Tag: Insurance

A Toolkit for Choosing Health Plan Options

Preparing yourself with the proper tools helps to make any job a bit easier. If you are baking, you need the proper ingredients. When building something, you need hammers, nails and other related items. It’s the same when you are preparing for your Health Plan Open Enrollment session; or if you are a caregiver, for your person’s Medicare Annual Enrollment. The proper tools include questions you will need to ask yourself and those relating to available options.

Be sure you compare benefits before just looking at the premium amount.

■ Are you considering the best plan for you and your family?
■ What are the annual, maximum, out-of-pocket costs for the plan?
■ Is the plan mostly co-pays (set amounts) or co-insurances (percentage of the cost)?
■ Does the plan have a proactive prevention model that includes wellness classes, a fitness program, basic dental coverage and various ways to access the provider (your doctor or healthcare team), such as in-person and phone appointments, e-visits and video visits?
■ Are the provider locations convenient for you (doctor’s offices or medical facilities)?
■ Are there multiple services offered under one roof to help you spend less time in traffic and more time with family and friends?
■ Are you responsible for helping others find an option that fits their needs?
■ Do they have Medicare? The annual enrollment begins in October, so start looking at options.

Important question you’ll want to ask about health plans:

■ Do all of your providers accept Medicare and new patients throughout the year?
■ Does this plan have social workers or coordinators who can help you, the caregiver, meet the needs of the person you are caring for?
■ Is there a copay or coinsurance for this service?
■ Is there someone locally who you can meet with virtually or on the phone (for your convenience as a caregiver) regarding your questions?
■ Can they mail or email you the materials before you talk so that you have time to study the benefits and write down all your questions?

The complexities of Medicare and a group health plan can be daunting. Preparing the right questions can be one of your most effective tools.

KAISER FOUNDATION HEALTH PLAN INC.— HAWAII
Medicare Sales: 808-432-5915 | www.kp.org
For more information on resources available to everyone, visit healthy.kaiserpermanente.org.
This information was provided by the Hawaii Kaiser Permanente Medicare Team as an educational resource.

Preparing yourself with the proper tools helps to make any job a bit easier. If you are baking, you need the proper ingredients. When building something, you need hammers, nails and other related items. It’s the same when you are preparing for your Health Plan Open Enrollment session; or if you are a caregiver, for…
Options for Paying for Long-Term Care

In life, we always have options. And when it comes to covering the costs of long-term care, it is no different. In this article, I’ll share a few viable strategies you can use to help cover the future costs of care in our Aloha State. It is by no means all-encompassing and exhaustive, but meant to get you thinking on this critically important topic.

As a financial advisor, I believe more and more American’s understand the need for long-term care insurance (LTCi). And the first line of defense to ensuring quality long-term care is available when you need it is having a LTCi policy. But when it comes to providing long-term care, we are facing serious hurdles and dilemmas. First is the availability of LTCi. Twenty years ago, there were over 100 carriers providing LTCi. In 2020, there are less than 10 quality LTCi carriers. The fact that big players are withdrawing from the LTCi market is opening eyes and shaking things up. At my Honolulu practice, I also routinely see the difficulty of qualifying for LTCi coverage. Carriers have really tightened eligibility standards and constricted their underwriting requirements, especially for women.

Notwithstanding, individuals who want LTCi coverage certainly have options. And there are LTCi strategies your financial advisor can help you with, from spousal benefit sharing to eliminating “riders” such as inflation protection, which can help keep premiums within your budget. At the same time, one needs to remember the proverbial price of paradise truly is applicable to long-term care costs, as well. On the high end of the long-term (or extended-care) scale, the cost is steep. I have recently heard estimates as high as $1 million to simply enter a coveted long-term care facility on the east side of O‘ahu. Some may say that is exorbitant and overpriced, but it is reality. On the least expensive side, the lowest hourly rate for care is about $26 per hour.

When it comes to having LTCi options, the onus and responsibility for seeking out alternatives lies squarely on you. I encourage you to take the time to choose an advisor who is adept in this specialized area of planning. An expert well-versed in LTCi can help your family in more ways than one. When I conduct educational seminars on LTCi, my professional advice to participants is to get price quotes from several insurers.

