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What is a Medicare Special Needs Plan?

The goal of a healthcare plan is always to help you obtain the healthcare you need while managing out-of-pocket expenses. And because healthcare needs are highly unique depending upon each individual, it’s no wonder that there is no single healthcare plan that is right for everyone. That is especially true with regard to Medicare plans, because we tend to develop a variety of needs later in life. A Medicare Special Needs plan is designed to suit you as an individual.

Medicare Special Needs plans are Medicare Advantage plans that have been designed specifically to provide for the needs of people diagnosed with certain medical conditions. These HMO or PPO plans are arranged around the benefits, providers, and medications best suited to a group of people who share certain diagnoses or characteristics.

The following Medicare beneficiaries might qualify for a Special Needs Plan:

• Those who live in a nursing home or who live at home but require in-home nursing care
• Those who qualify for both Medicare and Medicaid
• Those who are diagnosed with certain conditions, such as diabetes, HIV/AIDS, end-stage renal disease, dementia, or chronic heart failure

A Special Needs Plan will provide benefits targeted to member needs, including care coordination services. All of these plans provide prescription drug benefits (Medicare Part D). Some will require you to have a primary care doctor, while others will not. If you qualify on the basis of enrollment in both Medicare and Medicaid, you should check to be sure your preferred providers accept Medicaid.

A Special Needs Plan can help those with certain conditions manage their care more effectively and affordably, but the plan might not be right for every person in every geographic area. Consult with one of our qualified brokers to learn more about Special Needs Plans before making the decision to enroll in one.

The Right Nutrition Can Benefit Your Eyes

Even those who have enjoyed perfect vision all their lives will sometimes discover a decline in their eye health after age 60 or so. Sometimes this change is simply a natural part of aging. But because eyes respond to our lifestyle choices just like any other part of our bodies, proper nutrition and other smart choices can help to ward off some diseases of the eyes and preserve your vision.

We are all subject to something called oxidative stress, which is damage to the cells of our body from stress factors such as smoking, drinking alcohol, excessive sun exposure, contact with known carcinogens, and others. But certain vitamins are known as antioxidants. They fight back against this damage to the body, helping you to stay healthier.

Vitamins A, C, and E are the two most well-known antioxidants, and can help you ward off serious diseases like age-related macular degeneration and glaucoma. But lesser-known trace nutrients like lutein, zinc, and zeaxanthin also play important roles in preserving health.

Eating a wide variety of colorful, fresh fruits and veggies will help you to obtain most of the antioxidants you need. But for zinc, you should focus on seafood, eggs, dairy, and meat. If you’re a vegan or vegetarian, seeds, lentils, and beans also contain zinc.

Omega-3 fatty acids provide the final piece of the puzzle. Some people who experience dry, chronically irritated eyes find that the condition reverses when they begin to consume more Omega-3 fatty acids in fish, oils, walnuts, and certain seeds.

Of course, those with limited appetites often find it difficult to obtain enough nutrients from food. If this is the case for you, a high-quality daily multivitamin can help bridge the gap in your nutrition. Talk to your doctor or nutritionist about which multivitamin is right for you.

What You Need to Know Before You Turn 65

Those of you who are set to turn 65 this year are likely aware that you are reaching the age of Medicare eligibility. But enrolling in Medicare will involve a series of decisions which require careful contemplation. Here’s what you need to know before your initial Medicare enrollment window opens.

You might not be required to enroll.Most people will enroll in Medicare when they turn 65. But those who are still employed by a company employing more than 20 people, and participating in a group healthcare plan, can delay their enrollment until that coverage ends someday. The same rule applies to spouses who are enrolled in the plan.

But you might choose to anyway. Even if you’re not required to enroll in Medicare due to your current healthcare coverage, you can choose to do so anyway. Medicare will serve as supplemental coverage, possibly helping to reduce your out-of-pocket expenses.

If you are required to enroll, make sure to do it on time. Those who fail to enroll in Medicare when they’re required to do so will face higher premiums when they enroll later. Your enrollment window begins three months before the month of your 65th birthday, lasts for that entire month, and then extends for three months afterward.

You will face a number of decisions. You can enroll in Original Medicare, comprised of Medicare Parts A and B, and you will pay a premium for Part B coverage (most people with enough work credits will receive Part A coverage for free). If you go this route, you might also wish to add a Part D (prescription) plan or a Supplemental (Medigap) plan.

Alternatively, you can enroll in a Medicare Advantage plan, which is run by a private health insurance company according to standards set forth by Medicare. This plan is organized around a network of providers, and often includes other benefits such as prescription drug coverage.

You can access help for free. Brokers who specialize in Medicare plans can help you sort through your options, and there is never a fee for receiving this help. Just give us a call to speak with a licensed agent as your Medicare enrollment window approaches. We’ll help you understand the ins and outs of the Medicare system and guide you toward the plan or plans that suit your needs.

Throughout your lifetime, you’ve probably become accustomed to dealing with various health insurance issues. So you might know that pre-existing conditions sometimes complicate health insurance enrollment, and you’re wondering if the same situation can happen with Medicare. The answer is: It depends on the condition, and it depends on your Medicare plan.

Medicare plans that do not deny coverage based on pre-existing conditions…

If you want to enroll in a Medicare Advantage plan, you won’t be denied coverage due to a pre-existing condition. You can enroll or switch between Medicare Advantage plans at the same times you would normally be able to do so.

If you want to enroll in Original Medicare, pre-existing conditions won’t prevent that option. However, if you want to add a Medicare Supplement (Medigap) plan, you could be denied based upon your condition.

Medicare plans that might deny coverage based upon a pre-existing condition…

During your original Medicare enrollment window, you can enroll in Original Medicare plus a Supplement (Medigap) plan, regardless of any pre-existing conditions.

However, if you decide to elect a Medigap plan later, your health is assessed, and you could be denied based upon a medical condition. That’s why it is so important to consider the Medigap option very carefully at the time you turn 65 and enter your original enrollment window. If you turn down the opportunity to enroll in a Medigap plan, you might not be able to do so later.

Working with a licensed agent can help you to understand the differences between plans, and sort through all of the options available to you. This is especially true if you have a pre-existing condition, so don’t hesitate to give us a call if you need help comparing plans.