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Congratulations!  You made it.

Turning 65 is a big deal and you should feel great about reaching such a big milestone in your life.

You’ve earned the right to relax and enjoy the fruits of your labors, whether your time has been spent raising a loving family, enjoying success in your chosen profession, or living in a home and place of your dreams.

Or, all of the above!

One of the biggest benefits of turning 65 is that you’re now eligible for Medicare.  That alone should be cause for celebration since one of the challenges seniors face is how to pay for medical treatment at a time in their lives when healthcare may matter the most.

Everyone is already familiar with Medicare to some degree or another.  We’re here to help you fill in any holes about what it is, how to qualify and get coverage, and some special situations and benefits you need to know that might apply to you.

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older and citizens or permanent residents of the United States, certain people younger than 65 with disabilities, and those with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD, permanent kidney failure requiring dialysis or a transplant).

Medicare has four parts:

  1. Medicare Part A covers medically necessary inpatient hospital stays, care in skilled nursing facilities, hospice care and some home health care.
  2. Medicare Part B covers certain doctors’ services, durable medical equipment (i.e. wheelchairs), preventative care, outpatient services, lab tests and x-rays, and ambulance services.  Part A and Part B are often referred to as Original Medicare.
  3. Medicare Part C is also known as Medicare Advantage and is a health plan offered by private insurance companies approved by Medicare to provide Part A and Part B benefits under one plan. Some people choose to get Medicare coverage through a Medicare Advantage plan instead of through Original Medicare. Medicare Advantage plans must offer the same level of coverage as Original Medicare and many times will offer expanded benefits such as prescription drug coverage and dental, vision and wellness programs.
  4. Medicare Part D provides stand-alone prescription drug coverage that works alongside Original Medicare. It is offered through private insurance companies that have contracts with Medicare.

What are the Medicare eligibility requirements?

Part A

If you are 65 or older, you are eligible for Part A coverage at no cost if:

  • You currently receive or are eligible to receive Social Security benefits. You must have 40 credits accumulated through the payment of payroll taxes.  You earn one credit for every quarter you have worked as long as you meet minimum income guidelines.  In other words, 40 credits equals 10 years of a qualifying work history.  If you have less than 40 credits, then you can still get Part A coverage, but you will need to pay a premium.
  • You currently receive or are eligible to receive railroad retirement benefits.
  • Your spouse receives or is eligible to receive Social Security or railroad retirement benefits. This applies to spouses who are living, deceased or divorced from the person seeking coverage.
  • You or your spouse worked long enough in a government job where Medicare taxes were paid.
  • You are a dependent parent of a deceased child who is fully insured.

If you are less than 65 years old, you are eligible for Part A coverage at no cost if:

  • You have received or you have been entitled to receive Social Security disability benefits for 24 months.
  • You are getting a railroad retirement board disability pension and you meet certain conditions.
  • You get Social Security disability benefits because you have ALS (Lou Gehrig’s disease).
  • You worked in a government job long enough where you paid Medicare taxes, and you have been entitled to receive Social Security disability benefits for at least 24 months.
  • You have kidney failure and you receive dialysis or a kidney transplant, and you meet other certain requirements.
  • You’re the child or widow(er) and you are age 50 or older of someone who worked in a government job long enough where they paid Medicare taxes, and you meet Social Security disability program requirements.

Part B

If you are eligible for Part A coverage at no cost, you’re eligible to enroll in Part B coverage by paying a monthly premium.  Some people with higher incomes will pay a higher Part B premium.

If you’re not eligible for Part A at no cost, you can still buy Part B without buying Part A if you’re 65 or older and a United States citizen or a lawfully admitted noncitizen who has lived in the country for at least five years.

Part C

Part C coverage is offered by private companies, with benefits that are similar to those offered by Medicare that may provide extra coverage and lower out-of-pocket costs.  If you have Medicare Part A and Part B coverage, then you can buy Part C coverage.  Once you have reached the coverage limits that Medicare covers, you will be entitled to enhanced benefits under a Medicare Advantage Plan. Read more about part C plans here.

Part D

If you have Part A and Part B coverage, then you’re eligible to buy Part D coverage.  Part D coverage benefits are available as a stand-alone plan or they may be part of a Medicare Advantage Part C plan.  Depending your income level, this premium may be higher for some people.

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How does Medicare differ from Medicaid?

People often confuse Medicare with Medicaid, so it’s important to clear up any misunderstandings about what each program is.  The main difference between the two is that Medicare is an insurance program and Medicaid is an assistance program.

Medicare helps people pay medical bills from funds they have paid over the course of their working life. For the most part, Medicare serves people 65 or older, with some exceptions for younger disabled and dialysis patients. Premiums are many times required for certain parts of Medicare. It is a federal program and is uniformly administered across the United States.

Medicaid has no age restrictions and serves people of all ages based on income. Generally, patients are not required to pay any costs for medical services, except in a few limited circumstances.  Medicaid follows federal guidelines, but it is administered by state and local governments.

What is Medigap insurance?

Medigap is a supplemental insurance policy sold by private companies that helps pay for some health care costs not covered by Original Medicare.  This can include copayments, coinsurance, and deductibles.

Unlike Medicare, Medigap policies cover medical care when you travel outside the United States.  To qualify for a Medigap policy, you must already be enrolled in Medicare Part A and Part B.

When Can You Enroll in Medicare after turning 65?

If you do not have a qualifying disability or medical condition that allows you to enroll in Medicare before you turn 65, then you can enroll in Medicare when you turn 65.

If you already get Social Security or railroad retirement benefits, you will be contacted about three months before you turn 65. If you live in one of the 50 states, Washington, D.C., the Northern Mariana Islands, American Samoa, Guam or the U.S. Virgin Islands, you will automatically be enrolled in Parts A and B. Because you have to pay a premium for Part B, you will be given the opportunity to opt out of that coverage.

If you are not already getting Social Security or railroad retirement benefits, you can enroll in Medicare during the Initial Coverage Election Period.  This will allow you to avoid paying penalties or a being subjected to a gap in your health care coverage.

The Initial Coverage Election Period is a seven-month period beginning three months before the month you turn 65 and ending three months after your 65th birthday.

It’s important to note that you can sign up for Medicare coverage even if you don’t plan on retiring when you turn 65.

You can also apply for Medicare before you turn 65 if:

  • You’re a disabled widow(er) between 50 and 65.
  • You work for the government and became disabled before turning 65
  • You or an immediate family have permanent kidney failure
  • You had Part B coverage in the past but dropped the coverage
  • You turned down Medicare Part B coverage when you first got Medicare Part A coverage
  • You or your spouse worked for the railroad industry.

If you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance annually during a “general enrollment period” that takes place January 1 through March 31. Your coverage begins on July 1 of the year you enroll.  Be aware that you may have to pay a late enrollment penalty for as long as you have Part B coverage. Your monthly premium will go up 10% for each 12-month period you were eligible for Part B but didn’t sign up for it.

If you are in a Medicare Advantage plan and want to switch to Original Medicare, you can do so between January 1 and February 14.   If you do switch, you will also have until February 14 to join a Part D plan as well. Your coverage begins the first day of the month after your enrollment form is received.

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Be prepared for an enormous amount of mail.

What kind of mail should you expect to receive?

If you are eligible for Medicare when you turn 65, you should get a “Welcome to Medicare” packet and a Medicare card in the mail from the Social Security Administration about three months before you turn 65.

If you aren’t collecting retirement benefits yet, then you’ll need to contact Social Security to apply for Medicare.  You should do this about three months before you turn 65, otherwise you will not be enrolled in Medicare in a timely manner.  After you have enrolled you will get a “Welcome to Medicare” packet that will include your Medicare card.

What do I need to know about how to use my Medicare card?

You should carry your Medicare card on you so that when you need medical services, you can produce it just like you would for other forms of insurance.  Only give your Medicare card and information to medical providers such as doctors’ offices, hospitals, pharmacists or other health care providers that you trust.  If you forget or lose your card, a health care provider may be able to look up your Medicare number and information online.

If you lose your card or can’t use it anymore because it is damaged, you can get a replacement card by providing your name, Social Security number and your date of birth to the Social Security Administration.  You can do so online by using your “my Social Security” account if you have one (if you don’t, you can also create one).

If you have a Medicare Advantage plan, you will be given a separate card that will be used for the services offered by your plan.  Be sure to present the right card when you are being treated so that the right program can be billed for services.

