicare supplements carry a monthly premium, so you need to consider how much you’ll need to use your coverage.  If you anticipate a significant amount of doctors visits and copays, you might find the monthly premium of a medicare supplement worth it due to the savings of copays and deductibles.

Remember, Medicare supplement plans can cover up to all the benefits listed below.

• Part A deductible
• Part B deductible
• Coinsurance for Part A and Part B
• Part A hospice coinsurance / copayment
• Skilled nursing coinsurance
• Excess charges
• Foreign travel emergency care up to plan limitations
• First 3 pints of blood for a medical procedure

Back to Top

Medicare Supplements for Disabled People

This is a sticky subject for individuals who are disabled, eligible for Medicare (after 24 months of disability), and under the age of 65.

Many Medicare supplemental insurance companies do not offer plans for individuals under 65.

Here’s why.

If you’re on Medicare and under the age of 65, it’s strictly because you’re on disability.  In the eyes of the insurance company, that means adding you to their portfolio of products will result in a higher amount of claims.

If you’re disabled and looking to get a Medicare Supplement plan, you should definitely speak with an agent who can shop the medicare supplement plans in your state to get paired with the right plan.

How much do Medicare Supplements Cost?

As we stated at the beginning, Medicare supplements are standardized and plans of the same type must by law offer the same exact benefits.  The only difference is the price you pay each month.

Below is a list of the 39 plan G rates of a female turning 65.  For this example I used the state of MO, but this should give you a good idea of what to expect in your area.

Here is what’s important to remember.

• Every plan G must offer the same benefits.
• Each company can charge a different price for the exact same benefits.
• The most expensive Plan G is A rated and costs $341 per month.
• The least expensive Plan G is A+ rated and costs $144 per month.
• Do not let someone sell you a plan requires you to pay more than you need to!

Missouri Medicare Supplement Plan G Rates

Company	Established Year	AM Best Rating	S&P Rating	Monthly Rate
COLONIAL PENN LIFE INSURANCE COMPANY	1998	A	BBB+	$341.66
AARP Medicare Supplement Plans, insured by UnitedHealthcare	1998	A+	AA-	$298.82
GPM Health and Life Insurance Company	2010	A-		$288.95
AARP Medicare Supplement Plans, insured by UnitedHealthcare	1998	A+	AA-	$277.76
COLONIAL PENN LIFE INSURANCE COMPANY	1998	A	BBB+	$276.9
UNITED AMERICAN INSURANCE COMPANY	1966	A	A+	$265.
Assured Life Association	2005	n/a	n/a	$256.2
Accendo Insurance Company (a CVS company and Aetna affiliate)	2020	Stable	na	$229.66
Omaha Insurance Company	2012	A+	n/a	$226.47
CIGNA HEALTH AND LIFE INSURANCE COMPANY	2016	A		$225.94
Americo / Great Southern Life Insurance Company	2015	A		$224.59
United Commercial Travelers (UCT), The Order Of	1988	B	n/a	$215.48
GLOBE LIFE AND ACCIDENT INSURANCE COMPANY	1981	A	AA-	$214.
OXFORD LIFE INSURANCE COMPANY	1999	A	A–	$208.34
PEKIN LIFE INSURANCE COMPANY	1984	A-	N/A	$195.77
Americo / Great Southern Life Insurance Company	2015	A		$195.29
United Insurance Company of America		A	n/a	$194.33
State Farm Mutual Automobile Insurance Company	1981	A++	AA	$192.87
Lumico Life Insurance Company	2018	A		$191.75
USAA LIFE INSURANCE COMPANY	1992	A++	AA+	$191.59
Humana Insurance Company (Value)	2012	A-	n/a	$190.88
National Health Ins Co (Allstate)	1965	A+	N/A	$190.41
SBLI USA Life Insurance Company, Inc (Prosperity)	2016	A-		$189.52
State Farm Mutual Automobile Insurance Company	1981	A++	AA	$189.3
SBLI USA Life Insurance Company, Inc (Prosperity)	2016	A-		$187.62
Healthy Alliance Life Ins Co (Anthem)	1966	A	n/a	$185.29
Humana Insurance Company (Value)	2012	A-	n/a	$182.66
AETNA HEALTH AND LIFE INSURANCE COMPANY	2013	A	AA-	$182.51
PHYSICIANS MUTUAL INSURANCE COMPANY	1970	A		$182.2
Medico Corp Life Insurance Company	2006	A	n/a	$181.25
Humana Insurance Company (Value)	2012	A-	n/a	$181.24
TRANSAMERICA LIFE INSURANCE COMPANY	2005	A	AA-	$180.22
Puritan Life Insurance Company of America	2007	B++	n/a	$177.85
National Health Ins Co (Allstate)	1965	A+	N/A	$177.08
Humana Insurance Company (Value)	2012	A-	n/a	$173.43
OLD SURETY LIFE INS CO	1995	n/a	n/a	$169.01
Healthy Alliance Life Ins Co (Anthem)	1966	A	n/a	$163.4
AARP Medicare Supplement Plans, insured by UnitedHealthcare	1998	A+	AA-	$155.5
AARP Medicare Supplement Plans, insured by UnitedHealthcare	1998	A+	AA-	$144.47

 

Back to Top

How do I pick a Medicare supplement plan?

Choosing and changing your Medicare supplemental insurance plan can be daunting, but it doesn’t have to be if you follow these four steps:

• Choose a Medicare Supplement plan A-N based on what fits you best.  Remember, the most common Medicare Supplement plans are Plan F, Plan G, and Plan N.
• Review the annual rate increase history. (If you’re agent can’t pull this information for you, then you need to find a new agent)
• Review the insurance company loss ratios to be proactive in choosing a plan that will offer you price stability year over year. (remember the agent rule above,  this is common information available to licensed agents)
• Annually review your plan within the 60-day window of your anniversary period to take advantage of the guaranteed issue period should you need to make a change.

If you take the time to analyze your options, you’ll feel much better about the decision you make.  Any independent agent can access this information, so you need to press them to show you the data behind the company they are proposing.

It’s the only way you’ll truly know you are choosing the best Medicare Supplemental insurance plan for you.

If you would like to discuss your Medicare supplemental insurance plans, please call at 719-451-7552 or contact us via email.  We look forward to helping you navigate your options and make an educated and confident decision for your Medicare Supplement.

PolicyZip is located in St. Louis, MO and serves the greater area with licensed agents available to meet face-to-face.  We are a life insurance and Medicare Insurance Agency.  St. Charles, Jefferson, Pike, and St. Louis counties are among the core areas we serve.  For those looking for Medicare supplemental insurance online or in any state, we have a call center staffed with nationally licensed agents qualified to educate you on your options.  One of the best reasons to work with PolicyZip is that we make shopping for your medicare supplemental insurance easy.

Back to Top

Florida Medicaid Explained

What is Medicaid?

Medicaid provides health coverage to more than 66 million Americans, including eligible low-income adults, newborns and children, pregnant women, elderly adults and people with disabilities. It is administered by individual states according to federal requirements. State and federal governments share costs for the Medicaid program.

In Florida, Medicaid is administered by the Agency for Health Care Administration.  It is the chief health policy and planning entity for Florida and oversees a $25 billion budget for Medicaid that serves more than 4.2 million of the state’s residents who receive Medicaid benefits.  The agency also oversees licensing for more than 48,000 health care facilities and is responsible for sharing important data that helps shape public health policies in the state.

AHCA administers the Statewide Medicaid Managed Care (SMMC) program.  Most Florida Medicaid recipients are enrolled in the SMMC Program. It has three components: Long-Term Care (LTC) program, Managed Medical Assistance (MMA) program, and the Dental program.

Medicaid eligibility in Florida is overseen by the Florida Department of Children and Families (DCF) or the Social Security Administration for those people who receive SSI benefits.

DCF’s Automated Community Connection to Economic Self Sufficiency (ACCESS) is a system that allows customers to connect with the public assistance information, including Florida Medicaid, 24/7 after they set up a MyACCESS account.

ACCESS Florida promotes strong and economically self-sufficient communities by determining eligibility for food, cash and medical assistance for individuals and families.

Florida Medicaid has services for many scenarios.

