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Men and Medicare: What You Should Know

In the coming year, more than 1.6 million American men will turn 65. Discounts at restaurants, movie theaters and hardware stores await. Awaiting, too, are new options regarding healthcare coverage that their parents and grandparents never had the luxury to consider.

For past generations turning 65 meant obtaining healthcare coverage through Medicare and the only real decisions were whether or not to enroll in supplemental coverage and, if so, with whom? That all changed with the passage of the Balanced Budget Act of 1997, which allowed Medicare beneficiaries the option of receiving benefits through Medicare Advantage (MA) plans. (Many seniors had previously doing so via a series of demonstration projects that dated back to the early 1980s.) Those plans were augmented in 2003 with the landmark Medicare Prescription Drug Improvement and Modernization Act, which provides a prescription drug benefit for seniors and people living with disabilities.

MA plans provide all of the traditional benefits found in Medicare plus a host of additional benefits designed to make the plans attractive and appealing to a senior’s specific health and lifestyle needs. These added benefits could include dental, vision, gym membership, transportation and personal case management, especially for those with chronic conditions. But which plan to choose and how to make that decision?

For men entering the Medicare world for the first time, this can be particularly challenging in areas where multiple carriers offer a variety plans that leave seniors with dozens of options from which to choose. When making this important decision, here are five things to consider:

• Remember that you are making this choice for YOU, not for your wife, child or other dependent. When selecting a commercial carrier, most people consider what is right for the health needs of both themselves and their family. But turning 65 is a chance to be selfish – what works for you? If you are 65 and healthy you may want a relationship with a health plan that simply says “Be there when I need you” and are fine with interacting with your plan through unobtrusive online health information and preventative care programs that fit your busy lifestyle. But if you have chronic conditions, your main concern may be affordable physician visits, managing complex medication regimens, and additional help from care managers in navigating the healthcare system.

• Medicare has a quality rating system in which plans are ranked from one to five stars, with five being the highest. The system was established to help educate consumers on quality and make quality data more transparent and comparable between plans. The rankings consider such factors as clinical outcomes, access to preventive services such as screenings and vaccines, managing chronic conditions, preventive care, and consumer satisfaction. Star ratings are calculated each year and may change from one year to the next. Use them in helping to make your decision.

• Monthly premiums and co-pays can vary significantly from plan to plan. The good news is some MA plans have no monthly premium at all in 2016. But there is more to cost than just premiums. Carefully review deductibles and co-payments you’ll be required to pay when you go for care. Consider what best fits your needs and wallet.

• Many seniors take several medications to help them manage chronic, long-term conditions, and out-of-pocket drug costs can vary quite a bit among health plans. Take a good look at pharmacy coverage and be prepared to ask the right questions. Are my drugs covered? What are the copays? Are there discounts to make maintenance medication more affordable, such as getting a three-month supply of drugs at either a retail or mail-order pharmacy while only paying for two months?

• The availability of an individual’s doctor in the health plan’s network is one of the most important factors in choosing an MA plan. This is particularly important for those entering the Medicare population for the first time. See in which plans your physician – and your hospital – participate. Provider networks can vary greatly from plan to plan so don’t be caught by surprise.

Annual enrollment period for Medicare-eligible individuals is currently underway (and ends December 7). Men aging into Medicare should embrace this new chapter in their lives and make smart, informed decisions about their ongoing healthcare needs. Few decisions are as important.

What Is an SEP?

What are SEPs? Do I need one?

I have been getting this question a lot lately. What is a SEP? SEP stands for Special Election Period. This is a time frame that Federal and/or State Governments allow individuals and or families to enroll into a Health plan or new health plans based on what’s happening with them.

There over a dozen of different SEPs to work with in the Health and Medicare insurance industry. They could be related to something as simple as moving into a new plan in area, or losing an existing or gaining a job or position, They could be related to attaining or losing a attained age. It could be related to special dates like your birthday or having their plan cancel doing business in an already existing area. These opportunities are there to help members to enroll into major medical coverage without having to wait for open or annual enrollment period.

Working with the correct SEP can help people get themselves and their families the Health and Medicare plans that they need to maintain a quality of life. It can provide the new or disenfranchised a chance to get the major medical health plans that they both want and need. By using the correct SEP correctly, they could save thousands of dollars that may not be available to them.

There are over 15 different and separate SEPs in Medicare Advantage plans, Part D Plans, and Medicare supplements. There are almost as many SEPs available when you’re working with the affordable health care or ACA. This can give you additional options and services that you may have never know about them.

The number most important thing about SEPs is you. Everyone needs a major medical plan for themselves and or their spouse or family. Just one 4 day visit to a hospital for an emergency and put someone’s financial footing on shaky ground with medical bills reaching 6 figures. Medical cost are the number cause of bankruptcy in our nation. Can you imagine working all your life and run into that accident without being prepared, a complete life savings can be completely wiped out in the matter of weeks or days. The end game could be horrible.

There are SEPs in both Medicare and the ACA. If you don’t need one, that’s good. If you might need one, it could even be better. Keep the questions coming.

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