Medicare Part D: Plans and price comparison

By Alston J. Balkcom

There are several steps you should take before choosing a Medicare Part D policy. A Medicare beneficiary is likely to be faced with a myriad of choices, so the first step is to eliminate some of those options from consideration. You will only want to consider policies that serve your local area. You will want a plan that has a low overall cost. You will want to make sure you understand your policy before you enroll.

 

A great free tool you should use

Medicare.gov has made selecting a Medicare Part D policy a lot easier! This government website is full of resources that will make your quest for the best prescription drug plan a lot easier.

 

Rules you must know

It is important to note that you cannot have two prescription drug plans. It is also important to note that enrolling in a prescription drug plan, can in many instances, automatically disenrolls you from your Medicare health plan. This is not the case if you have a Medicare Supplement or Medigap plan. Be sure you understand these rules before you join a plan.

 

Medicare advantage policies and prescription benefits

(If you choose to have your medical services covered by a Medicare Advantage policy, you should investigate the programs that provide prescription benefits to their members. For many, this is a better way to get prescription drug coverage.)

Understanding your coverage in some detail is important, however there is no point in reviewing details of policies that are unlikely to work well for you. This is where Medicare.gov's and its plan finder comes in.

This tool is free and easy to use. After telling the website where you live and giving it the names and dosages of your medications, you will receive an estimate of the costs you are likely to pay for any given policy.

Determining the premiums you might pay for a plan is fairly easy. However there is more you will need to know. You will want to know if a given policy covers the medications you use and if the insurance will include a local pharmacy in their network.

The Medicare plan finder can do all this for you. In addition, it will give you an estimate of your costs for the following year. Since you will be paying for both the policy's premium and the copayments and deductibles, the estimate includes all of the above in the calculation.                                                                                                      

This tool is widely used by insurance agents as well as Medicare beneficiaries. (It will also help you compare Medicare Advantage policies.)

 

Other steps to take

After you have gotten your short list of policies that are likely to work well for you a logical next step to take is to start learning more about each policy. You are likely to have a monthly premium. You may have a deductible. You are likely to have copayments and coinsurance for your prescriptions also.

You can get information about each plan from the company. You should be able to view or print the information from the company's website. Whether or not you choose to enlist the aid of an agent to help with enrollment, knowing the benefits each policy will provide before signing a contract is crucial.

 

Summary

You are likely to find several plans offered to you from several private insurance companies that seem to meet your needs. By using Medicare.gov's Medicare Plan Finder before you make a change, you will be able to see which plans provide coverage for your state and town.

You will see which are likely to have a low cost when the monthly premium, deductible and copayments are all considered. By contacting the various company's websites or agents you can learn what is required of you in regards to using their network. Following these steps should make it easier for you to select the right prescription drug plan for you needs.

About the author: Alston J. Balkcom is a veteran insurance agent.  He is the head of a family-owned insurance agency.  He helps clients find Medicare health plans in Connecticut.

* Image licenses: US-PDGov 

Considering Long-Term Care Insurance?

Like the smoker who knows cigarettes can cause cancer, but assumes it will never happen to them, or the teenager who thinks it’s okay to send just one text while driving, many people think long-term care insurance is something they’ll never need. Or maybe they just hope they won’t need it.

Unfortunately, people put off making a decision about long-term care (LTC) insurance because they are in denial over the possibility of needing it. But once you need it, it’s pretty hard to qualify.  Insurance is tricky that way. True, you may be paying for something you’ll never end up using but remember it’s going to be less expensive the younger you are. And if you wait too long, you may no longer be eligible.

One thing to remember about LTC insurance is that you can always add to your policy later.  If you’ve decided that long-term insurance is something you might be interested in buying, start out with a policy you can afford. Variables include the amount that is paid out for care, how many years the policy runs, and the waiting period required after the claim is approved.

Many long-term insurance policies also offer riders that allow you to make changes later. Common ones include a cost-of-living increase in benefits and protection against inflation.