• Florida Medicaid for AdultsFlorida Medicaid for Seniors
• Florida Medicaid for Elderly
• Florida Medicaid for Assisted Living
• Florida Medicaid for Autism: This falls under the federally mandated medicaid benefits.
• Florida Medicaid for Long Term Care
• Florida Medicaid for Nursing Homes
• Florida Medicaid for Mental Health
• Florida Medicaid for Dental

The Difference Between Medicaid and Medicare

The federal government administers two healthcare related programs to assist individuals.  One is Medicaid and the other is Medicare.  Although they sound alike and are sometimes confused with each other, they are distinctly different.

The main difference is that Medicaid is an assistance program and Medicare is an insurance program. 

Medicare helps people who are 65 and over or who have qualifying conditions under age 65 by providing coverage for their medical bills.  Medicare is divided into four parts known as Part A, Part B, Part C and Part D.  Each provides certain types of coverage.  For some services and coverages, beneficiaries may need to pay a monthly premium.  If a person has paid into Medicare throughout their working life, then some parts of Medicare will be free.  Medicare is strictly a federal program and is administered uniformly throughout the United States.

Medicaid is an assistance program and has no age restrictions.  It is based purely on need and will provide benefits if a person falls below certain income and asset levels.  Most all services are provided at no cost, except in a few limited cases.  Although Medicaid adheres to federal guidelines, it is administered by state and local governments.

Who Qualifies for Florida Medicaid?

In Florida, the Department of Children and Families (DCF) determines eligibility for public assistance programs, including Medicaid.  Federal regulations and Florida Statute and Administrative Rules contain the specific polices that must be adhered to for eligibility.  For those people who receive Supplemental Security Income, the Social Security Administration will determine eligibility.

He or she who qualifies for Florida Medicaid must be a U.S. citizen or a qualified non-citizen, must be a Florida resident, and must provide Social Security numbers to facilitate data matching.  Eligibility may be verified electronically through the Federal Data Services Hub.

Applicants must also apply for all benefits to which they are entitled including pensions, Social Security and Medicare benefits.  Income from wages and self-employment is also used to determine eligibility as well.

Family-Related Medicaid is based on need and there are strict income limits for those who want to receive benefits. Income limits are based on the expected tax filing status for each applicant.  A household’s countable income, after allowable deductions, must be less than the applicable income limits.  To view the 2018 limits for each target group, go here.

Households with income that exceeds limits for Family-Related Medicaid will be enrolled in the Medically Needy Program.  Those applicants may be referred to the Federally Facilitated Marketplace or the Children’s Health Insurance Program.

There are several targeted groups who are potentially eligible for Medicaid:

• Parents and caretaker relatives of children
• Children under age 19
• Children from 19 to 21
• Newborns and infants under age 1
• Pregnant women
• Former foster care children between 18 and 26 years old
• Non-citizens with medical emergencies
• Aged or disabled individuals not currently receiving Supplemental Security Income (SSI)

People may also be eligible for Medicaid for up to three months prior to the date they apply if they have unpaid medical bills for one or more of the three months preceding the month that they apply.  This is known as retroactive Medicaid and individuals will be notified by mail if it is determined they are eligible.

Medicaid is authorized for a 12-month period and to continue receiving coverage, a beneficiary must complete and submit a renewal annually.  All beneficiaries are required to report any changes that may affect their eligibility within 10 days of an event taking place.  Some of the examples of changes affecting eligibility may include:

• Florida Medicaid for Pregnancy
• Florida Medicaid for Newborns
• New or increased earnings
• Termination of employment
• Arrival or departure of members in a household
• A change in address
• A change in living arrangements
• Relocation to another state

What Does Florida Medicaid Cover?

States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. Federal law requires states to provide certain “mandatory” benefits and allows states the choice of covering other “optional” benefits.

Mandatory benefits include services like inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services like prescription drugs, case management, physical therapy, and occupational therapy.

Federal Mandatory Medicaid Benefits

Following are the federally-mandated Medicaid benefits:

• Inpatient hospital services
• Outpatient hospital services
• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
• Nursing facility services
• Home health services
• Physician services
• Rural health clinic services
• Federally qualified health center services
• Laboratory and X-ray services
• Family planning services
• Nurse midwife services
• Certified pediatric and family nurse practitioner services
• Freestanding birth center services (when licensed or otherwise recognized by the state)
• Transportation to medical care
• Tobacco cessation counseling for pregnant women
• Autism Spectrum Disorder (Autism)

Florida Medicaid Covered Services

In addition to the required medicaid services, Florida Medicaid also covers several additional services.  Click on the link to each of these services to get more detailed information:

• Allergy Services
• Ambulatory Surgical Center
• Anesthesia Services
• Assistive Care Services
• Behavioral Analysis
• Behavioral Health Overlay Services
• Birth Center and Midwife Services
• Cardiovascular Services
• Certified School Match Program
• Certified Substance Abuse County Match
• Chiropractic Services
• Community Behavioral Health Services
• County Health Department (CHD) Services
• Dental Services
• Dialysis Services
• Durable Medical Equipment (DME) and Medical Supplies
• Early Intervention Services
• Evaluation and Management Services
• Family Planning Waiver Services
• Federally Qualified Health Center Clinic Services
• Gastrointestinal Services
• Genitourinary Services
• Hearing Services
• Home Health Services
• Hospice Services
• Hospital – Inpatient
• Hospital – Outpatient
• Hospital – State Mental Health
• Integumentary Services
• Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Services
• Laboratory Services
• Medical Foster Care (MFC) Services
• Neurology
• Nursing Facility
• Oral and Maxillofacial Surgery Services
• Orthopedic Services
• Pain Management Services
• Podiatry Services
• Prescribed Drug Services
• Prescribed Pediatric Extended Care (PPEC) Services
• Program of All-Inclusive Care for the Elderly (PACE)
• Radiology and Nuclear Medicine Services
• Redirections
• Reproductive Services
• Respiratory Services
• Rural Health Clinic Services
• School-Based Services Programs – County Health Department (CHD) Program
• Specialized Therapeutic Foster Care
• Statewide Inpatient Psychiatric Program Services
• Targeted Case Management – Child Health
• Targeted Case Management – Children at Risk of Abuse and Neglect
• Targeted Case Management – Mental Health
• Therapy Services – Occupational
• Therapy Services – Physical
• Therapy Services – Respiratory
• Therapy Services – Speech-Language Pathology
• Transplant Services
• Transportation – Emergency
• Transportation – Non-Emergency
• Visual Aid Services
• Visual Care Services

What is the Medically Needy Program?

This program can help pay for Medicaid-covered services. Beneficiaries enrolled in this program have income or assets that exceed the limits for regular Medicaid.

Before Medicaid benefits can be approved, an enrollee must meet their “share of cost” meaning that they must pay a portion of the medical bills they incur before Medicaid benefits kick in.  This is similar to what a deductible would be in a health insurance policy.  The amount of “share of cost” is based on a family’s monthly income.

Once an individual meets the share of cost for the month, the individual must contact DCF to complete bill tracking and approve Medicaid for the remainder of the month.

Information about this program can be found in the Medically Needy Brochure.

What is the Florida Medicaid Waiver Program?

The Florida Medicaid waiver helps elderly and permanently disabled adults at risk of being placed in a nursing home to remain living in their own homes or those of their caregivers while receiving assistance.  The waiver also includes adult day care to give respites to caregivers to go to work while also caring for an aging parent.

When an application is made, applicants are assessed to determine what level of care they require.  They can be approved for any of the following benefits:

• Adult day health care
• Attendant care
• Case management
• Chore services
• Disposable medical supplies
• Durable medical equipment
• Home delivered meals
• Homemaker services
• Nutritional risk reduction (counseling)
• Personal care
• Pest control
• Respiratory therapy
• Respite care
• Skilled nursing (however not for long term)

To qualify, persons under 65 must be certified as disabled by the Social Security Administration.

Florida Medicaid for seniors 65 and older do not need to be fully disabled but must require nursing home level care.

Waiver participants must also qualify for Florida Medicaid with a determination based on income and financial resources.  The spouse who is not applying is allowed to keep sufficient income to all him or her to keep living independently.

It should be noted that demand exceeds available resources for this program and as such waiting lists to receive services are normal.

To apply, persons under 60 years of age should contact the Florida Department of Children and Families. Persons 60 and older should contact the Department of Elder Affairs.

When is Florida Medicaid Open Enrollment?

People can apply for Medicaid at any time in Florida.  Those who are accepted can also make changes in their plan online, by phone or in person at statewide customer service centers.

