Northeast Ohio Medicare Insurance Guidance by Strachan-Novak Insurance Services

If you’ve turned 65 or are getting close to it, you’re likely swamped with information about Medicare plan options such as prescription drug plans, supplemental health insurance policies and Medicare Advantage plans.

Some folks may enjoy the challenge of figuring out the process of choosing health insurance coverage. After all, it’s important to choose the right coverage for your needs. However, if you’re not one of them, consider an appointment with a licensed sales agent who can help you navigate through the various options and help you get the right coverage for your health care needs.


Finding a Fit

Brokers (or agents) are licensed by the state and undergo annual required training and testing by the plans they sell.

There’s no cost for the service offered by a licensed sales agent because the agent is paid a commission by the private insurance carrier based on your enrollment in the plan.

 Consider meeting with an agent before you turn 65 so you can anticipate costs and coverage. Caregivers or family members who are helping make these decisions can participate in the meeting, too.


A licensed sales agent assures that your enrollment application gets properly completed, follows up with the carrier to ensure timely processing, and provides notification of your enrollment status.

The agent also will research prescription drug plans (PDP) because each has a list of covered drugs. An agent can help determine if your drugs are covered,  the co-pays associated with a plan and which plans to offer the best benefits for your situation.

In addition, the sales agent also verifies that your doctors, hospitals and other medical providers are in-network. This is an important step before selecting a plan because many Medicare plans have a network of doctors that they use.

An agent follows up annually to discuss changes to your medical needs, to discuss any upcoming changes to your current policy, and to provide updates on the health insurance industry.

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A Insurance Philosophy: Protect Yourself, Loved Ones

Each year when “life happens,” we’re reminded of the importance of life insurance.

You may recall the story of former NFL quarterback and now radio and TV sports broadcaster Boomer Esiason and the effects of having no life insurance.

Boomer was 7 when his mother died of cancer. She had no life insurance. His father was left to raise him and his two sisters alone.

Boomer related, “We lived paycheck to paycheck, but my dad did an incredible job taking care of our family. He taught me the true meaning of what it means to be a responsible dad.”

It was his father’s sacrifice that motivated Boomer to protect his family with life insurance. Boomer explained to an interviewer, “Life insurance is about protecting the future and the people you love, which is especially the case when you are caring for someone with special needs.”

Boomer’s oldest son, Gunnar, was diagnosed with cystic fibrosis at age 2.


Life insurance can do some pretty amazing things for loved ones. It can buy time to grieve when clients utilize Final Expense Life Insurance, which takes care of funeral, burial and other end-of-life expenses. Life insurance also reduces stress on surviving family members and may provide financial security.

If you own an old policy, it may be time to review it for expiration dates, named beneficiaries and death benefits. Any policy written before 2006 needs reviewed. Those in the retirement planning business see policies every day that are underfunded, which means the policy is not going to be considered valid.

Do you remember the beneficiaries in all of your policies? With an out- dated policy, a beneficiary you want now might not be who is listed. That can cause strain for family members left behind.

After you review your life insurance policies, encourage your children and loved ones to get life insurance.

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New Rules – Medicaid, Your House and Big Change

Ohio has made a significant change regarding homeowners who apply for Medicaid benefits for nursing home or assisted living care.

Until July 31, 2016, an unmarried homeowner who wanted Medicaid to pay for long-term care costs had 13 months to put his home up for sale. If the Medicaid applicant was married and the spouse still lived in the home, there was no obligation to sell.

That 13-month time period is gone. As part of the Aug. 1, 2016 change in rules, Ohio Medicaid rescinded the 13-month rule. Now, the unmarried applicant must decide to keep the house or to sell before applying for Medicaid.


If the person decides not to sell, he can choose to invoke Medicaid’s “intent to return home” condition. That means he is not required to sell the house before getting Medicaid coverage. The intent must be expressed in a written, signed statement. This exemption ends if he later establishes a “principal place of residence” elsewhere.

This new “principal place of residence” condition can jeopardize Medicaid coverage.

If someone has been in a nursing home or assisted living community for many months (not for rehabilitation purposes) it’s unlikely his home can still be called his principal place of residence.

If the person’s health isn’t likely to improve, the principal place of residence has probably become the nursing home or assisted liv- ing community. Even if the intent to return home is real, it may not be realistic. As a result, Ohio Medicaid may stop paying expenses for someone whose intent to return home is not realistic.

For now, it’s uncertain if Medicaid will challenge an applicant’s written statement of intent to return home. Upon renewal of Medicaid benefits, however, if he remains in the nursing home or assisted living community, Medicaid officials may rule the person’s house is no longer his “principal place of residence” because, by the time of the first renewal, he will have lived out of the house for at least a year.

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Medicaid Changes – “Too Much Income” to Qualify? What Does That Mean?

On Aug. 1, 2016, the Ohio Department of Medicaid drastically changed eligibility rules for Medicaid benefits for people who are disabled and others who need long-term care.