No doubt about it, long-term insurance can be a great safety net to have. But the truth is it’s not right for everyone. Experts advise that if you have more than $50,000 in savings in addition to a home and car, it is probably worth your while to purchase LTC insurance.  However, if your assets total less than $50,000 and your annual income is primarily from Social Security, it probably doesn’t make sense to spend the money on the annual premiums. The fact is that even with the insurance benefits, you’ll probably end up going through your entire savings. That’s the bad news. The good news is that you’ll be eligible for Medicaid, which will take over payments for your nursing home or in some cases, assisted living care. 

If you can afford the insurance, one nice benefit (besides getting at least a portion of your care paid for) is that LTC insurance will cover a variety of long-term care services:  nursing home or assisted living care, adult day care, respite, hospice, memory care facilities and even in-home care.

Medicaid, on the other hand, will generally only cover care in a skilled nursing home, which means the person will need to move away from “home” or their assisted living facility once their funds have run out.  And while the level of care is as good or better in a nursing home, the atmosphere is usually more sterile and double rooms are not uncommon.

There isn’t a right or wrong answer to the question of long-term care insurance. If you’re a baby boomer or beyond, it’s a good idea to sit down with someone knowledgeable about the subject and find out whether an LTC insurance policy is right for you. Just do it soon!

Assessment of universal health care

Image attribution: Kborer. US-PD

Universal Health Care likely means lower and slower quality of health care services, increases in taxes, bureaucracy, and unnecessary government spending. A Los Angeles Times article entitled 'Universal healthcare's dirty little secrets' illustrates these points. It is a lack of faith in the ability of American citizens to make informed decisions for themselves in addition to an unconsidered write off of any private/public hyrbrid health care solution and the principles of capitalism in and of itself. "So what is potentially fiscally functional solution?" you may ask.

Government can regulate what isn't in its control, it has done this before with anti-trust, federal approval of drugs, federal oversight of building code etc. The Government does not have to have absolute control of health care to assist in a solution. Possible solutions include, cost caps, legalized private insurance, co-op insurance, partially subsidized insurance, federal investment insurance and so on. The amount of solutions are as many as a creative bureaucrat can think of.

To illustrate further, think of a small community of around 100 people. 2 within the community are doctors. Let's assume the average income is 30k and the tax increase is 10 percent or $3000/year. Even if the tax increase were only 5 percent that would be $1500 or $125/month per person. Incidentally that could get you fairly decent private insurance. Given there would be a tax increase of 5-10% does it make more sense to have more or less control of one's health care? If one pays the taxes, the Government decides for you, if you pay for private insurance you decide.

The next point in this opposition to universal health care is in regard to high hospital bills and ever increasing private medical costs. This is clearly and issue and has the potential to wipe out many families savings. It does not mean a thoughtful fiscally conservative solution to the problem does not exist, and it is unreasonable to assume that such a solution does not exist.

Economically, the healthier a nation is, the less health insurance individuals should need. This being the case the Government may be better off spending one percent of taxes to promote healthier lifestyle than 5 percent fixing the problems created by poor lifestyle choices. Even if only 25 percent of the population becomes healthier from a healthy living campaign that's a net savings of 10 percent off the five percent of taxes since only one percent was spent and 25 percent of five percent is 1.25 percent. Subtract the one percent healthy living campaign expenses from the 1.25 percent and that's 25 basis points the Government saved itself and tax payers. On a grand scale of say a billion dollars, that would mean savings of two and a half million dollars.

Yet another reason universal health care should be avoided is because people often know more about their health than the Government or its potential doctors ever will. An optimized plan that doesn't increase taxes, decreases Government spending and allows for affordable contributions from employers and individuals could be as follows. 

Every individual in the country is legislated to pay $20.00/month to a private health insurance plan and subsidized for this payment by a decrease in personal vehicle property taxes at the State level, and a federal subsidy paid for by a fractional decrease in some of the less useful Government programs. Furthermore, additional funds can be generated from mandated sliding scale minimum contributions from employers based on employer profitability calculations. 