Medicaid applications in Florida can also be filed through the Health Insurance Marketplace for those seeking coverage.  Open enrollment for Marketplace insurance is typically offered for those who may not qualify for Medicaid or who may want different benefits than what Medicaid offers.  Open enrollment runs for about six weeks in October, November or December each year and gives applicants the ability to sign up for healthcare coverage during that time.

There are also supplemental enrollment periods that accommodate people who may qualify due to life events such as losing other coverage, getting married or having a baby.

Where Do I Apply for Florida Medicaid?

The easiest way to apply for Florida Medicaid is online by completing an application you will find here.

Applications can also be turned in at any of the ACCESS Service Center locations found throughout Florida.  To find the location nearest to you, go here.

Florida also works with several community partner agencies that help the Department of Children and Families provide access to all forms of public assistance.  This includes applying for food stamps, cash or Medicaid.  To find a local community partner agency near you, go here.

How Do I Apply for Medicaid in Florida?

You can apply for Florida Medicaid online by completing an application you will find here.

You can also complete a hard copy paper application that can be mailed, faxed or returned in person to any ACCESS Service Center location.

To get a hard copy of the Florida Medicaid application, go here.

There are also several community partner agencies that help the Department of Children and Families provide access to all forms of public assistance, including Medicaid. To find a local community partner agency near you, go here.

You will need to provide your full name, Social Security number and birthdate as well as any citizenship or immigration documentation.  Income and employer information will also be required, and you will also need to provide details on any existing healthcare coverage or potential healthcare coverage through your employer.

What Happens After I Apply for Florida Medicaid?

After you submit an application, it can take up to 30 days to process your request.  If you need a disability determination, the process could take longer.  If you signed up for email alerts when you created your MyACCESS account, you will be sent a notification when there is something posted to your account.  If you didn’t sign up for email alerts, you will be sent notices by the U.S. mail.

When your application is reviewed, it may be determined that you will need to be interviewed to get more information about your situation.  If this is the case, you will be contacted by phone to arrange for the interview.

If it is determined that you need to provide more information, you will be sent a notice detailing what is needed, along with a deadline to provide the information.  Several items may be requested, including proof of identity or citizenship, proof of earned and unearned income by providing check stubs, child support information or notices from other government agencies.  You can fax, mail or upload these documents to your MyACCESS account, or turn over the information at a local Community Center partner.

After you have completed these steps, it may take an additional 30 days to process your application.

If your application is approved for food or cash assistance, you will be mailed an Electronic Benefits Transfer (EBT) card, or you can use an existing card if you received benefits within the past 24 months.

If you are eligible for Medicaid, you will receive a gold card in the mail for all eligible members as well as Medicaid Choice Counseling information.  You will present this gold card when you receive Medicaid covered services through your provider.  If you picked a plan while your application was being processed, you will be enrolled in that plan. If you did not pick a plan while your application was being processed, a plan will be chosen for you.

If you are denied Medicaid benefits, you will receive a notice in the mail or through your MyACCESS account explaining why you did not qualify for benefits.  You have the right to appeal a denial.

Applicants determined not eligible for Medicaid will be referred electronically to the Federally Facilitated Marketplace or Florida KidCare.

How Do I Change My Florida Medicaid Plan?

After you have enrolled in a Medicaid plan, you can change your choice in several ways.

The easiest way is to go online to the Statewide Medicaid Managed Care page and log on to your account.  From there you will be taken through the steps to make your desired changes.

If you can’t make a change online, you can access the MMA automated phone system at 1-877-711-3662.  You will need your pin number to access your account

Florida Medicaid also offers counselors that are available to assist with changes by calling 1-877-711-3662, Monday through Thursday, 8 am to 8 pm, and Friday from 8 am to 7 pm.  TDD users only should call 1-866-467-4970.

You will need to make sure you have your Florida Medicaid number or Social Security number and birth year for each person you want to make changes.

How Do I Cancel My Florida Medicaid Plan?

To cancel your Florida Medicaid coverage, you will need to call the DCF at 866-762-2237 if you currently reside in Florida.  If you live outside Florida, you will need to contact Florida medicaid to determine the proper process.  Most states will provide a mailing address, we strongly advise calling DCF prior to making any changes.

Can Florida Medicaid be Used Out of State?

Many people assume that Medicaid benefits from one state can be used when traveling to another state.  Although Medicaid is managed with oversight from the federal government, each state is given flexibility to set its own eligibility and coverage requirements.

Unfortunately, in the vast majority of cases, Florida Medicaid will not cover health services provided in another state.  At best, Florida Medicaid will only cover out-of-state emergency room visits to stabilize an emergency situation.  All other non-emergency costs will not be covered, and costs will be out-of-pocket for a beneficiary.  When in doubt, it is best to contact Florida Medicaid first to determine if a service will be covered elsewhere.

Florida Medicaid beneficiaries who will be moving to another state, either temporarily or permanently, must apply for Medicaid in the new state where they will reside.  Federal law prevents a person from being enrolled in Medicaid in two states at the same time, so a beneficiary will need to cancel their Medicaid coverage in Florida before applying for coverage in a new state.  The good news is that retroactive coverage does exist, and beneficiaries should not be concerned about a gap in coverage when seeking a new plan in a new state.  The only concern is that each state has its own set of eligibility criteria, and what qualifies in Florida may not qualify in other states.

How Do I Contact Medicaid in Florida?

Florida Medicaid Customer Call Center

8 am to 5pm, Monday through Friday

1-866-762-2237

Florida Relay 711 or
TTY 1-800-955-8771

FAX: 1-866-886-4342

Florida Medicare Mailing Address

ACCESS Central Mail Center
P.O. Box 1770
Ocala, FL 34478-1770

ACCESS Florida Medicaid website

http://www.myflorida.com/accessflorida/

ACCESS Service Center Locations

The state maintains Service Centers throughout Florida.  To find the Service Center nearest to you, go here.

Florida Department of Children and Families

The Florida Department of Children and Families also maintains regional facilities for your convenience.

Central Region – Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange, Osceola, Polk, Seminole, Sumter

Northeast Region – Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union, Volusia

Northwest Region – Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, Washington

Southeast Region – Broward, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie

Southern Region – Dade, Monroe

SunCoast Region – Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas, Sarasota

The Agency for Health Care Administration also provides information several state health care related topics.  This includes things such as Civil Rights Compliance, Complaint Investigations of Facilities, Financial Statements for the ACHA, Hospital Financial Data, Recipient and Provider Assistance, and many more.  To access a complete list of information topics, go here.

 

Accountable care organizations (ACO Model) could transform U.S. healthcare system, and we want to make sure you understand how they work and why they are so wildly disruptive to the traditional fee for service healthcare model.

For more than a decade, a debate has been growing about the state of healthcare in America.  The issue has intensified even more as baby-boomers seek higher levels of care, putting more stress on the nation’s healthcare system than ever before.  Costs continue to escalate, taking a much larger share out of the nation’s economy, and forcing an urgent discussion between the healthcare providers and government about how to find a better model to deliver quality care in a fiscally responsible way.

From these discussions, one of the most viable solutions gaining traction across the board has been a move toward value-based healthcare and the creation of accountable care organizations.

In this article we’re going to explain to you the importance of Accountable Care Organizations and why they are playing a critical part in the positive overhaul of US based healthcare.  Simply choose from any of the links below to learn more about how accountable care organizations work:

Quick Navigation: Guide to Accountable Care Organizations

• An Overview of Accountable Care Organizations
• What Are Accountable Care Organizations?
• Accountable Care Organizations vs Fee For Service
• Who Owns Accountable Care Organizations?
• When Did Accountable Care Organizations Start?
• Accountable Care Organizations vs. Patient Centered Medical Home
• How Do Accountable Care Organizations Work?
• Do Accountable Care Organizations Save Money?
• How Do Accountable Care Organizations Make Money?
• Are Accountable Care Organizations Only for Medicare?
• What are the Pros and Cons of Accountable Care Organizations?
• How Are Accountable Care Organizations Funded?
• How Many Accountable Care Organizations are There in the U.S.?

An Overview of Accountable Care Organizations.

To better understand accountable care organizations (ACO) and how they could have a major impact on how healthcare is delivered in the future, it’s best to back up a bit and take a broader look the health of the American healthcare system.

What Are Accountable Care Organizations?

Accountable care organizations are groups of doctors, hospitals and related healthcare providers who have joined together to provide a coordinated system of care.