In April 2018, Medicare began mailing new Medicare cards to more than 57 million participants as part of a fraud and identity theft prevention strategy.  New cards do not have Social Security numbers on them.  Instead they have a unique 11-digit callout known as a Medicare Beneficiary Identifier, or MBI.  This serves as a beneficiary’s Health Insurance Claim Number (HICN) instead of the previously used Social Security number.  The deadline for replacing all Medicare cards must take place by April 2019.  There will also be a 21-month transition period that will run through December 31, 2019.  Providers will be able to use either the MBI or the HICN.

How can I enroll in Medicare?

If you are not automatically enrolled, then there are three ways to apply for Medicare Parts A and B:

  • Visit Social Security’s website
  • By phone. Call Social Security’s national customer hotline at 1-800-772-1213.
  • In person. Visit your local Social Security office.  Use the agency’s locator tool to find the office nearest to you.

To apply for a Medicare Advantage plan (Part C or D) or a Medigap plan, you can visit the provider’s website or call the provider that offers the plan you want to buy.  You can also contact the provider and get a paper enrollment form and return it by mail.  All plans are required to offer a paper enrollment option.

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How do I get more information about Medicare enrollment and programs for people turning 65.

To learn the steps you need to take to enroll in the various Medicare programs, go to www.medicare.gov.

If you have questions about Medicare, you can also call 1-800-MEDICARE (1-800-633-4227) to speak to a live customer service representative 24 hours a day, 7 days a week.  If you are hard of hearing or deaf, call Medicare’s TTY number at 1-877-485-2048.

How do I verify if I am eligible for free Medicare at age 65?

You are eligible for premium-free Part A coverage at age 65 if you or your spouse worked and paid Medicare taxes for at least 10 years.  You get premium-free Part A if you are already getting retirement benefits from Social Security or the Railroad Retirement Board or if you are eligible to get Social Security or Railroad benefits, but you have not yet filed for them.  You can also get premium-free coverage if you or your spouse had Medicare covered government employment.

Keep in mind that while many people get free Part A benefits, everyone who wants Part B coverage must pay for it. You must also pay a monthly premium for Part C and Part D coverage in addition to your Part B monthly premium.

Medicare has an eligibility and premium calculator that you can access here to see if you qualify for free Part A coverage.

Does Medicare start the month you turn 65?

If you sign up for coverage during the first three months of your Initial Enrollment Period, then your coverage starts the first day of the month you turn 65, unless your birthday is on the first day of the month.  If your birthday is on the first day of the month, your coverage starts the first day of the prior month.

If you have to buy Part A coverage, the coverage start dates are a bit different.

If you sign up for Part A (if you have to buy it) and/or Part B in this month: Your coverage starts:
The month you turn 65 1 month after you sign up
1 month after you turn 65 2 months after you sign up
2 months after you turn 65 3 months after you sign up
3 months after you turn 65 3 months after you sign up
During the January 1–March 31 General Enrollment Period July 1

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Do I have to sign up for Medicare Part A at age 65?

No.  But if you do not sign up during the Initial Enrollment Period your health care coverage may lapse.  In addition, if you sign up at a later date, you may have to pay additional penalties for the duration of the time that you are signed up.

Do I sign up for Medicare Parts A, B, C, and D at the same time?

No, but you do need to already be signed up for Parts A and B before you can sign up for Parts C and D.

How do I shop for Medicare plans online?

You need to be careful when shopping for Medicare plans online.  Charges can vary widely from plan to plan and from market to market.  In a recent Consumer Reports article investigating Part D drug plans, the watchdog found that mistakes in the sign-up process could cost beneficiaries hundreds of dollars a year.  Their advice based on the input of an industry expert was this:

“Complicated though it may be, using the Medicare.gov tool is still the only way for you—or someone helping you—to compare Medicare plans, says Frederic Riccardi, vice president of client services for the nonprofit Medicare Rights Center, which helps people sign up for plans.”

There is a wealth of other information out there that you may also tap into as well.  The best of this may be The State Health Insurance Assistance Programs (SHIP), a national network that provides trustworthy, unbiased and one-on-one counseling and assistance for individuals and families who are seeking help with Medicare insurance plans.

Another smart move is to work with a local independent agent in your area.  In addition to being licensed to sell insurance in a specific state, an agent must also pass an annual American Health Insurance Plans (AHIP) certification exam to sell Medicare plans.  Agents are required to demonstrate specialized Medicare knowledge to pass the exam.

Are there benefits to buying a Medicare plan from a local agent?

Absolutely.

Available Medicare plans vary by market and metro area, so having a local expert working for you gives you the best opportunity to compare the pros and cons of plans that you can actually purchase.  An agent’s expertise is also further bolstered by the fact that agents who sell Medicare plans are also required to go through additional training and must get a special certification each year to be able to sell Medicare products.

Your best move is to work with an independent agent who represents many companies that sell Medicare plans in your area.  By contrast, a captive agent will only represent one or two plans, and this may be the right resource to use if you know exactly what plan you want.  You could probably track down the same information on your own, given enough time but with a lot more effort.

Using an agent means they’re doing the heavy lifting and helping you to narrow down choices efficiently so you not only save time, but money as well because you won’t be spending your hard-earned dollars on options you may not need.

Am I covered by Medicare if I travel outside of the United States?

Medicare covers beneficiaries when they are physically located in the 50 U.S. states, District of Columbia, and U.S. territories that include Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

In rare cases, Medicare Part A may cover medically necessary services in a foreign country when a foreign hospital is closer than a U.S. facility. You can learn about these exceptions here.

In some cases, Medicare Part B may cover medically necessary health care while on board a cruise ship within the territorial waters adjoining the U.S. Generally, Medicare won’t pay for services you get when a ship is more than six hours away from a U.S. port.  Medicare drug plans don’t cover prescription drugs you buy outside the U.S.

If you have a Medicare Advantage plan, you should check to see if it covers medical care abroad. Otherwise, it is recommended to purchase travel insurance before your trip, which can help to offset the costs of overseas emergency care if it’s needed.

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A few things to know about Medicare if you’re turning 65 and still working

If you still plan to work at age 65 and beyond, your relationship and coverage by Medicare will vary depending on your employer.  At the very least, you should still enroll in Medicare Part A because it’s free and it may help cover some of the costs not covered by your employer’s group insurance plan.

You may not need to sign up for Part B right away.  This will depend on whether or not your employer’s health insurance is your primary provider or if Medicare Part B will be your primary provider.  If Medicare is your primary provider, then you should sign up for Part B immediately.  Your employer should be able to tell you who your primary provider will be.

If you continue working and don’t have an employer or union group health plan, or it is secondary to Medicare, your best bet is to sign up for Medicare Part B during your Initial Enrollment Period.

Also, just because you have some form of health insurance coverage, it does not mean you should not sign up for Part B.  For example, COBRA coverage does not count as a health insurance plan for Medicare purposes, nor does retiree or VA benefits.  Your health insurance must be from an employer where you are currently actively working.  And, if your employer has less than 20 employees, you will probably still need to sign up for Part B to make sure you have adequate health coverage.

If you’re looking for more information…

Here’s some additional resources you might want to access for more information about signing up for Medicare.

Checklist: Things to do when you turn 65

Enrolling in Medicare is one of the most important and essential things you can do when you turn 65, but there are lots of other things to think about when you reach this milestone.

To retire or not to retire?  That is the question.  Most everything else you do plays off this critical decision.  Chances are you already know what you’re going to do but understanding what the implications are is just as important and may require you to do some homework before reaching a final decision.

Your Social Security strategy.  Do you want to retire at full retirement age or start drawing reduced benefits at an earlier age?  Or, can you want until after full retirement age (up to age 70) to draw even more benefits?

Consider downsizing.  If you haven’t done so already, consider downsizing to a smaller place to live.  Start by decluttering and be unmerciful in deciding to keep only the items that are most precious to you.  Maybe you want to live closer to your children or grandchildren, enjoy a warner climate or pay less in living expenses.  There are a number of reasons to make the move to simpler digs and now is a good time to assess your needs and desires.

Stay healthy.  It sounds obvious, but are you ready to give up smoking or limit your alcohol and food intake?  What about losing weight and exercising more?  Are you making plans to also have an active social life as well? Your body is more vulnerable as you age and to get the most out of your senior years, you must do everything you can to remain as healthy and independent for as long as possible.

Are your legal documents in order?  Do you have a will, a living trust and an advanced healthcare directive in place?  What about a designated power of attorney when you can’t make decisions for yourself?  Not having these documents in place could cost you dearly at the time you and your family need them the most.

Don’t forget about life insurance.  Do you have the right kind and right amount of life insurance for your family’s needs?  Just like going to a doctor for a check-up, you should schedule a time with your insurance agent to do a review of your coverage.

