Common Questions
Here are the most common insurance questions Lesher Health Solutions receives.
Our insurance brokers are always available to answer any questions and address any concerns you may have. Call us at (813) 675-9226 for any further inquiries.
Reuse of Alphabet letters to ID different things
For some reason, supplement plan designs are identified by letters of the alphabet, namely, “A” through “N” just to confuse the public with Medicare Parts A – D. Supplement letters are PLANS; Original Medicare letters are PARTS.
Time Limits to enroll with guaranteed issue
(when prior existing medical conditions do not matter)
Supplements – Open Enrollment Period – 6 months after the 1st of birth month or during a special enrollment period
Supplements are easier to get when you are young and healthy or during a Guaranteed Issue Period. Supplements may use pre-existing conditions to deny your application outside of those periods.
Supplements provide the greatest access to doctors and medical procedures without the interference or added management restrictions of insurance companies in Advantage plans. If Medicare pays, then the supplements must pay their allotted portion. To get this privilege, you pay for it like auto insurance (up front as a premium). Just as some car owners may pay for auto insurance for 15 years before they ever need to file a claim – but most people buy a plan they can rely-on when and if an accident happens or medical condition/event happens.
Why is Medicare so confusing?
[see full review in resource tab click button “2023 Understanding Medicare Basics”]
Medicare is confusing. It has grown and evolved through multiple steps of legislation; each is a separate piece that gets smushed or buttressed together under an umbrella the US calls Medicare. There is no coherent design structure that fits everything together. Rather each piece has its own set of rules and regulations. Each beneficiary must select the pieces they like and then learn the rules that match those pieces.
Unexpected Penalties
However, buyer-beware; some pieces get mad if you do not pick them right away when you are first eligible (Part B & Part D of Medicare). They will penalize you for the time you missed, if you pick them up later in life. And, that penalty will last for the rest of your life.
Part B – 10% every 12-month w/o coverage
Part D – 1% every month w/o coverage (passed 60 days)
How and when you pay
Advantage Plans (Part C/D) – pay as you go
It is a managed care plan with a network of doctors and step therapy care with pre-approvals for procedures over a certain dollar amount.
The incentive is lower cost and more benefits.
When you use a medical service, you will be charged a flat fee (copay) or a percent share of the cost (co-insurance).Follow the money
Advantage plan insurance carriers are paid, in addition to copays and coinsurance, a dollar value per member from the funds the government collected while you worked (payroll deduction for Part A) and from the money you are paying for Part B out of your social security check. The insurance company makes money by not spending it all. Advantage Plans accept all the risks and costs for keeping you healthy.
Insurance companies must use 85% of the money received as member benefits. That is why healthy members will get more dollar value savings from give-back plans that offset some of the member’s cost for Part B Medicare premium. Healthy members do not use medical services. This option is mostly available with tight HMOs (see “2023 Understanding Medicare Basics”)
Often TV and other ads forget to tell you that you must already be paying/paid the Part B premium to be eligible to apply for an Advantage Plan. Advantage plans replace Medicare Part A and Part B.
What is the best Medicare plan available?
“It depends . . .” and any other answer would be wrong. Medicare is designed for individuals and the local care that will support a person near their residence. The previous answer to why is Medicare confusing should give you a good hint. Selecting the best options available under the Medicare umbrella should be seen as a Match-test. The options selected should match the person.
Principles to remember:
1. The primary reason to have medical insurance is:
a. to live your whole life as healthy as possible
b. to have access to the care you need at the time you need it.
2. All medical costs are linked to the medical services you receive.
These services can be listed without reference to diseases or medical condition.
3. Your cost calculation should include everything that contributes to the total out-of-pocket costs:
a. Premium
b. Deductibles
c. Copays
d. Coinsurance
e. Supplies and Over the Counter items
f. Transportation
g. Prescriptions
4. Factor in the total potential cost-risk or total maximum out-of-pocket costs. These include the what-if questions.
5. REMEMBER that Part D costs are under different rules and cost calculations then the medical piece of a MAPD Advantage plan; an Advantage Plan with Prescription Drugs.
2. Do you travel?
a. Are you willing to find a doctor in-network
b. Travel Frequently or occasionally?
3. How much does it cost to pay for your medications?
a. Use a tool to calculate your prescription costs.
b. Sort results by cost.
c. Everyone’s costs will be different.
4. Identify the medical services the person uses that will impact costs
a. List those services to compare copays and coinsurance with Advantage Plans.
5. Determine each person’s specific factors.
a. Which factor is most important?
b. Where are the compromises?
These are some basic areas that should be addressed.
1. Can you use your current doctors?
a. How much are you willing to pay to always see your doctor?
b. Can you give them up?
c. Which doctors can you give up?
d. If you get sick, is any specialist, ok? or do you want access to other specialists or one that you research and find on your own? Do you want Moffit? Or is Florida Cancer Specialists just fine? Would you want to be able to go to Mayo Clinic in Minneapolis if needed?
e. What is more important, lower cost or higher access to the medical services you may want?
My current insurance company has significantly increased my rate. How can I get a lower rate?
If your current insurance company has increased your rate, you can be sure to find lower rates with Lesher Health Solutions. Our insurance brokers are here to find you the most competitive prices on the market today, and we’ll fit you with an insurance package that suits both your needs and your budget.
Is there a fee for getting an insurance quote?
With us, there isn’t.
Book a no-obligation consultation with our team, and you’ll receive free insurance quotes from different carriers so that you can easily compare and contrast. We work with you to find the right insurance quote, no strings attached.
What is a deductible?
When submitting an insurance claim, a deductible is an amount you’re responsible for before the insurance company covers the rest.
As your dedicated insurance brokers, we do our best to introduce you to carriers with the lowest deductibles so that you barely ever have to pay out of pocket. This way, not only will you shop the most competitive rates, but you’ll also discover trustworthy lenders that prioritize their clients.
How do limits and deductibles impact my premium?
Your premium is how much you pay your insurance company regularly to keep your coverage in place. Depending on the insurance type and specific policies, you can pay your premium monthly, quarterly, biannually, or annually. Limits and deductibles are common factors that affect your premium rates.
An insurance limit is the maximum amount covered when making a claim—usually, the higher your coverage limit, the higher your premium. Our insurance agents can guide you in the right direction when it comes to pinpointing the perfect coverage limit for your needs. And they’ll stay on budget, too!
An insurance deductible is the amount of money you have to pay out of pocket for a covered claim. Generally, you may be able to save money on premiums by selecting policies with higher deductibles. Consult with our insurance professionals to see what’s in your best interest.
When should I review my insurance protection?
At Lesher Health Solutions, we believe it’s a good idea to review your insurance protection at least once a year. Still, if you have gone through a significant life change, it’s best to check in with us as soon as possible.
Get in touch with us now at (813) 675-9226 to schedule an appointment.