The overall goal is to provide a higher quality healthcare experience for patients; providing the right care at the right time and avoiding unnecessary duplications of services while also reducing treatment errors through better communication among providers.

There are three primary stakeholders in accountable care organizations.

1. Providers. The size and scope of an accountable care organization will dictate how many and what kind of healthcare providers are in the ACO.  All ACO providers include hospitals and physicians but depending on the other providers, may include health departments, social security departments, home care services and others depending on the type of services they provide and the size of the ACO.
2. Patients. Because accountable care organizations were originally conceived by the Centers for Medicare and Medicaid Services, the majority of ACO patients are Medicare beneficiaries.  In larger and more integrated accountable care organizations, patients may also include uninsured and homeless people.  More and more, private accountable care organizations are also expanding their patient populations.
3. Payers. Medicare is the primary payer to accountable care organizations.  In some instances, private insurance companies and employer-purchased insurance programs are also payers as well.  Payers are an integral part of ACOs because they play a key role in helping set higher quality standards and striving for lower costs.  Payers may collaborate with each other to make sure payout incentives are aligned and create consistent financial incentives for providers to achieve their quality care goals.

Back to Top

Accountable Care Organizations vs Fee For Service

Currently, the clear majority of Americans pay for healthcare under a fee-for-service model. This traditional model pays healthcare providers based on the quantity of tests and procedures so that a patient is exposed to multiple options to receive the best care.  The downside is that patients are often burdened with tests and procedures they don’t need, weighing down a system with unnecessary treatments, and more important, with unnecessary costs.

The fee-for-service model has been effective with patients receiving quality care and the treatments they need. However, the emphasis on quantity over quality is not a sustainable model for the healthcare industry.

Enter value-based healthcare with a promise to radically transform the way healthcare will be delivered in the future. Under this new model, the emphasis is on healing a patient as opposed to just managing their healthcare problems.

It’s an exciting concept worth digging into here.

Back to Top

Value-based Healthcare is the Concept — Accountable Care Organizations Are the Execution of That Concept.

To deliver on the concept of value-based healthcare, a new type of healthcare delivery system needed to be put in place.  This led to the creation of Accountable Care Organizations (ACO).

The actual physicians and team that implement the strategy of value based care to improve the patient experience and have better cost containment.

When Did Accountable Care Organizations Start?

The term was first introduced a decade earlier and was later included in the Affordable Care Act (ACA).  When the ACA was signed into law in 2010, the Medicare Shared Savings Program was created.

This program pioneered the launch of ACOs and spelled out the broad terms of value-based healthcare, making providers jointly accountable for the health of their patients and providing financial incentives to save money by cooperating with each other.

In 2011, the U.S. Department of Health and Human Services proposed an initial set of guidelines for accountable care organizations under the Medicare Shared Savings Program.  Administered by the Centers for Medicare and Medicaid Services, three core principles guided the development of ACOs:

1. Provider-led organizations with a strong base of primary care that are collectively accountable for quality and per capita costs across the continuum of care;
2. Payments linked to quality improvements and reduced costs;
3. Reliable and increasingly sophisticated performance measurement, to support improvement and provide confidence that savings are achieved through care improvements.

For the accountable care organization concept to work, a system would have to be created to seamlessly share information.  Doing so would create efficiencies and save money while making it easier to hit quality care targets.  ACOs that accomplished these goals would get to keep a portion of the savings.

Back to Top

Accountable Care Organizations vs. Patient Centered Medical Home

With an accountable care organization, patients will have many providers that will serve as “homes” and provide them with healthcare services.  In other words, many providers will assume primary responsibility for the care of a patient.

As part of the overall need to reform healthcare, another value-based healthcare model has emerged that also focuses on the same goals as ACOs. The Patient-Centered Medical Home model (PCMH) also strives for improved care through coordination with healthcare professionals, but instead of many homes, the PCMH focuses on a primary care physician as the single home for a patient.  The primary provider takes a much more front and center role than under the ACO model.

The primary care physician provides continuous care and refers the patient to other specialists and hospitals as needed.  All selected providers collectively accept responsibility for the patient’s care. Under the PCMH plan, all providers may be given bonuses for improvements in primary care services for each patient, providing an additional incentive to offer quality care.

Back to Top

How Do Accountable Care Organizations Work?

The concept behind accountable care organizations is simple: Teams of healthcare providers come together to share patient data, focus on prevention and better coordinate patient care.  Following are the benefits for a patient:

• Local healthcare providers voluntarily decide to work together to provide patients with coordinated care.
• Doctors, hospitals and other healthcare providers will communicate with each other and partner with a patient to help make the best possible and most informed healthcare decisions.
• Patients spend less time filling out paperwork because doctors across the ACO may already have medical history contained in a centralized electronic health record.
• There will be less duplication of tests due to coordinated care because doctors and hospitals are sharing information.
• The patient is made the center of the care and because of this, doctors do a better job of communicating with the patient and helping them make better choices.
• For patients in Medicare ACOs, Medicare will share certain health information with the ACO about the care a patient is getting from their doctors and hospitals.
• The privacy and security of a patient’s medical information is protected by federal law. Patients have the right to request that Medicare not share certain information with the ACO.
• Doctors and hospitals will likely refer patients to hospitals and specialists within the ACO network. But patients can still choose to see providers outside the ACO network.  Healthcare providers who are part of an ACO are required to let patients know they are in an ACO network.  Patients are then free to opt out if they do not want to participate in an ACO.
• Under the ACA, an accountable care organization must manage the healthcare needs of at least 5,000 Medicare beneficiaries for at least three years. In addition, all ACOs must meet a lengthy list of quality control measures to make sure they are not saving money by skimping on necessary care.

Back to Top

Do Accountable Care Organizations Save Money

Yes.

The model for accountable care organizations places financial responsibility on the doctors.  With the goal of improving care and limiting unnecessary tests and procedures, ACOs can save money by giving incentives to doctors, hospitals and other providers to form connections and facilitate coordinated delivery of healthcare.

By coordinating care, unnecessary medical care and improved outcomes will reduce the overall amount of care a patient needs.  When this happens, cost savings are achieved.  By early measures under the ACO model, it was estimated that Medicare savings of about a half billion dollars were realized from 2012-2015.

Back to Top

How Do Accountable Care Organizations Make Money?

With a traditional fee-for-service model, doctors and hospitals are paid for each test and procedure, rewarding providers for doing more even when it is not needed and, consequently, driving up costs.

Accountable care organizations create incentives to be more efficient and meet specific quality of care benchmarks by focusing on prevention and more closely managing patients with chronic diseases.  ACO providers get paid more for keeping their patients healthier and out of hospitals.

Accountable care organizations are incentivized to save money and may have to pay a penalty if they do not meet their performance and savings benchmarks.  Most ACOs have not opted to take on that amount of risk yet, preferring smaller payouts in exchange for not participating in downside risk.  Some ACOs can actually receive payments in advance to help them build out their infrastructures that are necessary for coordinated care.

Back to Top

Are Accountable Care Organizations Only for Medicare?

Although ACO’s started out as a public option under Medicare, they have grown and expanded into the commercial payer market as well.  It is not unusual for an ACO to have multiple contracts with payers including several private insurance companies and Medicare.

Medicare offers three main accountable care organization options, each with varying degrees of risk for the ACO:

1. The Medicare Shared Savings Program (MSSP) was rolled out in 2012 and was the first ACO option put into place for Medicare fee-for-service providers. At inception, it was intended to improve the quality of care, connect providers and encourage savings.
2. The Pioneer ACO Model was also introduced in 2012 and was specifically targeted to work with early adopters of coordinated care who had already developed high performing healthcare networks. Because of the pre-existing infrastructure already in place, the Pioneer ACO assumed higher risk and shared savings than the MSSP ACOs.
3. The Next Generation ACO Model was designed for experienced ACOs and allows them to assume an even higher degree of risk and reward than the other two Medicare models. The Next Generation model is tasked with testing to see if larger financial incentives combined with a larger network of data and delivery of services can lead to even better patient outcomes and lower costs.

End-Stage Renal Disease Care a Growing Model for ACOs

Medicare also has a targeted Comprehensive End-Stage Renal Disease Care ACO Model which is focused exclusively on dialysis facilities, nephrologists, and other kidney care professionals.  Large dialysis organizations with more than 200 facilities can receive shared savings payments, but also are liable for shared losses. They also share in greater levels of risk than their smaller counterparts.