Are your retirement and pension accounts in order?  Have you allocated funds in a more conservative manner consistent with what you should be doing for your age?  Are you maximizing your catch-up contributions?  Have you thought about budgeting with the income you’re going to get in retirement?

Get a comprehensive physical.  It’s easy to let this go, especially if you don’t have any nagging or persistent health problems.  But just like a good car with a lot of miles on it, you need to take preventative steps on a regular basis to catch health issues early.

The “end-of-life” conversation.  As uncomfortable as it may be, you can actually save your spouse and your children a lot of anxiety by letting your end-of-life wishes be known before they become an issue.  Have this difficult conversation now so that you can focus on enjoying your long and happy golden years.

Don’t wait on that bucket list.  If you’ve made it to 65, you’ve earned the right to be good to yourself.  Many people who lead a frugal life find it hard to cut loose and enjoy things they have held off from doing or buying for all of their lives.  If you can afford it, take that vacation to Paris and London or buy that Corvette you always wanted.  When health problems overtake the plus-65 crowd, this can lead to a lot of regrets instead of being satisfied that they’ve led a great life with many wonderful memories.

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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.

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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BayCare Plus Medicare Advantage Plans Include Silver Sneakers

Yes, I would like to speak with an agent about BayCarePlus Medicare Advantage

Silver Sneakers is offered in more than 193 locations across the Tampa, FL area.  If you’re currently a silver sneakers member, you can simply choose the Silver Sneakers location near you in Tampa and start using your gym membership.

What Gyms Accept Silver Sneakers in Tampa, FL?

We compiled 193 Silver sneakers locations in Tampa, FL and the surrounding cities such as St. Petersburg and Clearwater.

 

Silver Sneakers St. Petersburg, FL

Below are 13 Silver Sneakers locations in St. Petersburg, FL

Oldsmar Senior Center

Address: 400 St. Petersburg Dr. E, 34677

Cardio and Strength
Schedule: Wednesday (10:00 AM), Friday (10:00 AM) Instructor Name: Carter Mayzik
Instructor Phone: (727) 614-2738

LA Fitness – St. Petersburg @ 4th St. N.

Phone: (727) 521-1500 Address: 5900 4th St. N., 33703

Anytime Fitness – St. Petersburg, FL

Phone: (727) 502-9100 Address: 900 Central Ave., 33705

Anytime Fitness – St. Petersburg, FL

Phone: (727) 388-9766 Address: 3725 49th St. N., 33710

Jim and Heather Gills YMCA of Greater St. Petersburg

Phone: (727) 328-9622 Address: 3200 1st Ave. S., 33712

YMCA of Greater St. Petersburg – Bardmoor Branch YMCA

Phone: (727) 394-9622 Address: 8495 Bryan Dairy Rd., 33777

Planet Fitness – St. Petersburg

Phone: (727) 826-0976 Address: 5335 66th ST. N., 33709

Youfit – St. Petersburg-9th Ave. N

Phone: (727) 209-6100 Address: 6157 9th Ave. N., 33710

LA Fitness – St. Petersburg – 22nd Ave. N.

Phone: (727) 322-4010 Address: 7044 22nd Ave. N., 33710

Anytime Fitness – St. Petersburg, FL

Phone: (727) 388-1314 Address: 4055 Tyrone Blvd., Bldg. B, 33709

Anytime Fitness – St. Petersburg, FL

Phone: (727) 864-0333 Address: 4949 34th St., S., 33711

Anytime Fitness – St. Petersburg, FL

Phone: (727) 345-1213 Address: 6800 Gulfport Blvd. S., 33707

Anytime Fitness – St. Petersburg, FL

Phone: (727) 954-3492 Address: 10660 Gandy Blvd N., 33702

BayCare Plus Medicare Advantage Plans Include Silver Sneakers

Yes, I would like to speak with an agent about BayCarePlus Medicare Advantage

 

Silver Sneakers Clearwater, FL

There are 10 Silver Sneakers locations located in Clearwater, FL

The Hamptons at Clearwater

Address: 1099 N McMullen Booth Rd, 33759
Zumba Gold(R)
Schedule: Thursday (5:30 PM) Instructor Name: Lena Redding Instructor Phone: (201) 563-5798

Anytime Fitness – Clearwater, FL

Phone: (727) 712-1575 Address: 2522 N. McMullen Booth Rd., Ste. B, 33761

Planet Fitness – Clearwater

Phone: (727) 201-8392 Address: 11141 US Hwy. 19 N., 33760

Curves – Clearwater, FL – Southeast

Phone: (727) 536-6910 Address: 1488 S. Belcher Road, 33764

LA Fitness – Clearwater – U.S. Hwy. 19

Phone: (727) 791-0980 Address: 21750 U.S. Hwy. 19 N., 33765

Anytime Fitness – Clearwater, FL

Phone: (727) 781-2222 Address: 30210 US Hwy. 19 North, 33761

YMCA of the Suncoast – Clearwater Branch YMCA

Phone: (727) 461-9622 Address: 1005 S. Highland Ave., 33756

Anytime Fitness – Clearwater, FL

Phone: (727) 330-7664 Address: 1595 S. Highland Ave., 33756

Anytime Fitness – Clearwater, FL

Phone: (727) 216-6378 Address: 701 Cleveland St., 33755

Clearwater Beach Library & Recreation Facility

Phone: (727) 462-6138 Address: 69 Bay Esplanade, 33767

BayCare Plus Medicare Advantage Plans Include Silver Sneakers

Yes, I would like to speak with an agent about BayCarePlus Medicare Advantage

Silver Sneakers in Tampa

Crunch Fitness – Channelside

Phone: (813) 443-9102 Address: 1120 E Kennedy Blvd, 33602

Central City Family Branch YMCA

Phone: (813) 229-9622 Address: 110 E. Palm Ave., 33602

Anytime Fitness – Tampa, FL

Phone: (813) 749-0420 Address: 2905 W. Kennedy Blvd., 33609

Jewish Towers

Address: 3001 W De Leon St, 33609

Revello Medical Center – Himes Ave

Address: 2601 N. Himes Ave, 33607

Schedule: Monday (11:15 AM), Thursday (11:15 AM) Instructor Name: Zakeia Smith
Instructor Phone: (610) 453-4017

LA Fitness – Tampa – S. Dale Mabry Hwy.

Phone: (813) 775-6492 Address: 301 S Dale Mabry Hwy., 33609

Crunch Fitness – South Tampa

Phone: (813) 284-7777 Address: 4055 S. Dale Mabry, 33611

South Tampa Family YMCA

Phone: (813) 839-0210 Address: 4411 S. Himes Ave., 33611

Youfit – Tampa-Hillsborough Ave.

Phone: (813) 849-4700 Address: 3916A W. Hillsborough Ave., 33614

Crunch Fitness – Hillsborough

Phone: (813) 563-6568 Address: 4340 W. Hillsborough Ave., Ste 600, 33614

FlavaFitness Studio

Phone: (813) 413-6457 Address: 3744 W. Lambright St., Ste. B, 33614

Planet Fitness – Tampa (Florida Ave.)

Phone: (813) 444-9955 Address: 210 W. Waters Ave., 33604

Youfit – Tampa-Gandy Blvd.

Phone: (813) 675-8888 Address: 4465 W. Gandy Blvd., 33611

Pearlena’s Adult Activity Center

Phone: (813) 270-1388 Address: 9309 N. Florida Ave., Ste. 101, 33612

Gold’s Gym Tampa

Phone: (813) 935-2639 Address: 3689 W. Waters Ave., 33614

Caltas 24/7 Fitness

Phone: (813) 882-4103 Address: 4913 W. Waters Ave., 33634

Humana Neighborhood Location – Tampa – Dale Mabry

Address: 10037 North Dale Mabry Hwy, 33618
Cardio
Schedule: Tuesday (10:00 AM) Instructor Name: Sandra Salvione Instructor Phone: (813) 765-1457

Anytime Fitness – Temple Terrace, FL

Phone: (813) 425-5000 Address: 9225 N. 56th St., 33617

Revello Medical Wellness – Lake Carrol Way

Address: 10213 Lake Carroll Way, Ste D, 33618
Cardio and Strength
Schedule: Tuesday (11:15 AM) Instructor Name: Zakeia Smith Instructor Phone: (610) 453-4017

Youfit – Tampa-Fowler Ave.