In theory this type of system would pay for itself and probably generate a surplus if managed well. Under such a system individuals would still have the freedoms associated with private health insurance and pay less for it. Similar health care systems are currently being proposed by legislators and Governors nationally.

Lastly, when Government takes things over, things get slowed down. In the Canadian health care system people often have to wait for longer periods to get crucial surgery and vital medical attention. With a private system, if someone has the insurance, they get the medical attention they need. Why sacrifice a perfectly good system with a few glitches for a complete overhaul. It's simply not necessary.

To summarize the positions made henceforth, the following points have been made in this opposition:

• Universal Health Care implies there is no hybrid or private solution as good.
• Health Care problems can be repaired without system overhaul.
• Responsible regulation yield better results both fiscally and medically. 
• Health care is a personal issue and should be an individual choice.
• Federalization of services often leads to a decline in quality.

The evidence is clear, a simple deferment to Universal Health Care is negligent of sound Capitalistic principles that have the potential to yield outstanding health care to many if not all Americans. Federal regulation is not universal health care but can adjust the benefits of a universal system so long as many interest groups priorities are considered and no doorway to universal health care is left open. In other words an advantageous health care system emphasizing private coverage under a moderate position can be nationally beneficial. In order to be beneficial it would ideally lowers cost, expands availability, enhances public health and benefits the country as a whole without being a stepping stone to Universal Health Care.

How to save money on surgery

Low cost high quality surgery may sound like a contradiction but isn't always the case. The reason highly valued medical services such as surgery can be obtained at a low cost is due to improved international health care training. Moreover, international medical operations that develop at a faster pace than standard of living in addition to different medical business models overseas can save money on surgery. 

In other words, when well trained doctors and dentists live in countries where the standard of living is lower, health insurance and surgery tends to be cheaper for individuals coming from economies with a higher standard of living; going to these countries for surgery can save money. Thus, finding low cost high quality surgery is an advantage for those patents who can take advantage of exchange rates, and geographic variation in cost of services.

Where to find cost effective surgery

Saving money on surgery does require a little research, after all, life is a precious thing and if one didn't value life, surgery wouldn't be necessary in the first place. Having said that, different countries have different surgical advantages. For example, for individuals in the United States seeking more cost effective cosmetic surgery, why not consider Mexico? The travel costs are relatively inexpensive, especially via automobile and the net medical costs are a lot cheaper. Additionally Doctors that are Board  Certified can be referred through former patients, referral services and Doctors.

If you're in the market to save money on heart surgery and don't have insurance don't despair just yet. Heart surgery costs in India might be able to give you a bypass for a few thousand dollars compared to the tens to hundreds of thousands charged in the U.S. If you're wondering if the Doctors there can be trusted with you heart, research might give you confidence. According to the Economist magazine (2), Indian hospitals have developed smarter and cheaper ways to provide quality heart surgery to patients. Moreover, some Indian medical models are being duplicated and sold to other countries.

The list of places to go to save money on specific surgery goes on and essentially involves what is known as medical tourism. Medical tourism is an industry that is comprised of patients, patient's families, specialized travel agents, medical facilities, and medical networks.

Surgery via the medical tourism industry

The medical tourism industry is growing according to health-tourism.com (1) and is attractive to both patients and health providers for a number of reasons stated in a an article by Forbes.com. (3) There's no doubt, globalization has created a more competitive playing field when it comes to current international medical treatment and costs. This lowers the cost of high ticket health care items such as surgery depending on the location and type of surgery.

Costs to keep in mind when considering medical tourism include pre-hospitalization stay, travel, post-operation facility, and any therapy that may be required after the surgery. If the total costs after individual and family travel are significantly lower for a surgical procedure similar to or better than a local procedure, then medical tourism may be a wise choice to save money on surgery after additional considerations and contingencies are also considered. For additional information on researching and obtaining medical treatment abroad, the following resources may be helpful.