Originally, small dialysis organizations could receive shared savings payments, but were not liable for shared losses. Beginning in 2017, they were able to include the option of assuming downside financial risk, accompanied by the opportunity for greater shared savings.

Based on the success of the Medicare ACOs, private healthcare systems began to realize there could be benefits and efficiencies found in shared data as a means of rewarding cost control and benchmarked quality healthcare.

Based on an American Journal of Managed Care study, it was determined that the private sector had three primary motivations for developing their own accountable care organizations.  These included the opportunity to improve the quality and efficiency of healthcare services, to jumpstart population health improvement, and to accept that changes in how medical payments are going to be made was an inevitable change coming to the healthcare marketplace.

In many markets, private ACOs are now starting to engage patient populations as the trend toward value-based healthcare gains wider acceptance.

Back to Top

What are the Pros and Cons of Accountable Care Organizations?

Accountable care organizations and the concept of value-based healthcare are a significant departure from the fee-for-service model.  While there are many reasons to like the ACO model, there are also several challenges to overcome.

10 Accountable Care Organization Pros

1: A Collaborative Delivery of Services

When all healthcare providers in an accountable care organization work together to ensure a better outcome for patients, they can combine their resources and analytics to create a single and comprehensive snapshot of care that results in better care.

2: Reduced Errors

ecause a collaborative approach means that healthcare providers are no longer working in provider silos, it is easier to implement checks and balances that rely on the combined skills and talents of providers.  With a greater collective approach, errors are less likely to happen.  Costs can be further reduced if better care reduces malpractice suits.

3: Greater emphasis is placed on prevention

Because there is a shift to improving the baseline health of patients backed by financial incentives, providers in accountable care organizations are more likely to implement preventative strategies instead of managing illnesses and conditions.

4: Patients spend less money overall

Because efficiency is the goal, patients will only receive the medically necessary treatments and procedures they need.  This means they’ll spend less on co-pays and meeting deductibles while their overall treatment arc should be shorter than under a fee-for-service model.  Less doctor visits, fewer and more targeted treatment protocols and fewer prescription medications go great lengths to not only reduce the patient’s financial burden, but the system’s financial burden as well.

5: Greater efficiency means more satisfied patients

When an accountable care organization meets its goals of delivering more efficient treatment with a greater emphasis on wellness, patients have a better healthcare experience and are more satisfied with their healthcare.

6: Healthcare providers are viewed more favorably

When patients are happy with their treatment, that translates into the healthcare industry being seen in a more positive light.

7: Payer’s costs are reduced

When ACO’s deliver better care at a reduced cost, payer’s costs are reduced and that lessens the bottom line impact that can put pressure on premium pools and investments.  When it all works, the healthcare industry is more fiscally solvent and healthy as well.

8: Society benefits as a whole

When people spend less money on healthcare, this frees up money that can be put back into the economy for other purposes.

9: Accountable care organizations are part of a solution that will make healthcare sustainable over the long term

The current fee-for-service model is rapidly becoming outdated.  Value-based healthcare is the preferred model for the future, and accountable care organizations will deliver that model in a way that best provides for a healthy and sustainable healthcare industry. Private healthcare providers are coming to this realization and they have started to embrace value-based healthcare and ACOs as a long-term viable solution.  Many providers have started pilot programs on their own, and others are seeking guidance from Medicare to make sure there is a coordinated effort.

10: Accountable Care Organizations vs. HMO

ACOs are a lot like HMOs.  To many people, accountable care organizations sound much like health maintenance organizations.  But the biggest difference with an ACO is that a patient is not required to stay in the network.  ACOs are trying to replicate the HMO model but without limiting patient options that created a consumer backlash a few years back.  ACOs are also required to meet a long list of quality measures to make sure they are not saving money by delivering substandard care.

6 Accountable Care Organization Cons

1: Resistance to change.

Many providers are profiting nicely from the current fee-for-service model and are apathetic when it comes to implementing a new system that may put less money into their pockets.

2: Changing over is a massive task.

The U.S. healthcare system is huge and that means any switch in how healthcare services are delivered is going to be a massive task, one that will take years to implement in a best-case scenario.  This will require significant time, resources and financial commitments to remake a system and integrate accountable care organizations into the healthcare fabric.

The other big challenge facing a makeover is trying to set policies that everyone in the system can agree on.  Accountable care organizations are already in place and operating on a somewhat limited basis.  They are continuing to gain traction but sharing patient information on a global scale among ACOs will be problematic given the fractured nature of American healthcare.

3: Financial concerns.

Changing to value-based healthcare and creating many more accountable care organizations is expected to save money in the long-term, but short-term it is expected to cost quite a bit more.  Providers will only see it as a hit to their bottom line since they won’t be able to bill payers as they have in the past.  Although they will be rewarded in a better way after the transition period, getting through that period will be a cause for concern.

The other big cost will be implementing a new billing system, because bundling payments will be the new norm in the future instead of payments for individual services.  In other instances, deciding which healthcare provider is responsible for which part of a patient’s treatment could prove problematic, creating questions about who should receive payment and who should be held accountable.

There are also concerns when trying to decide what costs of services should be among various providers because there will be varied structural costs based on each individual provider.

4: Creating measurement systems for patient outcomes.

Accountable care organizations will be judged and paid based on patient outcomes. Determining how to measure those outcomes is sure to cause debate until standards can be put in place.

5: ACOs are not familiar with evidence-based outcomes and quality measures.

The criteria to judge success for doctors and hospitals under a fee-for-service system is quite different than under a value-based system.  Accountable care organizations will need to implement different criteria based on a new kind of measured outcome to be able to get paid.  A lack of experience with this type of measurement system will create reluctance to implement value-based healthcare among some current providers.

6: Mergers and patient consolidation.

Private practice doctors are finding it necessary to consider joining ACOs as a means of having their private practice survive.  Many fear this consolidation could have a long-term negative effect on the healthcare industry.

Back to Top

Who Owns Accountable Care Organizations?

Private physicians own accountable care organizations.

They may be regional or as in the case of United Healthcare and Aetna, they have created a nationwide ACO serving many markets throughout the United States.

Back to Top

How Are Accountable Care Organizations Funded?

In many cases accountable care organizations are funded by the providers, but in some instances, as an incentive to create more ACOs, Medicare will fund them through its ACO Investment Model.

This is a model of a pre-paid shared savings that builds on Medicare’s experience with the agency’s Advance Payment Model.  The goal is to make the barrier to entry into an accountable care organization much lower, providing funding to build coordinated care infrastructure, especially in rural and underserved areas.  It is also designed to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk.

Back to Top

How Many Accountable Care Organizations are There in the U.S.?

In a study conducted by Leavitt Partners, in January 2016, there were 838 public and private accountable care organizations in the United States.  These covered service areas in all 50 states and the District of Columbia and indicated an increase of almost 13% from the previous year.  In 2016, almost 240,000 physicians participated in Medicare ACOs across the country.

It is also estimated that in 2017, between Medicare and private accountable care organizations, there were more than 28 million patients who were enrolled in ACOs.

The Center for Medicare & Medicaid Services has enrolled 561 Accountable Care Organizations (ACO) in the Medicare Shared Savings program in 2018, an increase from 480 in 2017. The number of beneficiaries in these ACOs in 2018 is 10.5 million.  Shared Savings ACOs receive a portion of any financial savings if they meet quality and cost benchmarks. Providers can also choose to share in losses in exchange for receiving a higher percentage of savings. For 2018, 101 ACOs have chosen these higher risk/reward payment tracks.

CMS also announced that 58 ACOs will participate in the Next Generation ACO model which gives participants the opportunity to take on even higher levels of financial risk, up to 100 percent. In exchange, Next Generation ACOs receive a greater share of potential savings.

While many challenges remain, the promise of the ACO model represents a big step forward in providing sustainable healthcare for millions of Americans in the future.  There will be growing pains as ACOs take hold but in the long-term this is a viable solution that will have a number of positive impacts on Americans and their health for years to come.

Back to Top

 

 

No matter how hard we try to avoid them, life is full of surprises, and visiting the dentist is no exception.  Sometimes, your teeth, mouth and gums break down despite how well you take care of them.  Age also takes its toll, potentially leading to bridges, crowns and dentures.  Accidents can also cause major damage.  You may lose or damage your teeth if they are knocked out or you bite down on something the wrong way and a tooth crumbles into several pieces.