Phone: (813) 341-1500 Address: 1104B E. Fowler Ave., 33612

Anytime Fitness – Tampa, FL Northdale

Phone: (813) 264-1861 Address: 11113 N. Dale Mabry Hwy., 33618

Omar K Lightfoot Recreation Center

Phone: (813) 506-6630 Address: 10901 N. 56th St., 33617

Shapes Fitness for Women – Temple Terrace

Phone: (813) 989-1676 Address: 11301 N. 56th St., 33617

Revello Medical Center – Webb Road

Address: 5901 Webb Rd, 33615

Cardio and Strength

Schedule: Tuesday (10:00 AM), Thursday (10:00 AM) Instructor Name: Zakeia Smith
Instructor Phone: (610) 453-4017

Anytime Fitness – Tampa, FL

Phone: (813) 886-9747 Address: 8424 W. Hillsborough Ave., 33615

Zone Fitness Club – Tampa

Phone: (813) 515-4181 Address: 4802 Gunn Highway, 33624

Youfit – West Brandon-Brandon Town Center

Phone: (813) 712-7800 Address: 322 Brandon Town Center Dr., 33511

Planet Fitness – Fowler

Phone: (813) 898-8993 Address: 5681 E. Fowler Ave., 33617

LA Fitness – Brandon

Phone: (813) 685-9160 Address: 2890 Providence Lakes Blvd., 33511

Planet Fitness – Waters

Phone: (813) 999-4980 Address: 7310 W. Waters Ave., 33634

Northwest Hillsborough Family YMCA

Phone: (813) 249-8510 Address: 8950 W. Waters Ave., 33615

Fitness for 10

Phone: (813) 654-6568 Address: 1903 W. Lumsden Blvd., 33511

Anytime Fitness – Riverview, FL

Phone: (813) 269-8463 Address: 10875 Bloomingdale Ave., 33578

LA Fitness – Tampa – Gunn Hwy.

Phone: (813) 960-3783 Address: 5735 Gunn Hwy., 33625

Youfit – Carrollwood-Dale Mabry Hwy.

Phone: (813) 284-2064 Address: 14350 N. Dale Mabry Rd., 33618

Fitness 360 Westchase

Phone: (813) 513-2967 Address: 10031 West Hillsborough Ave, 33615

Tampa Family Fitness

Phone: (813) 968-6088 Address: 14968 North Florida Ave, 34613

The Worx 24 Hr Fitness Magnolia Park

Phone: (813) 324-8827 Address: 9050 Progress Blvd , 33578

Florida Blue – Tampa – Carrollwood

Address: 15030 N. Dale Marby Hwy, 33618

Dance – Line Dancing
Schedule: Thursday (10:00 AM) Instructor Name: Sandra Soule Instructor Phone: (813) 239-4090

Anytime Fitness – Brandon, FL

Phone: (813) 409-2000 Address: 501 W. Brandon Blvd., 33511

Crunch Fitness – Tampa Palms

Phone: (813) 579-3692 Address: 15313 Amberly Dr., 33647

LA Fitness – Tampa – W. Hillsborough Ave.

Phone: (813) 814-1414 Address: 11252 W. Hillsborough Ave., 33635

Tampa Jewish Community Center

Phone: (813) 264-9000 Address: 13009 Community Campus Dr., 33625

Crunch Fitness – Carollwood

Phone: (813) 304-2491 Address: 15798 N. Dale Mabry Hwy., 33618

The MAC at First Baptist Church of Brandon

Phone: (813) 315-3280 Address: 216 N. Parsons Ave., 33510

Anytime Fitness – Tampa, FL

Phone: (813) 792-2900 Address: 9602 W. Linebaugh Ave., 33626

Planet Fitness – Seffner

Phone: (813) 575-2757 Address: 725 W Dr MLK Jr , 33484

YMCA Express

Phone: (813) 792-7838 Address: 9878 W. Linebaugh Ave., 33626

Xtreme FiT

Phone: (813) 649-8039 Address: 815 W. Bloomingdale Ave., 33511

Bob Sierra Family Branch YMCA

Phone: (813) 962-3220 Address: 4029 Northdale Blvd., 33624

Anytime Fitness – Riverview, FL

Phone: (813) 443-4747 Address: 11252 Boyette Rd., 33569

North Brandon Family YMCA

Phone: (813) 685-5402 Address: 3097 S. Kingsway Rd., 33584

YMCA Camp Cristina

Phone: (813) 677-8400 Address: 9840 Balm River View Rd., 33569

New Tampa Family YMCA

Phone: (813) 866-9622 Address: 16221 Compton Dr., 33647

 

 

LA Fitness – Tampa – Cypress Preserve Dr.

Phone: (813) 337-0966 Address: 5225 Cypress Preserve Dr., 33647

Youfit – East Brandon- East Brandon Blvd.

Phone: (813) 315-9821 Address: 1423 E. Brandon Blvd., 33511

LA Fitness – Valrico – State Rd. 60 E.

Phone: (813) 982-4149 Address: 1930 State Rd. 60 E., 33594

LA Fitness – Lutz – N. Dale Mabry Hwy.

Phone: (813) 962-7358 Address: 17631 N. Dale Mabry Hwy., 33548

Youfit – Tampa-Race Track Rd.

Phone: (813) 792-4305 Address: 13891 W. Hillsborough Ave., 33635

Apollo Beach Racquet Fitness

Phone: (813) 641-1922 Address: 6520 Richies Way, 33572-2125

Snap Fitness – Tampa

Phone: (813) 814-1984 Address: 12611 Race Track Rd., 33626

Anytime Fitness – Riverview, FL

Phone: (813) 677-4800 Address: 13184 US Hwy. 301 S., 33579

Anytime Fitness – Apollo Beach, FL

Phone: (813) 641-7171 Address: 6110 Hwy. 41 ., 33572

Crunch Fitness – Bloomingdale

Phone: (813) 381-4106 Address: 3236 Lithia Pinecrest Rd., 33594

The Worx 24 Hr Fitness

Phone: (813) 381-3903 Address: 13432 Boyette Rd., 33569

Campo Family YMCA

Phone: (813) 684-1371 Address: 3414 Culbreath Rd., 33594

St. Anthony’s Carillon Wellness Center

Phone: (727) 502-4444 Address: 900 Carrillon Pkwy., 33716

Snap Fitness – Apollo Beach

Phone: (813) 671-1200 Address: 236 Harbor Village Ln., 33572

Anytime Fitness – Odessa, FL

Phone: (813) 926-6777 Address: 17765 Gunn Hwy., 33556

Infinity Integrative Medicine

Phone: (813) 777-1511 Address: 531 Main St., Ste. G, 34695

Suncoast Fitness

Phone: (727) 822-9394 Address: 203 38th Ave. N., 33704

Town Apts N
Address: 1900 61st Avenue N, 33714
Zumba Gold(R)
Schedule: Monday (10:00 AM) Instructor Name: Linda Beaulieu Instructor Phone: (727) 280-3300
Zumba Gold(R)
Schedule: Friday (2:00 PM) Instructor Name: Kathleen McDonnell Instructor Phone: (727) 579-4427

Mainlands Clubhouse #3

Address: 10050 Mainlands Blvd, 33782
Zumba Gold(R)
Schedule: Wednesday (6:45 PM) Instructor Name: Linda Beaulieu Instructor Phone: (727) 280-3300

Mainlands Of Tamarac Unit 6

Address: 3550 Mainlands Blvd S, 33782

YMCA of the Suncoast – High Point Branch YMCA

Phone: (727) 507-9622 Address: 5345 Laurel Pl., 33760

Fitness 360

Phone: (727) 797-5100 Address: 1580 N. McMullen Booth Rd., 33759

Anytime Fitness – Lutz, FL

Phone: (813) 575-8879 Address: 1408 Dale Mabry Hwy., 33548

Mainlands Clubhouse #5

Address: 4275 Mainlands Blvd S, 33782
Aqua Zumba(R) (Outdoors)
Schedule: Thursday (6:00 PM), Saturday (9:30 AM) Instructor Name: Kathleen Bara
Instructor Phone: (727) 259-3277

Jazzercise at St Petersburg Fitness Center

Address: 2501 Dr. Martin Luther King Jr., 33704
(727) 687-6695

Anytime Fitness – Oldsmar

Phone: (727) 787-9000 Address: 3161 Curlew Rd., 34677

LA Fitness – Lutz – State Rd. 54

Phone: (813) 948-4040 Address: 23048 State Rd. 54, 33549

Pasco Health and Fitness

Phone: (813) 949-4120 Address: 23900 St. Rd. 54, Unit 102, 33559

LA Fitness – New Tampa

Phone: (813) 435-6040 Address: 6411 County Line Rd. E., 33647

Anytime Fitness – Wesley Chapel, FL

Phone: (813) 929-3191 Address: 1041 Bruce B Downs Blvd., 33544

Meadow Pointe I Clubhouse

Address: 28245 County Line Road, 33543
Zumba(R)
Schedule: Thursday (9:30 AM), Friday (9:30 AM) Instructor Name: Margarita Blasini
Instructor Phone: (813) 732-7011

Anytime Fitness – Lithia, FL

Phone: (813) 438-8474 Address: 16144 Churchview Dr., Ste. 201, 33547

Quadrum Fitness Center

Phone: (727) 827-7979 Address: 7670 49th St. N., 33781

City Gym

Phone: (727) 898-3302 Address: 33 6th St., Ste. 100, 33701

LA Fitness – Largo – E. Bay Dr.

