A Insurance Shoppe

Are rates higher going through a broker?

In my opinion… a brief overview of Medicare by Sam Schoppenhorst.

Going on Medicare, or if you are already on Medicare… I recommend you read the official government handbook “Medicare & You” Some of the following information has been taken from that handbook.

 In most cases, when you first get Medicare, you are in the Original Medicare Plan. Part A helps cover hospitalization, as well as blood, home health services, hospice care and skilled nursing care. Generally there is no premium for part eight, because either the recipient or their spouse paid Medicare taxes while they were working.  Part B helps cover medical services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover. Part B is optional, it helps pay for covered medical services and items when they are medically necessary it also covers some preventive services. Generally Part B covers services out of the hospital such as doctors, clinical and laboratory services, emergency room services, durable medical equipment, diabetic supplies, eye and foot exams, some well exams in screenings, physical therapy etc.

In addition to original Medicare, you may want to consider a Medicare supplement/Medigap policy to cover your out of pocket costs under both Medicare Parts A & B as well as a Medicare Prescription Drug Plan (Part D) to add drug coverage. These are two different insurance policies, each of which has premiums. 

 Because part A is so limited, we believe it is most important for you to opt for and pay the extra premium for part B coverage. Without part B coverage you cannot purchase a Medicare supplement or enrolled in a Medicare part C plan.

 Or, you may want to consider a Medicare Advantage Plan (Part C) (like an HMO or PPO) that provides all your Part A, Part B, and often Part D coverage.  You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall.  Generally speaking, the Medicare advantage plans have little or no monthly premiums. This is possible because Medicare pays an amount of money for your care every month to these private health plans, whether or not you use services.

 When considering which options are best for you, please consider…

• Is your doctor, specialist, preferred hospital, pharmacy etc. in the plans network of providers? Ask your doctor/provider to be sure.
• Ask your doctor/specialist under which options they can best treat you if you develop or have a serious health condition.
• Are your prescriptions covered and what will your cost be under the plan?
• Do the monthly premiums and out-of-pocket costs fit your budget?
• Are additional benefits and lower premium worth being confined to a network?
• Consider PPO plans have more freedom, then HMO plans.
• Under most circumstances, once you choose a plan you will be locked in until the following January 1^st.

Today’s environment, there are many people looking for individual insurance. In the year 2001, four insurance companies we had enrolled clients with, Reliance, National Travelers Life, Conseco Medical Insurance and United Health Care withdrew from the individual health insurance business in Arizona.  Other companies have also left the state; additionally many of the remaining company’s premiums have doubled in the past year.  Furthermore, we are seeing a higher percent of applications being declined.  

The underwriting process.  Applications are subject to medical underwriting approval.   Insurance companies are increasingly requiring the applicant’s medical records to underwrite (approve or deny) applications.  Some applicants will be approved as applied for, some will be issued policies with riders excluding coverage for specific conditions, and some applications will be declined. Upon approval, your new policy may have new waiting periods, rate-ups, and or exclusions for pre-existing conditions and or Prescriptions.  I believe many applications are declined because applicants simply forgot or omitted information; others did not disclose conditions because they did not know the diagnoses in their file. As a result when the underwriter compares records with the application they don’t match up.  If we were aware of conditions omitted, we may have recommended another company.  I strongly recommend you obtain a copy of your Doctor(s) records, and read them prior to completing your application.   Claims for “new” conditions, not disclosed on your application, (especially in the first year of coverage) will probably result in the insurance company requesting (investigating) your doctor’s records.  If they find you omitted information, your policy may be rescinded (voided or canceled).  This would probably result in claim payments being reversed leaving you responsible for any claims you had made and for ongoing claims. 

Look at the stability of the new company.  Many of those who lost coverage now have new health conditions that will make it hard or impossible to obtain insurance with another company.  Or you may be issued new coverage, like myself, with exclusions for pre-existing conditions. If your health changes, you may not be able to change companies.   

Please consider the above information as you Shoppe for your next health insurance plan.  After you have been accepted in the plan of your choice, we are here to service your account.  We have been servicing our clients since 1989! At Your Service, Sam Schoppenhorst, Agent/Broker