MUTUAL OF OMAHA
1600 Kapiolani Blvd., Ste. 1200, Honolulu, HI 96814
808-942-8133 | garrett.wheeler@mutualofomaha.com
www.mwheeler.incomeforlifemodel.com
FREE LTCi Seminar Workshop
ʻĀina Haina Public Library, 5246 Kalanianaole Highway
April 28, Tues., 5:30 pm
May 2, Sat., 10:30 am
RSVP: 808-377-2456

In life, we always have options. And when it comes to covering the costs of long-term care, it is no different. In this article, I’ll share a few viable strategies you can use to help cover the future costs of care in our Aloha State. It is by no means all-encompassing and exhaustive, but meant…
Affordable Adult Day Care

Often, families don’t know where to turn when a loved one suddenly needs constant care. Insurance and Medicare plans may cover very few long-term care expenses — or none at all. In the past, nursing homes were the only option for care outside of the family home. However, now there are many home- and community-based services that help support aging in place.

In Hawai‘i, adult day care services, home care and respite services are available. One of the most cost-effective options is adult day care. Programs provide eight to 10 hours of supervised care in a group setting facility licensed by the Hawai‘i Department of Health. Participants are engaged in exercises, music, arts and crafts, enabling them to socialize with their peers. This interaction reduces the clients’ loneliness and isolation, and also provides peace of mind and respite for families.

Day care fees range from $65 to $100 per day and include snacks and a meal. Some centers accept long-term care insurance, Medicaid and/or may be contracted with the state Kūpuna Caregiver Assistance Program. To find an adult day care center near your home or work place, contact the Aging and Disability Resource Center (ADRC) at www.hawaiiadrc.org or 808-643-2372 toll-free.

LIVE WELL AT IWILEI by Kahala Nui
888 Iwilwi Road, Ste. 105, Honolulu, HI 96817
808-218-7777 | www.livewellhi.com

Often, families don’t know where to turn when a loved one suddenly needs constant care. Insurance and Medicare plans may cover very few long-term care expenses — or none at all. In the past, nursing homes were the only option for care outside of the family home. However, now there are many home- and community-based…
A Medicare Miracle

I have spent a decade conducting educational workshops and meeting with individuals transitioning to Medicare or already there. I encourage everyone to explore resources at www.socialsecurity.gov and www.medicare.gov to become knowledgeable before services are needed. I also stress the importance of keeping Medicare cards, medication lists, the names of your physicians and any ongoing health conditions on hand. Designating a family member or trusted friend with the information is essential.

Rosa Elliot celebrating her 91st birthday

Recently, I dealt with my mother’s sudden and unexpected illness. When she was rushed to the hospital by ambulance, she was not in good shape; she would not have been able to provide insurance cards or any information. I was not far behind and was able to provide the triage nurse with current insurance cards, a list of her medications, when they were last taken and the name of her primary care physician. Within a few hours, a hospitalist told me
my mom had only four minutes to four hours to live. The physician started a course of antibiotics and fluids and everyone prayed. The intervention changed the course of her condition.

Within 48 hours, my mom was breathing on her own. I then completely devoted myself to the restoration of my mother’s health. I work side by side daily with therapists, social workers and physicians to assist with her care. I am grateful the Medicare program exists and for the opportunity to see how well it works in an emergency situation.

MEDICARE MOMENT WITH MARTHA
A radio program with Martha Khlopin
KHNR-690AM: Sundays 9:30am–10am
808-230-3379 | getmartha@aol.com

I have spent a decade conducting educational workshops and meeting with individuals transitioning to Medicare or already there. I encourage everyone to explore resources at www.socialsecurity.gov and www.medicare.gov to become knowledgeable before services are needed. I also stress the importance of keeping Medicare cards, medication lists, the names of your physicians and any ongoing health…
Boomers’ Declaration of Independence

When a dear friend got dizzy and fell, she agreed to go to the ER. We tried to help her, but we couldn’t find her insurance card, primary doctor’s name or her spare house keys.