Phone: (727) 451-9650 Address: 5320 E. Bay Dr., 33764

Anytime Fitness – Largo, FL

Phone: (727) 388-7009 Address: 5395 E. Bay Dr., 33764

 

SunCity Health Plex

Phone: (813) 419-5020 Address: 787 Cortaro Dr., 33573

Amped Fitness

Phone: (727) 873-6998 Address: 830 3rd Ave. S., 33701

Countryside Recreation Facility

Phone: (727) 669-1914 Address: 2640 Sabal Springs Dr., 33761

USTA Masters Tennis at The Henry L. McMullen Tennis Complex

Phone: (727) 669-1919 Address: 1000 Edenville Ave., 33764

Anytime Fitness – Sun City Ctr.

Phone: (813) 245-3107 Address: 3730-3846 SR 674, 33573

Christ Lutheran Church

Phone: (727) 526-3265 Address: 3451 30 Ave. N., 33713

Morningside Recreation Complex

Phone: (727) 507-4064 Address: 2400 Harn Blvd., 33764

Williamsburg Clubhouse

Address: 28429 Williamsburg Drive, 33543
Zumba(R)
Schedule: Tuesday (10:00 AM), Saturday (10:00 AM) Instructor Name: Margarita Blasini
Instructor Phone: (813) 732-7011

Anytime Fitness – Odessa, FL

Phone: (813) 333-9900 Address: 16244 State Rd. 54, 33556

Oakstead Clubhouse

Address: 3038 Oakstead Blvd., 34638
Cardio and Strength
Schedule: Monday (9:00 AM), Friday (9:00 AM) Instructor Name: Sandra Soule
Instructor Phone: (813) 239-4090

Strive Athletic Club

Phone: (813) 428-6973 Address: 2626 Cypress Ridge Blvd., 33544

Bayou Dance Club

Address: 6541 102 Ave North, 33782
Jazzercise(R)
Schedule: Monday (9:00 AM), Wednesday (9:00 AM), Friday (9:00 AM) Instructor Name: Bonnie Capra
Instructor Phone: (727) 687-6695

Kinetix Inspired Fitness

Phone: (727) 541-1969 Address: 6561 102nd Ave. N., 33782

Anytime Fitness – Palm Harbor, FL

Phone: (727) 330-7545 Address: 4942 Ridgemoor Blvd., 34685

 

The Long Center and Aging Well Center

Phone: (727) 793-2320 Address: 1501 N. Belcher Rd., 33765

YMCA of the Suncoast – North Pinellas Branch YMCA

Phone: (727) 772-9622 Address: 4550 Village Center Dr., 34685

 

Meadow Pointe 2 Clubhouse

Address: 30051 County Line Rd., 33543
Zumba Toning(R)
Schedule: Wednesday (9:30 AM) Instructor Name: Margarita Blasini Instructor Phone: (813) 732-7011

Concord Station Clubhouse

Address: 18636 Mentmore Blvd., 34638
Zumba(R)
Schedule: Tuesday (6:15 PM), Thursday (6:15 PM) Instructor Name: Carmen Uzelac
Instructor Phone: (727) 686-4939

Harbordale YMCA

Phone: (727) 821-9348 Address: 2421 4th St. S., 33705

Anytime Fitness – Pinellas Park, FL

Phone: (727) 388-9015 Address: 7620 66th St., 33781

 

 

Planet Fitness – Palm Harbor

Phone: (727) 786-1915 Address: 30701 US. Hwy. 19N., 34684

Youfit – Pinellas Park-66th St.

Phone: (727) 541-7296 Address: 6421 66th St. N., 33781

 

Gold’s Gym – Largo

Phone: (727) 240-1400 Address: 2178 E. Bay Dr., 33771

LA Fitness – Dunedin

Phone: (727) 601-0822 Address: 1681 Main St, 34698

BayCare Fitness Center (Palm Harbor)

Phone: (727) 772-2254 Address: 32672 U.S. 19 N., 34684

City of Largo Community Center

Phone: (727) 518-3131 Address: 400 Alt. Keene Rd., 33771

 

Anytime Fitness – Dunedin, FL

Phone: (727) 733-1100 Address: 1471 Main St., 34698

Palm Lake Village

Address: 1515 County Road, 34698
Strength and Balance
Schedule: Tuesday (10:30 AM), Thursday (10:30 AM) Instructor Name: BJ O’Brien
Instructor Phone: (727) 459-5811

Highland Recreation Complex

Phone: (727) 518-3016 Address: 400 Highland Ave., 33770

Plant City YMCA

Phone: (813) 757-6677 Address: 1507 YMCA Pl., 33567

LA Fitness – Palm Harbor

Phone: (727) 213-2458 Address: 35104 U.S. Hwy. 19 N., 34684

 

Snap Fitness – Palm Harbor West

Phone: (727) 330-7570 Address: 1370 Tampa Rd., 34683

Terrace Park of 5 Towns

Address: 8141 54th Ave N, 33709
Zumba Gold(R)
Schedule: Tuesday (2:30 PM) Instructor Name: Linda Beaulieu Instructor Phone: (727) 280-3300

All Care

Phone: (727) 545-4545 Address: 8900 Park Blvd., N., 33777

LA Fitness – Largo – Missouri Ave

Phone: (727) 559-2001 Address: 1229 Missouri Ave. N, 33770

Youfit – Largo – Missouri Ave.

Phone: (727) 228-9500 Address: 1111 Missouri Ave. N., 33770

 

Ross Norton Recreation & Aquatics Complex

Phone: (727) 462-6025 Address: 1426 S. Martin Luther King Jr. Ave., 33756

YMCA of the Suncoast – Greater Palm Harbor Branch YMCA

Phone: (727) 787-9622 Address: 1600 16th St., 34683

North Greenwood Recreation Complex

Phone: (727) 462-6276 Address: 900 N. Martin Luther King Jr. Ave., 33755

 

Anytime Fitness – Plant City, FL

Phone: (813) 567-1057 Address: 2402 James L Redman Pkwy., 33566

Anytime Fitness – Wesley Chapel, FL

Phone: (813) 994-1912 Address: 27325 Wesley Chapel Blvd., 33544

Limitless Fitness

Phone: (813) 717-7773 Address: 1418 S. Evers St. , 33563

Planet Fitness – Plant City

Phone: (813) 704-6955 Address: 1864 James L. Redman Pkwy., 33563

Curves – Plant City, FL

Phone: (813) 719-1822 Address: 1822 James L. Redman Pkwy., 33563

Dunedin Family Fitness

Phone: (727) 736-6698 Address: 2646 Bayshore Blvd., 34698

Seminole Isle

Address: 7253 Key Haven Rd., 33777
Aqua Zumba(R)
Schedule: Monday (6:00 PM) Instructor Name: Kathleen Bara Instructor Phone: (727) 259-3277

Cheek-Powell Fitness Center

Phone: (727) 462-7656 Address: 455 Pinellas St., Ste. 100, 33756

Dimmitt Community Center

Phone: (727) 518-3728 Address: 918 Osceola Rd., 33756

Youfit – Land O’ Lakes-Village Lakes

Phone: (813) 712-7700 Address: 21707 Village Lakes Shopping Center Rd., 34639

Curves – Seminole, FL

Phone: (727) 320-9737 Address: 8992 Seminole Blvd., 33772

Land O’ Lakes Family Fitness

Phone: (813) 388-2520 Address: 7016 Land O Lakes Blvd., 34637

YMCA of the Suncoast – Greater Ridgecrest Branch YMCA

Phone: (727) 559-0500 Address: 1801 119th St. N., 33778

YMCA of the Suncoast – James P. Gills Family Branch YMCA

Phone: (727) 375-9622 Address: 8411 Photonics Dr., 34655

Anytime Fitness – Palm Harbor 2

Phone: (727) 266-4126 Address: 679 Alderman Rd., 34683

Zone Fitness Club – New Port Richey

Phone: (727) 375-9663 Address: 1252 Seven Springs Blvd. , 34655

Snap Fitness – Tarpon Springs

Phone: (727) 937-4999 Address: 852 E. Tarpon Ave., 34689

Seminole Gardens

Address: 8275 113th St, 33772
Zumba Gold(R)
Schedule: Thursday (9:00 AM) Instructor Name: Yineth Zuniga Instructor Phone: (818) 903-8295
Cardio and Strength
Schedule: Monday (9:00 AM) Instructor Name: Yineth Zuniga Instructor Phone: (818) 903-8295

LA Fitness – Seminole – Park Blvd.