Many people don’t like going to the dentist because they fear the pain, even though dentistry has advanced to the point where pain has been minimized or eliminated for most procedures.

Perhaps what people now fear the most is the financial pain that comes from paying for everything from routine fillings to expensive restorative work.

What is Full Coverage Dental Insurance?

While not all financial dental pain can be eliminated, when a patient opts to purchase full coverage dental insurance, they can reduce a large amount of the costs associated with their dental work.

There are many options when it comes to full coverage dental insurance.  It’s best to anticipate current and future dental needs and then if it makes sense, purchase an appropriate policy to meet those needs.  Do the kids need braces?  Have you put off getting bridge work done?  Do you need to place a crown on a troublesome tooth?  Nobody can plan for all eventualities, but making an educated guess is a good start when it comes to deciding what insurance is right for you.

If you’re not sure what your future needs will be, sometimes it makes sense to just go with a policy that provides preventative and basic care such as regular visits and cleanings.

After you decide what your needs are, if you have a dentist you already use and like, check with him or her to see what dental insurance their office accepts.  It may be worth it to pay a little more if you’re happy with the service, or you may choose to go to a new provider if budget is your primary concern.

When shopping for dental insurance, you must also decide if you want to pay monthly premiums and co-pays when you visit, or if you would prefer to pay full amounts to the dentist all at one time.

Full service dental plans come with various options and can be tailored to your specific needs.  Preventative services receive the highest amount of coverage, but plans will vary depending on the types of procedures that are covered and to what degree.

Just like any other insurance policy, you pay a premium and receive coverage in exchange.  When you pay a higher premium, you will likely receive better coverage and have lower copays and deductibles.  However, you must shop around to make sure you find just the right mix of services, premiums and coverage for your particular situation.  You should also be aware that dental insurance plans may also provide coverage for using dentists that are out of the plan’s network, but in most cases, the costs to a patient will be more.  It’s always advisable to try and use an in-network dentist whenever possible.

What is Covered by Full Coverage Dental Insurance?

There are three levels of “full coverage” when it comes to dental insurance.  Depending on the level or the procedure, some plans require a patient to go through a waiting period before coverage will kick in.

Class I services include diagnostic and preventative visits such as x-rays and regularly scheduled cleanings.

For preventative services, there is usually no waiting period because dental insurance providers want patients taking a proactive role in their own dental health.  When a person keeps their mouth, teeth and gums clean and disease free, they require less invasive and costly procedures which could result in expensive future claims against an insurance provider.

Class II coverage include basic restorative care such as fillings and root canals.

Class III coverage includes major restorative care such as crowns, bridges and dentures.  This level includes all work that replaces damaged and missing teeth.

When you need to have major work done, you should also check with your medical insurance provider who may be able to cover some of the costs associated with your dental work.  For example, your medical insurance may cover the cost of antibiotics you will need to take before having a root canal done.  Similarly, medical insurance may cover a part of any oral surgery procedure that is required due to non-biting accidents or related diseases.  This can include jaw surgeries for extracting wisdom teeth, skeletal deformities, cleft palate or facial issues associated with sleep apnea or other airway obstructions.

Unfortunately, health insurance rarely pays for dentures, implants or bridges because these treatments only address function, comfort and appearance, so they are not deemed medically necessary.  However, health insurance may cover braces that are necessary to reposition teeth after a non-biting accident.

There are some other things to know when it comes to dental insurance coverage.

If a person has a medical emergency and needs treatment, then health insurance covers emergency dental work.  Traumatic injuries from accidents, playing sports or other similar situations should be covered and claims should be paid to remove, repair and restore natural teeth and any tissues in the mouth.  Filling a cavity or dealing with a toothache does not qualify as a medical emergency.  Reimbursement assumes that the patient already had health insurance in place before the accident or medical emergency took place.

Unless expressly stated or added as a rider, dental insurance will not cover procedures that are considered purely cosmetic.  This means there is no payment for tooth colored fillings, invisible braces or adult cosmetic orthodontics.  If this is a type of treatment you are considering, you should shop around to see what coverages are available and what you will be required to pay.

If you had dental insurance that expired no more than 60 days prior to seeking new coverage, that full coverage dental insurance providers will often waive the pre-existing condition exclusions.  This means if you need major work, the new provider will often pay for services without waiting periods.  Two groups that qualify for this benefit include anyone who recently lost coverage after changing jobs or for other life events (divorce or death) and people with existing plans who are seeking a second and supplemental policy.

Factors That Impact Full Coverage Dental Insurance Costs

Trying to determine how much full coverage dental insurance costs is like trying to figure out how much a car will cost.  You simply can’t put an accurate price tag on how much your coverage will cost without first identifying the factors that will impact what those costs will be.

In general, it’s estimated that Americans pay about $360 per year for dental insurance with costs running between $15 and $50 per month.  Factors that influence what exact premium costs will be are location, the type of dental plan you choose, your overall dental health and what type of provider you choose.

Another factor is how much the maximum annual benefit is for the policy you choose.  Most amounts fall between $1,000 and $2,000, but unlike medical insurance where you must meet a deductible before coverage kicks in, with a maximum amount in place, coverage ends when you reach your annual limit.  You are on the hook for any costs that go over the specified amount.

One of the most common full coverage dental insurance plans that is offered is known as 100/80/50 coverage.  Taking the three levels of dental care into account, this means that preventative care is covered 100%, basic care is covered 80%, and major care is covered 50%.

You can also add orthodontic care for an additional cost if you know that braces are in the future for one or more of your family members.  A few plans will let you also add cosmetic care coverage for teeth whitening, bonding, veneers, or bleaching procedures, but in most cases, this is an out-of-pocket expense.

To fund dental procedures that are required immediately but not covered by insurance, many people turn to financing programs that may include personal loans from a lender, practice payment plans set up directly by the dentist, or using a credit card to pay for services.  Each has pros and cons that should be weighed before making a final decision about how to pay for services.

Low Cost Alternatives to Pay for Dental Services

There are a number of options people can tap into if they are either low-income or just trying to save as much money as possible.  Here are some options to consider:

• At dental schools, students work on patients and are supervised by trained dentists. In exchange for giving students much needed experience, you will pay a low cost for appointments even if you have no insurance.  The American Dental Association has a list of dental schools you may be able to visit for services.
• Dental clinics offer a sliding fee scale for patients who pay for services based on income. Some services may also be free.  You can find a local branch from national clinics such as the America’s Dentists Care Foundation if costs are a concern for you.  An online search should also reveal several possible options locally or you can check with your state dental society to see what options they may have.
• With a discount dental plan, you will not need to make monthly premium payments and you can still get discounts on coverage. There are no annual caps or waiting periods for discount plans, but you should comparison shop to see what coverage is right for you.
• If you are a military veteran, the U.S. Department of Veterans Affairs has two dental insurance programs for retired service members and their families. You must enroll in advance and pre-existing conditions are not covered without a waiting period.  Former service members may be eligible for VA dental care under Class IIA, IIC, IV, or I for any necessary treatment to maintain or restore oral health and masticatory function.  The VA Dental Insurance Program is available for enrollment beginning November 15 each year with coverage starting December 1.
• Medicaid covers dental work for some adults and all children. There are no waiting periods for pre-existing conditions.  Families who meet eligibility criteria can enroll at any time but because this program is administered by individual states, coverage will vary depending on where you live.

Can I Get Full Coverage Dental Insurance with No Waiting Period?

Many people assume that once they are covered by dental insurance that most of their dental costs will immediately be covered, minus a small deductible.  Unfortunately, many of those same people get a rude awakening when they find out that most dental insurance plans include a waiting period which means you must wait a specified amount of time before you are covered for services.

The good news is that full dental coverage with no waiting period is available, but chances are there will be some caveats to your coverage.  You need to understand that just because full dental coverage is available, it does not mean that all of your costs are paid for.  Full coverage means that all major services are partially covered, but you will still need to pay some of the costs.

The percentage of coverage generally ramps up over a three-year period.  For example, in the first year of full dental coverage, a plan may cover 20% of the cost of major dental work after you meet your deductible.  In year two, this amount of coverage will increase up to 30% and then to 50% in the third year of coverage. Full coverage dental insurance with no waiting periods generally include a one-time deductible for as long as you are on the plan.