If something happens and you are in need of help, will your family and friends be fumbling at a time when every minute counts?

Do they know where you keep your keys, computer passwords, bank account numbers, meds, medical directives, will and estate plan?

It is critical for baby boomers to gather their documents into one file and let trusted family and friends know the location of this important information. Caregivers can be more effective when they know what you want and have the power to carry out your wishes.

Too many times, I have witnessed frustration, sadness, loneliness and depression when clueless but well-intentioned families misinterpret their loved ones’ wishes and needs because they were not made clear in advance.

Ensure they know your plans by organizing your important documents and let someone know about them for the benefit of all concerned.

LIVING AND CARING MĀNOA
Adult Residential Care Homes (ARCH) since 2001
Call for a complimentary tour:
Todd Pang, Sr. VP | 808-779-8871

If something happens and you are in need of help, will your family and friends be fumbling at a time when every minute counts? Do they know where you keep your keys, computer passwords, bank account numbers, meds, medical directives, will and estate plan?
Workplace Insurance and Medicare

One question that is frequently asked by people about to turn 65 who have health insurance through an employer is:

“Do I need to enroll in Medicare?”

Good question! If you or your spouse are still working when you turn age 65 and have insurance through your employer you may consider delaying Medicare Part A and Part B until you retire if you have Creditable Coverage, which means coverage as good as Medicare.

Or you can choose to elect your Part A, which is premium-free, and delay Part B until retirement. Depending on the size of the group, one plan would be primary while the other would be secondary.

The first step is to contact your (or your spouse’s) HR Department to make sure that your current coverage is creditable and find out how it will work with Medicare before you make your decision. When coverage through your employer ends you will be provided with a Special Enrollment Period that lasts for eight months, in which you will want to sign up for Medicare so you will not incur a penalty.

Another step you might want to take is to contact a licensed, experienced agent to assist you in researching the Medicare Advantage Plans, Medicare Supplement Insurance and Prescription Drug Plans that are available in your area.

COPELAND INSURANCE GROUP
1360 S. Beretania St., Suite 209, Honolulu HI 96814
808-591-4877 | margaret@copelandgroupusa.com

One question that is frequently asked by people about to turn 65 who have health insurance through an employer is: “Do I need to enroll in Medicare?” Good question! If you or your spouse are still working when you turn age 65 and have insurance through your employer you may consider delaying Medicare Part A…
Medicare News!
According to Kathryn Coleman, Director at the Centers for Medicare and Medicaid (CMS), a final rule issued in April 2018 has redefined the “primarily health related” supplement benefit definition. As a result, CMS expects Medicare Advantage plan sponsors to begin offering services for enrollees needing assistance with Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL). Plans are not required to provide any of the services and restrictions may apply, but it is a first step toward utilization of Medicare insurance for long-term services. That’s great news for caregivers of Medicare beneficiaries on limited incomes who did not make provision for non-medical care as they age. The list below details possible options resulting from CMS’s new ruling. This list is not exhaustive.

In-home support for individuals with disabilities and/or medical conditions needing help with ADLs and IADLs

Respite care for caregivers from a personal care attendant or short-term institutional care

Stand-alone memory fitness benefit

Non-Medicare-covered home and bathroom safety devices and modifications to prevent injuries

Transportation to/from doctor visits, the pharmacy or physical therapy with a health aide

Over-the-counter items not covered by Medicare or prescription drug plans

Whether Medicare Advantage plans implement any of these services in 2019, or beyond, there will be a growing interest and high demand for long-term services and support as Medicare enrollees age.

MEDICARE MOMENT WITH MARTHA
A radio program with Martha Khlopin
KHNR-690AM: Sundays 9:30am–10am
808-230-3379 | getmartha@aol.com
According to Kathryn Coleman, Director at the Centers for Medicare and Medicaid (CMS), a final rule issued in April 2018 has redefined the “primarily health related” supplement benefit definition. As a result, CMS expects Medicare Advantage plan sponsors to begin offering services for enrollees needing assistance with Activities of Daily Living (ADL) or Instrumental Activities…
Is It Time for Medicare?