Phone: (727) 440-8065 Address: 7635 113th St., 33772

Total Fitness Health Club & Spa

Phone: (727) 938-8551 Address: 1888 S. Pinellas Ave., 34689

Anytime Fitness – Tarpon Springs, FL

Phone: (727) 943-0400 Address: 1254 S. Pinellas Ave., 34689

The Groves Community Development District

Address: 7924 Melgold Circle, 34637
Strength and Balance
Schedule: Wednesday (9:00 AM) Instructor Name: Thomas Marbell Instructor Phone: (352) 409-2984
Strength and Balance
Schedule: Friday (10:30 AM) Instructor Name: Thomas Marbell Instructor Phone: (352) 409-2984

Family Fitness Center

Phone: (727) 375-1116 Address: 4028 Little Rd., 34655

USTA Masters Tennis at Southwest Recreation Complex

Phone: (727) 518-3125 Address: 13120 Vonn Rd., 33774

Southwest Recreation Complex

Phone: (727) 518-3125 Address: 13120 Vonn Rd., 33774

Anytime Fitness – Zephyrhills, FL

Phone: (813) 782-3100 Address: 34617 State Rd. 54, 33541

Treasure Island Athletic Club

Phone: (727) 360-6652 Address: 133 107th Ave., 33706

St Pete Beach Recreation Center

Phone: (727) 363-9245 Address: 7701 Boca Ciega Drive, 33706

Fit For Life

Phone: (727) 367-0075 Address: 575 75th Ave., 33706

Get Fitness Largo, LLC

Phone: (727) 595-4505 Address: 13845 Walsingham Rd., 33774-3244

Anytime Fitness – Largo, FL

Phone: (727) 388-9010 Address: 11700 Oakhurst Rd., 33774

Fitness Inc

Phone: (727) 937-6422 Address: 1817 US Hwy 19 S. Unit B, 34691

Snap Fitness – Seminole

Phone: (727) 474-3801 Address: 9360 Oakhurst Rd., 33776

Tropical Acre Estates

Address: 3221 Paradise Way, 33541
Cardio and Strength
Schedule: Friday (9:30 AM) Instructor Name: Michelle Mack Instructor Phone: (352) 457-1585
Senior Stretch
Schedule: Tuesday (12:00 PM) Instructor Name: Michelle Mack Instructor Phone: (352) 457-1585

Beach Front Fitness

Phone: (727) 498-7056 Address: 73 170th Ave. E., 33708

Planet Fitness – Holiday

Phone: (727) 935-4818 Address: 4637 Sunray Dr., 34690

Access Health Care Physicians

Address: 36542 Florida State Road 54, 33541
Strength and Balance
Schedule: Friday (9:30 AM) Instructor Name: Kristin Jenkins Instructor Phone: (813) 618-2252
SilverSneakers Yoga
Schedule: Tuesday (10:30 AM) Instructor Name: Kristin Jenkins Instructor Phone: (813) 618-2252

Elfers Senior Center

Phone: (727) 847-1290 Address: 4136 Barker Dr., 34680

Sunset Park

Address: 1700 Sunset Dr., 34689
Tai Chi/Qigong (Outdoors)
Schedule: Wednesday (9:00 AM), Thursday (9:00 AM), Friday (9:00 AM), Sunday (9:00 AM) Instructor Name: Minette Howell
Instructor Phone: (727) 331-7568

Town Hall of Indian Shores

Address: 19305 Gulf Blvd., 33785
BOOM – Muscle
Schedule: Friday (12:00 PM) Instructor Name: Yineth Zuniga Instructor Phone: (818) 903-8295
BOOM – Move It
Schedule: Friday (11:30 AM) Instructor Name: Yineth Zuniga Instructor Phone: (818) 903-8295

Find the Cheapest Insurance Quotes in your Area

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

My name is Drew and 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 licensed in 48 states.  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:

Let’s get started.

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2019 Medicare Changes: What You Should Know

Centers for Medicare & Medicaid Services (CMS) has announced Medicare Advantage and Part D 2019 Rate Announcement and Call Letter.

This is the last update on policy changes for the upcoming 2019 calendar year.

Here is the full report on the upcoming Medicare changes in 2019.

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) and a Part D. This is a very common solution for those looking to close the 20% gap from original Medicare.  Medicare supplements are standardized plans which means every plan must offer the same benefits.  For example, a plan F from AARP is the same as a Mutual of Omaha Medicare supplement plan F.  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 drug plan.  It’s a very predictable way to manage your monthly expenses.
  2. Medicare Advantage Plan. Medicare Advantage is a program offered by private companies such as United Health Care, Aetna, Humana, and many others.  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.
  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.

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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.

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What are the Most Common Medicare Supplement Insurance Plans?

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 plans you should review before making your decision.

Medicare Supplement Plan F

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

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.

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How Medicare Part D Works with a Supplement

There are two ways to sign up for a Part D Prescription Drug coverage plan: by enrolling in a standalone Part D plan (PDP)  or by 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.

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Best Medicare Supplement St. Charles and St. Louis Offers

This is one of the most common questions we hear when talking to individuals and families about their Medicare supplement.   St. Charles and St. Louis 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 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.

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How to choose 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.

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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 15th-December 7th.

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 1st, that means you can switch your Medicare supplement to another Plan F from September 1st through November 1st 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.

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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.

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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 15th and December 7th.  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.

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.

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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.

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What is the Best Medicare Supplement Plan in St. Louis for 2019?

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 2018 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

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Who are the Top 10 Rated Medicare Supplement Carriers for 2019?

In order to look at the top rated Medicare supplement plans for 2019, we again used data from CSG actuarial, the leading actuarial company in the Medicare space.

Top Medicare Supplement Companies for 2019

We wanted to list 10, but we believe there are seven superior medicare supplements for 2019 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 2019.

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 2019.  With an average rate increase of 2.5%, there is a strong chance you can expect this to continue in 2019.

For the record, they just release their rate increase of 1% for 2018, so the pattern is looking good for United American in 2019.

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 2019 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 2018.

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 2018.

If you’re curious about other Medicare Supplement plans in 2018 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.

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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.

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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.

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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

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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.

For example, a Medicare supplement plan g with AARP offers the same exact benefits as a Medicare supplement plan g with Transamerica, the only difference is the price.

Below is are example 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.  You can always contact us and we can run a full report for you.

Transamerica Life Insurance Company plan G $134.33
Americo Medicare Supplement $143.58
American National Life insurance Company of Texas $146.52
Everest Reinsurance Group $146.87
IAC $147.67
Manhattan Life Insurance Company $149.08
American Continental Insurance Company (Aetna) $149.86
Mutual of Omaha Medicare Supplement $150.51
Physicians Mutual Insurance Company $245.64
Gerber Life Insurance Company $256.85

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Conclusion

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 888-211-5685 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.

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Medicare Supplement Insurance plans, also known as Medigap, help cover some of the costs not covered by Original Medicare (Parts A and B). If you have a Medigap policy and are not satisfied with the benefits, coverage, or cost of that plan, you may be able to switch Medigap policies, helping you obtain a plan that better suits your needs.

When to Switch Your Medigap Policy

Switching Medicare supplement plans may arise from a want or need to do so. You may want to switch Medigap policies if:

  • Your Medigap policy offers benefits you don’t need.
  • You need more benefits from your Medigap policy that you didn’t need before.
  • You want to change insurance companies.
  • You want a new Medigap policy that is less expensive.

You may need to switch Medigap policies if you are eligible for one of the following guaranteed issue rights.

  • Your Medigap insurance provider is going bankrupt or going out of business.
  • Your Medigap insurance provider committed fraud.
  • Your Medigap insurance provider was misleading in some way.

If you qualify for one of the above situations (guaranteed issue rights), then you may switch Medigap policies outside of your Medigap open enrollment period.

Other Situations on Switching Medigap Policy

If you are wondering if you need to switch Medigap policies based on other situations, see the following common scenarios regarding switching Medicare supplement plans.