The other thing you need to be aware of when shopping for a plan with no waiting period is that annual maximum coverage amounts may come into play.  This means a plan will pay up to only a certain amount each year, and then the patient will be responsible for all of the overage amounts.  Plans with sliding increases in the percentage of coverage they offer may also increase the maximum annual amount each year as well.  If you are facing large dental expenses, this is a question you may want to ask when you are shopping for a plan.

Although you will still need to pay for a large majority of your dental work with a plan that offers no waiting period, you can still have major work done immediately and save some money in the process.  This may work best for patients who are in immediate need of major dental work such as crowns or dentures, those experiencing a lot of pain or may be missing prominent front teeth that cause them embarrassment, or someone who needs other work done as soon as possible to avoid a dental problem from growing worse and requiring even more costly work done at some point in the future.

Full service dental coverage may also provide exceptional value for parents of students who play contact sports.  Even using mouthguards, it’s not uncommon for high school football, hockey or lacrosse players to sustain blows to their mouths, resulting in lost or chipped teeth.  Waiting six months or more to replace or repair a damaged tooth or teeth is not viable at a time when children are still growing and developing.  Waiting too long can result in permanent damage or speech problems for children of all ages.

If no waiting period is a primary concern for you because you’re in immediate need of having major dental work done, then you do have a couple of options other than full coverage dental insurance.

1. Some people opt for coverage through a Dental DMO. The trade-off is that you are required to use in network providers, but you are typically granted coverage for a wide variety of services.  You simply pay a one-time fee for the service you are seeking with no worries about waiting periods, deductibles or annual maximums.
2. Other patients may choose to purchase a discount dental plan. This is not an insurance plan, but it can offer an affordable alternative when you use in-network dentists.  These types of plans generally charge a one-time annual fee instead of a monthly premium.  Instead of making a payment to an insurance provider, you make payments directly to a dentist.

In all cases, it pays to shop your various coverage options to see which one is right for you.

Can I Get Full Coverage Dental Insurance with No Maximum?

Yes.  In general, two types of dental coverage providers do not have an annual maximum.  They are Dental Health Maintenance Organizations (DHMO) and discount dental plans.

1. Dental Health Maintenance Organization plans require you to choose a primary dentist from the sponsor’s network and you pay a fixed dollar amount for services. Preventative treatments such as cleanings are included in the premiums you pay.

 

2. Discount dental plans entitle you to membership in a group that has negotiated discounted rates with a group of dentists. You pay for the services you receive plus an annual membership to belong to the plan.

Most all major dental insurers offer DHMO or discount plans, but coverage will vary by state.  Check with providers such as Delta Dental, Cigna Dental, Aetna, Humana or Careington to see if you can be covered under their offerings.

Where can I get Full Coverage Dental Insurance?

Many major dental insurers offer full coverage dental insurance.  You will need to decide which type of plan is right for your situation.  Dental plans fall into three main categories:

Indemnity or fee-for-service plans let you pick a provider and your insurer will pay a percentage of the dental provider’s fee.  These plans have the widest variety of choices in providers.  Deductibles will be lower and maximum amounts will be higher. This does mean that premiums will also be higher than with other plans

Preferred Provider Organization (PPO) plans allow you to pay lower fees to see in-network or preferred providers.  You aren’t required to do so, but you will save money by staying in-network.  With a PPO, some procedures may not be covered, or a waiting period will be required before coverage kicks in.  If you want some flexibility in which provider you see and don’t want to pay high premiums then a PPO may work best for you.

Health Maintenance Organization (HMO) plans require you to see providers in their specific insurance network.  Preventative services are covered 100% but basic services will come with some form of co-pay.  Premium payments are generally lower with an HMO.  You may not have a large choice of providers and restorative services will be covered at less than 50% if at all.

The best way to decide what full coverage dental insurance is right for you is to try and anticipate what services you or your family members might need, find out if there is a waiting period, and then shop for the package of benefits that best meets your individual situation.

What is the Best Full Coverage Dental Insurance?

The short answer to this is what ever plan best meets your needs for coverage, price, convenience, quality of service and overall value is the best full coverage dental insurance.

Just like any other important purchase, it pays to do your homework, talk to various providers, and to your friends and relatives to get input to help you decide.

You can also check out various review sites such as Top Ten Reviews which has recently published The Best Dental Insurance of 2018 on its website.

 

 

Urgent care is one of the fastest growing areas of health care, and BayCare has invested heavily in creating a network of BayCare urgent care centers across the Tampa Bay regional area.

BayCare Urgent Care provides preventive care like routine physicals to treatment for more urgent situations like the flu. BayCare locations serve adults and children ages two and older. No appointment is required, and online check-in is available to make it more convenient and fast.

There are many advantages to an urgent care facility versus an emergency room:

1. Less expensive. Generally, your out of pocket costs at an urgent care center will be less, sometimes significantly, than an emergency room.
2. Wait time. You can typically be seen by a provider in a half hour or less.
3. Hours of operation. Urgent care centers are typically open seven days a week, often into the evening hours.
4. Convenience. You can walk in without an appointment.
5. Locations. There are 15 BayCare Urgent Care locations in the Tampa Bay area.

Why is urgent care important?

Urgent care centers were created to handle non-life-threatening situations, thus reducing the stress on emergency rooms so they can concentrate on more serious injuries.

Does insurance cover urgent care?

In most situations, yes. Remember, urgent care is designed to handle non-life-threatening situations. An emergency room is designed and staffed to handle a much wider variety of issues; thus, its costs are often much higher than smaller urgent care centers.

Each Insurance provider decides whether it cover urgent care centers, but most do.

Is it less expensive to use urgent care versus the emergency room?

In most cases, yes. You will have to pay a co-payment or deductible at the time of your visit.

How do I know when to go to urgent care or the emergency room?

The easiest way to think about it is that emergency rooms are designed, staffed and equipped to handle life-threatening situations such as a patient experiencing a heart attack, stroke, broken bones, etc.

Urgent care is designed to handle non-life-threatening situations such as moderate fever, ear aches, flu, cuts and bruises, etc.

When should I go to urgent care versus my doctor?

That’s as great question. In cases where your issue could be treated with medicine, many doctors will prescribe medicine over the phone, saving you both the cost and time of a trip to urgent care.

Following are the BayCare Health System locations and contact information:

BayCare Urgent Care Locations

Clearwater: BayCare Urgent Care (Countryside)

3351 N. McMullen Booth Road
Clearwater, FL 33761

Clearwater: BayCare Urgent Care

711 S. Belcher Road
Clearwater, FL 33764

Haines City: BayCare Urgent Care

36245 U.S. Highway 27
Haines City, FL 33844

Largo: BayCare Urgent Care

13670 Walsingham Road
Largo, FL 33774

New Port Richey: BayCare Urgent Care

4821 U.S. Highway 19
New Port Richey, FL 34652

St. Petersburg: BayCare Urgent Care

2331 Fourth St. North
St Petersburg, FL 33704

St. Petersburg: BayCare Urgent Care (Tyrone)

1599 66th St. North
Saint Petersburg, FL 33710

St. Petersburg: BayCare Urgent Care (St. Pete Beach)

6455 Gulf Blvd.
St. Petersburg, FL 33706

Tampa: BayCare Urgent Care

3440 W. Dr. Martin Luther King, Jr. Blvd
Suite 100
Tampa, FL 33607

Tampa: BayCare Urgent Care

1155 S. Dale Mabry Highway
Tampa, FL 33629

Tampa: BayCare Urgent Care (Town ‘n’ Country)

6909 W. Waters Ave.
Tampa, FL 33634

Tampa: BayCare Urgent Care (Carrollwood)

11921 N. Dale Mabry Highway
Tampa, FL 33618

Tampa: BayCare Urgent Care (New Tampa)

17512 Dona Michelle Drive
Suite 5

Tampa, FL 33647

Valrico: BayCare Urgent Care

2016 State Road 60 East
(In front of LA Fitness)
Valrico, FL 33594

Winter Haven: BayCare Urgent Care

400 First St. North
Winter Haven, FL 33881

 

Every senior is going to experience some degree of a drop-off in their eyesight as they grow older. But the good news is that through lifestyle choices, regular check-ups and maintaining a watchful eye on your eyes, you can enjoy a life in focus for many years after you turn 65.

How to Keep Your Eyes Healthy

One of the easiest ways to maintain your eye’s health is through diet. You should eat foods that are rich in antioxidants such as vitamins A and C, which can be found in fish and leafy green vegetables. When you don’t get enough antioxidants or you over consume saturated fats, free radical reactions can take place, potentially harming the macula. Just as elsewhere in the body, when you eat a diet of high-fat foods, this can constrict the blood vessels around the eye, possibly leading to serious vision issues.