Were you a high school senior in 1972, singing Alice Cooper’s classic hit, “School’s Out” (for Summer)? Then you may be turning 65 soon and wondering if you need Medicare insurance. Figuring it out on your own may leave you clicking through a lot of scam websites and staring at a mountain of brochures and flyers that arrived in the mail. Medicare was created in 1965 to provide security and peace of mind, not cause you to lose your mind, patience or your money.

These tips will help you keep your cool:

◆ Call Social Security at 1-800-772-1213 or visit their website at www.ssa.gov, at least three months before your 65th birthday to ask them to determine your Medicare eligibility and enrollment dates.

◆ Contact the employee benefits specialist for your own or a spouse’s current or former employer to see if you qualify for retiree medical insurance benefits.

◆ Check with Medicare at 1-800-633-4227 or www.medicare.gov to learn about Medicare premiums, late enrollment penalties and Medicare insurance options available in your county.

The peace of mind that comes with understanding how Medicare works will have you humming a different tune: “Summertime” (and the Living is Easy)!

MEDICARE MOMENT WITH MARTHA
A radio program with Martha Khlopin
KHNR-690AM:
Sat., 2 pm–2:30 pm, Sun., 9:30 am–10 am

808-230-3379 | getmartha@aol.com

Were you a high school senior in 1972, singing Alice Cooper’s classic hit, “School’s Out” (for Summer)? Then you may be turning 65 soon and wondering if you need Medicare insurance. Figuring it out on your own may leave you clicking through a lot of scam websites and staring at a mountain of brochures and…
Medicare: Making the Most of Your Health & Drug Plan

Congratulations! You have made your decision of the Medicare Health and Drug Plan for 2013. For many, this might mean that you stayed with the plan that you had in 2012 and for some, you may have looked at the options available in your area and have enrolled with a new Medicare plan. The decision that you made is for the calendar year 2013: so let’s look at some ways that you can use the plan to your “advantage”— after all, they are called Medicare Advantage Health Plans.

When you receive your health or drug plan packet that includes the evidence of coverage and other important information, make sure you and your caregiver take a moment to look at what the plan covers and how to access those services. Also, if you would like someone else to be able to ask questions of your plan on your behalf, take a moment and fill out the “authorized representative” form. This is always better done sooner rather than later.

First, what should we NOT do? We should not assume that your neighbor, friend or family member has the same plan as you and ask them what providers to use. Plans have different rules and different providers. A health maintenance organization (HMO) works very different from a preferred provider organization (PPO). We have seen many a Medicare member be responsible for a medical bill because they went outside the allowable network.

What should we do? Understanding what type of plan you have enrolled in is the first step; we have several different types of plans in Hawai‘i including HMOs (you must use the plan’s network or their contracted providers) PPOs (you can use both preferred providers (and pay less money out of pocket), PFFS (works with any provider who accepts the plan and agrees to treat you) and SNP (special needs plans that are available for those with Medicare and Medicaid), who are the providers and how can you save the most money.

Still have questions, first call your health or drug plan (remember when possible it is best to call later in the afternoon in Hawai‘i and you will have less of a wait time), they are best able to answer the questions about your specific coverage. You can always find the phone number on your membership card.

Are you new to Medicare in 2013? Join us on our “Welcome to Medicare” webinars that are held in February/April/June/August. To sign up for one, go to www.hawaiiship.org and look for the webinar box. Certified SHIP volunteers are also available to help you navigate the Medicare system. We can be reached at 1-888-875-9229. The Hawai‘i SHIP receives a federal grant from the Centers for Medicare & Medicaid Services to provide information and assistance to you regarding your Medicare benefits. The program is located under the Department of Health’s Executive Office on Aging.

Congratulations! You have made your decision of the Medicare Health and Drug Plan for 2013. For many, this might mean that you stayed with the plan that you had in 2012 and for some, you may have looked at the options available in your area and have enrolled with a new Medicare plan. The decision…