  • Your Medigap policy is older – If you bought your Medigap policy before 2010, or even as long ago as before 1992, you do not have to switch your policy, but there are a couple of things you should know about older Medigap plans. If you bought a plan before 2010, that plan may offer coverage that isn’t offered by newer plans. Therefore, you may be better off keeping that plan rather than switching to a new policy. If you bought your Medigap policy before 1992, you still do not have to switch plans, but keep in mind that your plan may not be a guaranteed renewable policy and may have a greater premium increase.
  • You are moving out of the state – Even if you are moving to a different state, you may still keep your current Medigap policy as long as you still have Original Medicare.
  • You have a Medicare SELECT plan and are moving outside the plan’s coverage area – You can either purchase a standardized Medigap policy from your current insurance provider as long as the new plan offers equal or fewer benefits than your current Medicare SELECT plan, or, using your guaranteed issue right, you may purchase a Medigap Plan A, B, C, F, K, or L that is sold my most insurance companies in most states.

Things to Keep in Mind About Switching Your Medigap Policy

If you want or need to switch medicare supplement plans, keep in mind the following information about changing Medigap policies.

  • Under Federal law, you typically do not have the right to switch Medigap policies unless you are switching within your open enrollment period, or you are eligible for a guaranteed issue right.
  • If the insurance company is willing to sell you a Medigap policy outside of the open enrollment period, you may have to answer some medical history questions or pay a higher premium for the new Medigap policy.
  • You do not have to wait a certain period of time after purchasing your first Medigap policy before you may switch to a new Medigap policy.
  • You may have to wait up to 6 months before pre-existing conditions or new benefits your old plan did not offer are covered by your new Medigap plan after switching policies.
  • You should drop your Medigap policy if you have a Medicare Advantage plan, and it is illegal for insurance companies to try to sell you a Medigap policy if you have a Medicare Advantage plan.

How to Switch Medigap Policies

To switch your Medigap policy, you must either switch during your 6-month Medigap open enrollment period or be eligible for one of the guaranteed issue rights mentioned earlier.

Once you have decided to switch change Medicare supplement plans, first call the insurance provider of the new Medigap policy to apply for that policy. If the insurance company accepts your application for a new Medigap policy, you should then call the insurance provider of your old Medigap policy to request for the coverage to end.

After Switching Medigap Policies

After you have successfully switched Medicare supplement plans, you are given a 30-day period in which you can decide if you want to keep or cancel your new plan. This 30-day period is known as a free-look period, which begins right when you get your new Medigap policy.

Once you change Medigap policies, it is recommended that you do not cancel your old plan right away. It is a good idea to keep your old Medigap policy until you have decided that you are satisfied with your new policy. This way, you can easily go back to using your old Medigap plan if you decide that you do not like your new policy.

Medicare late enrollment penalties are amounts added to your monthly premiums as a result of not enrolling in Medicare during your Initial Enrollment Period. Unless you qualify for a Special Enrollment Period, you may be subject to Medicare enrollment penalties if you wait to sign up for Medicare after you are already eligible for enrollment.
Medicare enrollment penalties are a thing to be aware of and to be taken seriously. Medicare late enrollment penalties are not one-time penalty fees; they are extra amounts you must pay in addition to your monthly Medicare premiums. For some Medicare Parts, you must pay these additional amounts for the rest of the time you have that insurance (as opposed to only having to pay for a certain period).

Each type of Medicare (Parts A, B, and D) have a different late enrollment penalty that is calculated differently. These penalties vary from person to person depending on how many months you go without enrolling in a certain type of Medicare after becoming eligible. The Medicare late enrollment penalty costs can add up and become quite expensive, which is why it is important to be aware of these penalties and remember to enroll in Medicare during your Initial Enrollment Period.

Medicare Part A Penalty

Medicare Part A is usually premium-free for most people. As long as you or your spouse paid Medicare taxes while working for at least 10 years, you are not required to pay a monthly premium for Medicare Part A. If you are not eligible for premium-free Medicare Part A, you may purchase Part A for a monthly premium, which could be as high as $411 per month according to the Official U.S. Government Site for Medicare.

You must sign up for Medicare Part A (and Part B) during your Initial Enrollment Period, which is the 7-month period that includes the three months before the month that you turn 65, the month you turn 65, and the three months after the month you turn 65. If you do not enroll in Part A during your eligibility period, you may be subject to Part A late enrollment penalties.

The Part A late enrollment penalty is typically a 10% increase in your monthly premium, which you must pay for twice the amount of time you were eligible to enroll in Medicare Part A, but did not enroll. For example, if you enroll in Part A after being eligible for one year, your Part A premium increase will apply for two years. If you have a $200 monthly premium after signing up for Medicare Part A after one year of being eligible for enrollment, your monthly premium will be $220 ($200 + ($200 x .10)) for the next two years.

Medicare Part B Penalty

As with Medicare Part A, if you do not sign up for Medicare Part B during your Initial Eligibility Period, you may be subject to Part B late enrollment penalties. Typically, a 10% increase will apply to your monthly premium for each 12-month period you are eligible for Part B, but have not yet enrolled.

For example, if the last month of your Initial Enrollment Period to sign up for Medicare Part B was January 2014, and you enrolled in March 2016, there was a 26-month period in which you were eligible to enroll, which is two full 12-month periods. Since each 12-month period you go without enrolling amounts to a 10% increase in your monthly premium, in this scenario, you would be subject to a 20% increase. Medicare Part B late enrollment penalties apply for the duration that you have Part B insurance.

Medicare Part D Penalty

Medicare Part D late enrollment penalties may apply if you do not have credible prescription drug coverage (Medicare Part D, Medicare Advantage plan, or other Medicare health plan that covers prescription medications) for any continuous period of 63 days or more following your Initial Enrollment Period.

The Medicare Part D late enrollment penalty is calculated by multiplying the national base beneficiary premium (which is $34.10 for 2016) times 1% of the number of months you did not have Medicare Part D or other credible prescription drug coverage. This number is then rounded to the nearest .10, which is the penalty amount added to your monthly premium.

For example, if your Initial Enrollment Period ends June 30, 2014, and you did not sign up for Medicare Part D until the Open Enrollment Period ending December 7, 2015, this means that your prescription drug coverage did not begin until January 1, 2016, and that you went without prescription drug coverage for a total of 18 months (July 2014 through December 2015). In this scenario, your penalty would be 18% (1% x 18 months). The monthly Part D late enrollment penalty would be calculated as follows:

.18 (18% penalty) x $34.10 (national base beneficiary premium for 2016) = 6.138

Rounded to the nearest .10, your monthly penalty comes to $6.10, meaning you must pay an extra $6.10 in addition to your monthly premium for Medicare Part D.

Since the national base beneficiary increases each year, this means that your monthly Medicare Part D late enrollment penalty will also increase with each year.

In conclusion, avoiding Medicare late enrollment penalties is simple as long as you make sure to enroll in Medicare once you become eligible. Going without any type of Medicare for a certain period of time after becoming eligible is not only a risk to your health, but also a potentially expensive decision.

Discover more about Medicare Enrollment.

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Many people find them asking themselves, “do I need to enroll in Medicare every year”?

The short answer is NO.  Why, because you enroll in Original Medicare once when you become eligible either at age 65 or if you are on disability for 24 months or longer.

The real question here is do you need to renew your Medicare Supplement, Medicare Advantage Plan, and Medicare Part D plan?

That answer is YES, but it depends on the situation.  Below are those details.

Medicare Renewal Frequently Asked Questions (FAQ)

  1. When is Medicare open enrollment? October 15th through December 7th.  This is the only time you can openly change your Medicare Advantage plan or Part D plan.  Any other changes throughout the year require a special enrollment period which we’ll explain in further detail below.
  2. Do I have to renew my Medigap during open enrollment? No, Medigap plans are not subject to the open enrollment guidelines of the Centers for Medicare and Medicaid (CMS).
  3. When do I renew my Medicare Part D?  Medicare Part D plans must follow the CMS guidelines for enrollment.  You can openly change your Part D drug plan during open enrollment, but must have a special enrollment period if you want to change any other time during the year.
  4. Do you have to apply for Medicare every year? No, but you absolutely should review your Medicare Advantage Plan and Medicare Part D prescription drug plan for changes.  Again, Medicare Advantage and Part D plans must follow the open enrollment guidelines from CMS, so make sure you review during those times with a licensed agent.
  5. Do I have to re enroll in Medicare each year? No, you enrolled when you became eligible for Medicare and will not have to re enroll.
  6. How to renew Medicare online? First you should speak with a licensed agent to review the available plans for the upcoming year. Then you should determine if the Medicare Advantage Plan you are enrolling in has an e-application platform.  If they do, then you can coordinate with your agent how to get enrolled online.  If you aren’t changing your plan, then there is no reason you need to renew online.
  7. Why do I need to renew my Medicare every year?  You don’t need to renew your Medicare plan every year, but you need to REVIEW it.  Plans change and unless you review your plan each year, you may get hit with an unexpected bill.