Other lifestyle choices can affect your vision, too. If you smoke, quit. Aside from all the other documented health problems that come with smoking, it also exposes your eyes to higher than normal degrees of oxidative stress, increasing your risk of things that can harm the health of your eyes.

Another important choice that affects your eyes is exercise. Exercise improves blood circulation and that improves the amount of oxygen that goes to your eyes. Making sure you wear sunglasses to protect your eyes from UV rays when you are outside and being mindful of taking breaks and setting your computer up for optimal eye health are two other ways to help ensure healthy eyes.

Reasons to Visit Your Optometrist

On top of the health benefits, having healthy eyes can also help with lower premiums or deductibles whether that be in your life insurance policy or health coverage. For these reasons, you shouldn’t be afraid to visit the optometrist for regular check-ins. Additionally, there are several things you should be on the look out for in between visits to the optometrist:

Cloudy eyes – this is one of the best indications that cataracts may be forming on one or both of your eyes. Cataracts remain the leading cause of vision loss among seniors in the United States. Surgery remains the most effective way to treat cataracts.

Blurring or the onset of tunnel vision – the loss of peripheral vision, nausea, halos around lights or blurred vision are indications of glaucoma. Glaucoma results from increased pressure on the eye cavity that creates nerve damage. Although there is no cure, medications and surgeries can slow its progression.

Spotting – fatty deposits that build up under eyelids resulting in spots could be an indication of high blood lipids. High blood lipids may indicate the presence of diabetes, high cholesterol or even cancer. If you notice spots, you should schedule an examination as soon as possible.

Yellowish eye hue – hepatitis, cirrhosis and gallbladder problems may result in the production of too much bilirubin, a brownish-yellow compound that is produced by the liver when it attempts to break down red blood cells.

Unable to close and eye or excessive watering – these symptoms are an indication of Bell’s palsy which is a temporary paralysis on the side of a face. Bell’s palsy generally clears up in about 10 days, but you should visit a doctor to rule out anything more serious.

Dark and blurry spots – when a small and central portion of a person’s retina begins to fail, age-related macular degeneration may be at fault. Although it is not painful, there is no cure, but doctors can sometimes prescribe treatments to slow the progression.

Bulging eyes – this is an indication of an overactive thyroid, also known as Graves’ disease. Doctors can treat this condition with medication or surgery.

The presence of a stye – if a small and red bump appears on your eyelid and does not go away, this could mean cancer is present.

According to the 2010 Census, there were more than 50,000 people living in the United States who were at least 100 years old. That represents a significant jump in centenarians from previous generations. Although many have ailments commensurate with their age, surprisingly, many are still fully functioning adults. About one-third still live at home and roughly one in four were described as “cognitively intact.”

That bodes well for seniors who have set living to 100 as a goal, because maintaining a good quality of life makes all the difference in the world.

While some of living a very long life is tied to genetics, and another part is just good old fashioned luck, there are several things youngsters who have just reached 65 can do to improve their odds of seeing 100 candles on their birthday cakes.

Steps To Get There

Eat right. May sure your diet is rich in fruits and vegetables.

Don’t forget the nuts. Nuts in general, and walnuts, in particular, offer a variety of life-extending health benefits.

Exercise. More is better. Target workouts for five days a week if possible. On top of mental benefits, exercise and avoiding obesity can help you avoid a variety of other problems that can often shave years off someone’s life. Jack LaLanne, who passed away at 96 was once quoted as saying “Exercise is king. Nutrition is queen. Put them together and you have a kingdom.”

Spend time with a hobby. Doing what you love reduces stress and gives you a sense of accomplishment.

Laugh. Find a reason to do it often. It really is the best medicine.

Go shopping. Even if you don’t buy anything, the ritual of going out into a retail environment can lower the risk of death by about 25% for men and women.

Get cooking. People who cook at home at least five nights a week have a higher propensity to live longer.

Practice yoga. It’s not for everybody, but it does improve your longevity.

Practice optimism. When you see the glass as half full instead of half empty, your optimism will translate into a more outgoing and easy way of life.

Marriage is the best medicine. Married couples tend to live longer according to a Duke University Medical Center study.

Make it a happy marriage. The more arguments you have with your spouse, the more likely your health will suffer.

Brush. And floss. Good dental hygiene reduces risk for heart disease, strokes and dementia.

Don’t smoke! This one is so obvious it barely needs to be stated. One study showed that women who smoked and gave it up lived as much as ten years longer than their counterparts who continued with the habit.

Become a parent. Contrary to what some folks might think on those days when you want to pull your hair out as a mother or a father, being a parent can actually extend your life.

Get smart. Staying in school to get at least a high school diploma will help you live longer according to a Harvard University study.

Go to church on a regular basis. It can add up to three years to your life expectancy.

Volunteer. When you give your time to help someone else, it may actually be you who benefits by living a longer and more purposeful life.

Make some whoopee. Having sex two to three times a week may reduce the chance of heart disease by as much as 45 percent for men. Women who have sex on a regular basis may live as much as eight years longer than those who do not.

Drink coffee. It’s rich in antioxidants, but the trick is to keep your consumption to four cups or less a day.

How does your garden grow? – Gardening is a calming activity that can also give you a great source of delicious home grown vegetables.

Turn off the tube. Research from The University of Queensland, Australia showed that every hour of television watched after age 25 reduced a person’s life by 22 minutes. That can really add up, especially during football season!

As you grow older and approach the age of Medicare enrollment, your body changes in many ways. Because of this, how your body processes food also changes, and this will have an impact on your diet, nutritional needs, and your appetite.

Metabolism Changes

It’s no secret that growing older means your metabolism is going to slow down. When your metabolism slows down, you don’t burn as many calories as quickly as you did before, and that means you don’t need to eat as much to maintain a healthy weight. A lack of exercise causes your metabolism to slow down even more than it might otherwise, also contributing to the need to eat less.

To compensate for a slowing metabolism and the need to eat less food, as you age you should begin to shift to a diet that is as nutrient-rich as possible. It’s estimated that men with average activity levels will need about 2,300 calories daily, while women will need about 1,800 calories to maintain a healthy weight. If you get little exercise or are housebound due to illnesses or other health related issues, then that sedentary lifestyle means you need even fewer calories.

As your metabolism changes, your digestive system also changes as well. When you grow older, your body produces less of the fluids you need to process food in your digestive system. This means that it is more difficult for your body to absorb nutrients such as folic acid, vitamins B12 and B6 and others, that are critical for your optimum health. Because of this, you need to increase your intake of these nutrients to make sure you get the same levels of them as when you were younger.

Digestive Changes

Other digestive problems that increase as you age may include chronic gastritis, constipation, gas or sour stomach issues. Many times, this may cause seniors to avoid healthy fruits and vegetables, increasing the likelihood of malnutrition. Taking medications can cause an appetite to be depressed or it can result in a chronic upset stomach, both of which can also lead to malnutrition.

Another food challenge seniors face is that as the body ages, changes take place in taste and smell. A common complaint among seniors is that food does not taste the same or as good as it did in the past. The decrease in the functioning of taste buds means that the taste for salty and sweet also decreases, and many times that can make food taste more sour and bitter. The loss of smell also means that there is less anticipation and satisfaction when choosing foods, sometimes contributing to poor food choices.

Dental Issues

A common but frequently overlooked health problem that contributes to nutrition issues in seniors are dental issues. When teeth can wear out, become hyper-sensitive, or are removed, it can lead to seniors avoiding certain types of hard or sticky foods. Dentures that don’t fit right or that produce pain in gums also make it difficult to enjoy food, which can lead to not eating properly or sometimes, not at all.

Psychological and Social Issues

Psychological and social issues can come into play as a person ages, and they definitely impact nutrition. Seniors who are depressed or lonely often times lose interest in eating. In some cases, just the opposite is true, and a senior may seek solace in food and eat too much, putting on many unwanted pounds.

Malnutrition may also come about as the result of:

• A loss of a spouse or other family member
• Financial concerns and the ability to afford food
• The inability to go grocery shopping due to health or psychological issues
• Hospitalization which changes a senior’s diet and adds stress, resulting in a rejection of food.

Many nutrition issues can be minimized with the creation of a nutrition plan, either with the help of a trained dietician or self-administered after doing appropriate research.