• Patients without borders

• Medical Tourism Association

• Healthbase

• Med retreat

Medical tourism has emerged for a number of reasons including excessive costs of health care in foreign countries, lower operating costs in other countries, improved international medical professional training, differentials between medical care and standard of living, and improved medical operations. Individual patients might do well to take advantage of the plethora of potential benefits available through medical tourism. Life is precious, but it might end up costing less for an even better medical result with medical tourism.

Sources:

1. http://www.health-tourism.com/medical-tourism/statistics/
2. http://www.economist.com/displayStory.cfm?story_id=13496367
3. http://www.forbes.com/2006/10/25/health-medical-tourism-biz-cx_1026oxford.html
4. http://www.time.com/time/magazine/article/0,9171,1003450-2,00.html
5. http://healthbeyondborders.files.wordpress.com/2009/01/med-tourism-cost-comparison.jpg

When Insurance is Prudent

Insurance is often times prudent because it is a hedge against misfortune. Anyone who does not like risk may be inclined to want lots of insurance because it can really help a lot should an unfortunate circumstance arrive. What's more, many people experience some kind of adversity or another in their life and in many cases insurance can help with that. There are many reasons why insurance is prudent, a few of which are outlined below:

• Peace of Mind: It is nice to know if something bad happens, one's family will be taken care of, or the related bills will be paid, or the car will be fixed etc.

• Socially Responsible: Owning insurance is also socially responsible in some cases because sometimes life is about responsibility and taking care of dependents or those affected by others mistakes or unfortunate circumstances.

• Self Respecting: Owning insurance is a sign of self respect because it means one values their life and isn't just willing to put it on the line in the name of low probability of something bad happening.

• Risk Management: Insurance of any kind lowers risk in life. The more insurance one has the more assistance insurance companies can provide if necessary.

• Legally required: Often automobile and mortgage insurance can be a requirement rather than a choice. In these cases one simply has no choice but to be insured or face potential penalty.

• Future Insurance Protected: If one is insured, that insurance can generally not be taken away should one's circumstances change. However, if one doesn't have insurance and one experiences a need for insurance, an insurance provider may deny an application for insurance.

The prudence of knowing which insurance is right

In addition to understanding why insurance is prudent, it is also helpful to know which type of insurance is prudent. The reason for this is because not everyone needs to be insured by every type of insurance product and not everyone can afford every type of insurance that is available because there are so many. In other words, it is also prudent to be able to distinguish between probable risk, and low risk. To illustrate, the list below demonstrates just how many types of insurance can be acquired, and this does not include all the types of insurance available.

• Health Insurance • Life Insurance • Auto Insurance • Liability Insurance • Long term care insurance • Hazard Insurance • Accidental death Insurance • Dental Insurance • Mortgage Insurance • Investment Insurance • Gap Insurance

All these insurances can add up to a tidy sum and if there is never an actual need for the insurance one may regret the decision financially. The inverse is true if one does need the insurance but didn't have it. For example, if one is a medical doctor and frequently performs operations, liability insurance can be a very good idea to protect against lawsuits. However, if one is in a profession that can not be so easily sued, the need for liability insurance declines.

Insurance is thus prudent, but it is not always prudent to have every kind of insurance. What's more, there are many types of sub-categories of insurance that may suite one's needs better than other policies. For example, if one doesn't have a family, a highly leveraged life insurance policy might not be as necessary as a more simple type of policy such as term life. Also, some insurance policies, such as employer health savings accounts may be tax deductible and thus financially prudent.

Summary

Insurance is prudent for several reasons such as legal requirements, an insurance to be insured in the future, potentially better sleep, and social responsibility to family members and/or loved ones.

Knowing this, it is also prudent to assess which type of insurance is wise and which types can be put on hold or avoided through savings or another financial instrument. There are many types of insurance to choose from, and thinking about one's own life and needs can assist in determining the wisest of policies to purchase.