Let’s dive into all the details you need to know about your Medicare renewal below.

Medicare Renewal Basics

In general, you do not need to renew your Medicare plan as long as you are happy with your current MA-PD or Part D drug policy. Medicare renewal is not required since, in most cases, Medicare coverage continues each year without the need to re-enroll in the same plan. In other words, Medicare automatically renews as long as you are continuing to pay the required premiums.

This applies both to beneficiaries enrolled in Original Medicare (Medicare Part A and Part B).

However, if you are currently enrolled in a private Medicare Advantage plan or Medicare Part D prescription drug plan, you’ll want to make sure and understand when you can renew each year.

Medicare Part D renewal should always be considered as the drug companies change their formulary (published drug list) every year.  The last thing you want is to get a surprise at the pharmacy and realize your generic drug is now considered brand or your tier 2 is now a tier 3.

So, the take away here is make sure you review your Medicare Advantage Plan or Medicare Part D prescription every year before it auto renews.  This is your only time to change.

When Medicare Renewal May Be Required

Although renewing Medicare is not required, there are certain situations in which you may need to take action regarding your policy. If any of the following situations applies, you may need to re-enroll in a new Medicare Advantage policy:

  • Your Medicare plan’s coverage area has changed, and you no longer live within that coverage area.
  • Your plan did not renew its Medicare contract for the following year.
  • Your plan left the Medicare program.
  • Medicare ended its contract with your plan.
  • You currently have a group health plan through your employer (NOT RETIREMENT PLAN) which would allow you to enroll in Medicare Part A and Part B outside of the IEP once you stop working.
  • 8 month SEP after you stop working.
  • You qualify for state pharmaceutical assistance plan (SPAP) which is a prescription drug discount program based on your household income.
  • You drop your Medicare Advantage plan to try a Medigap Plan for the first time.
  • You are enrolled in a Medicare Special Needs Plan (SNP) for conditions such as diabetes and heart disease.
  • You are a dual eligible for Medicare and Medicare and enrolled in a Medicare Dual Eligible Special Needs Plan (D-SNP).

In these situations, you may be given a Special Election Period (SEP) in which you will have an extended amount of time to decide on a new Medicare plan. SEP is an extension of the Medicare renewal period, or otherwise known as the Annual Election Period (AEP), or open enrollment which you must qualify for.

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Medicare Enrollment Period Basics

What is the Medicare Initial Election Period (IEP)?

IEP is the period of time when you initially become eligible for Medicare and enroll in Medicare Part A, Medicare Part B, Medicare Part D, and your Medicare Advantage Plan or Medigap Policy.  You only have one Medicare IEP.

When is Medicare open enrollment (AEP)?

Annual Election Period (AEP) or otherwise known as Open Enrollment occurs from October 15th to December 7th, and allows Medicare plan beneficiaries to make changes to their policies, such as:

  • Switch from Original Medicare to Medicare Advantage
  • Switch from Medicare Advantage to Original Medicare
  • Change Medicare Advantage plans
  • Enroll in or drop Medicare Part D prescription coverage (Medicare Part D)

What is Medicare Special Enrollment Period (SEP)?

This is enrollment period you must qualify for to change your Medicare Advantage Plan or Medicare Part D prescription plan outside of the AEP window as outlined above.  If you cannot qualify for an SEP, then you will not be permitted to change your Medicare Advantage Plan or Part D prescription drug plan outside of AEP.

Medicare Plan Non-Renewal

In the case that your Medicare plan is not renewing its contract for the upcoming year or is leaving the Medicare program, you should be given a 90-day notice of its termination, outlining your options for enrolling in a new plan.

Yes, this happens often.  Companies are always moving in and out of the Medicare market.

You will also receive the SEP notice, giving you extra time to review your options and decide on a new Medicare plan.

If by the end of your SEP you have not taken any actions regarding the selection of a new policy, you may be automatically enrolled in the alternative plan being offered by your Medicare Advantage provider or Original Medicare.

Make sure you are reviewing your SEP notice carefully as all SEP’s are not created equal.

Reviewing Your Medicare Policy

Even though you do not need to renew Medicare coverage, it is recommended that you review your Medicare plan each year during AEP in which you may make any necessary changes to your current Medicare coverage. As mentioned earlier, during AEP you may switch from Original Medicare to Medicare Advantage and vice versa, switch to a different Medicare Advantage plan, opt in or out of prescription drug coverage (Medicare Part D), or make any other changes to your Medicare coverage based on your current needs.

It’s important to review your Medicare coverage each year during open enrollment as your health needs may change or the policy terms or costs may be revised. For example, each year Medicare Advantage and Medicare Part D plans will send beneficiaries an Annual Notice of Change, which outlines the plan changes for the upcoming year. Once you receive the notice, you should review to make sure your plan still fits your needs or is still the best plan option available.

Does My Medicare Plan Offer Additional Benefits?

Many Medicare plans offer additional benefits that aren’t offered through original Medicare.  It’s important to review your summary of benefits to determine the additional benefits you may qualify for.  Below are some of the other benefits you may qualify for with select Medicare Advantage plans and more recently some Medigap plans.

Medicare Plans that offer additional benefits

  • AARP Medicare Complete
  • Aetna
  • Alignment Health Plan
  • Amerigroup
  • Arkansas Blue Cross and Blue Shield
  • Anthem Blue Cross and Blue Shield
  • Avmed Medicare Choice
  • Blue Shield of California
  • Caremore Health Plan
  • Coventry Health Care
  • Essence Healthcare Medicare Advantage
  • Florida Blue
  • Freedom Health
  • Health Advantra
  • Humana
  • Kaiser Permanente
  • Medical Mutual
  • Medigold Medicare
  • Optimum Healthcare
  • Scan Medicare Plan
  • United Health Care
  • Wellcare Medicare Plans
  • Many more.

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What to Do During Medicare Open Enrollment

During AEP, you should review your Medicare Advantage plan and any changes it may be implementing for the upcoming year.  You need to decide if that plan is still the best option for you based on your current health needs. If you are not completely satisfied with your current Medicare plan, AEP is the time to make changes to your coverage.

Consider the following questions during Medicare open enrollment to help you decide whether or not you should make any changes to your current Medicare plan.

  1. Is Original Medicare or Medicare Advantage a better option for me?

Medicare Advantage typically offers more benefits than Original Medicare. If you are currently enrolled in a Medicare Advantage Plan and decide that you do not need the extra benefits included in your plan, you may want to switch to a Medigap or Medicare Supplement.

Likewise, if you are currently enrolled in a Medigap Plan and want to try a Medicare Advantage plan, you can switch one time and always go back to original plan.

  1. Does my current Medicare plan cover my prescriptions?

Review your plan to determine if prescription coverage is included. Depending on your prescription needs, this may mean enrolling or dis-enrolling in a Medicare Part D plan if you have Original Medicare, or changing Medicare Advantage plans.

In either instance you should take your list of medications and enter them into the drug database on Medicare’s website.  This will help you determine your estimated drug costs based on the available Medicare Advantage Plans or Medicare Part D plans in your area.

  1. Am I satisfied with my current Medicare Advantage plan?

Review your Medicare plan’s coverage and costs and compare with other Medicare Advantage plans available, and decide if your current plan is still the best option for you. You may find a different plan that fits your health care coverage needs with lower premiums.  In that instance Medicare renewal might make sense for you.

Conclusion

Below is a summary of what you need to know regarding Medicare renewal.

  • When is Medicare open enrollment? October 15th through December 7th.
  • Do you have to apply for Medicare every year? No, but you absolutely should review your Medicare Advantage Plan and Medicare Part D prescription drug plan for changes.
  • Do I have to re enroll in Medicare each year? No, you enrolled when you became eligible for Medicare and will not have to re enroll.
  • How to renew Medicare online? First you should speak with a licensed agent to review the available plans for the upcoming year. Then you should determine if the Medicare Advantage Plan you are enrolling in has an e-application platform.  If they do, then you can coordinate with your agent how to get enrolled online.  If you aren’t changing your plan, then there is no reason you need to renew online.
  • Why do I need to renew my Medicare every year?  You don’t need to renew your Medicare plan every year, but you need to review it.  Plans change and unless you review your plan each year, you may get hit with an unexpected bill.

If you have any specific questions or concerns regarding Medicare renewal, re-enrollment, or plan changes, you may contact a licensed insurance agent or Medicare benefits advisor for specific guidance during Medicare AEP.