My column in the September/ October 2016 issue of this magazine highlighted three significant changes in these new rules: How Medicaid deals with the applicant’s home, how Medicaid treats retirement funds that belong to an applicant’s spouse, and the applicability of a rule (new in Ohio) that bars Medicaid coverage for people who have too much income.


As I wrote in the last issue, “too much income” sounds weird. But because Medicaid provides money for medical coverage for the poor, having “too much income” can make someone ineligible for help.

Those whose gross income is higher than $2,199 per month are ineligible for Medicaid coverage for long-term care. (That amount is adjusted from time to time to compensate for inflation.) That $2,199 is not enough to pay for long-term care for most people; it would cover a few hours of home care each week.

Because the amount of income that blocks eligibility is not enough to keep up with the costs of long-term care, a method has been created to make it so that only part of a Medicaid recipient’s income actually counts as income. As an aside, don’t look for logic here. This stuff is crazy. It’s what satisfies the rules, though. The only explanation I can offer for this “too much income” thing is that these are the rules.

To make some income not count as income for Medicaid purposes, recipients can run some of their income each month through a Qualified Income Trust, commonly referred to as a Miller Trust.

“Qualified Income” is not counted as income for Medicaid eligibility purposes, and the monthly money that goes through the Qualified Income Trust is “Qualified Income.” The result is someone can become (or remain) eligible for Medicaid help with long-term care costs by using a Miller Trust.

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The A, B, C and Ds of Medicare: What Covers What?

Trying to figure out the different parts of Medicare can be confusing. That’s because each part (A, B, C and D) provides different benefits. When you’re ready to enroll, it’s important to understand those differences. Here’s the skinny:


Provided by the federal government at no cost to most people, Medicare Part A covers care you receive in a hospital, in a skilled nursing facility or through home health care and hospice care. You are eligible to begin receiving benefits when you turn 65.


An optional plan that requires a premium, Medicare Part B covers several medically necessary services that are not covered by Part A. These include outpatient care, ambulance services, durable medical equipment, preventive care and part-time intermittent home health/rehabilitative care. You can enroll in Part B at the same time you enroll in Part A.


You can get Medicare Part A and Medicare Part B together in a plan managed by a private insurance company, like Medical Mutual. This is known as Medicare Part C or Medicare Advantage. Offered in contract with the federal government, these plans offer additional benefits, like prescription drug coverage. Medicare Advantage plans may require a monthly premium in addition to the Original Medicare Part B premium. You must live within the plan’s service area.


Also offered by Medical Mutual and other private insurers, Medicare Part D is an optional prescription drug plan available to anyone enrolled in Medicare Parts A and B. Premiums and out-of-pocket expenses can vary depending on the plan you choose. You must live within the plan’s service area.

I hope this gives you a glimpse of all the parts of Medicare. With a little more research, you can learn more and decide what best fits your needs.

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Medicaid Changes – Prepare and Plan for New Rules

On Aug. 1, 2016, the Ohio Department of Medicaid drastically changed eligibility rules for Medicaid serving people who are disabled and people who need long-term care.

These changes will affect people at the time they need/want Medicaid coverage and make it even more important for people to think ahead about the time that they will need long-term care.


Those are weird words to write: too much income. However, in the weird world of Medicaid for long-term care, they are real. Anyone with gross income above the Special Income Level (currently, $2,199.00 per month) triggers a new requirement in Ohio’s Medicaid rules on how the so-called “excess income” must be handled each month.

Income above $2,199 must be transferred from the person’s account(s) into a separate account in the name of a Qualified Income Trust (also known as a QIT or Miller Trust).

Money in a Miller Trust must be paid out each month as part of the person’s share in his long-term care costs. The amount of money that the person spends and the amount that the person keeps are the same under the new rules as they were under the old rules.


Under Ohio Medicaid’s old rules, a single person applying for Medicaid for nursing home or assisted living costs had 13 months after the beginning of eligibility during which to decide whether he couldreturn home. If unable to return home, then the Medicaid recipient had to put his house up for sale by the end of month 13. While the house was for sale, Medicaid eligibility would continue.

Under the new rules, a single person cannot automatically wait for 13 months. The person must either make a written declaration that he intends to return home, or the house must be sold.

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Cases & Controversies – An Open Enrollment Guide for Newcomers

For you pros at Medicare open enrollment, you know that this is when you review your Medicaid Advantage Plan, Supplement and Drug plans to make sure you are set for another year.

For newbies, there are some legal issues regarding Medicare coverage that don’t get much publicity but are very important.


Many people incorrectly think that Medicare won’t pay much for skilled care such as rehabilitation, therapy, wound dressing and other daily health needs in a skilled facility or at home. Services and Medicare billing are stopped quickly because they think that Medicare will not pay anymore if the patient is not showing “improvement” or he “fails to progress.” This idea has become pervasive in health care, and people simply accept it as the law.

However, “improvement” is not the standard by which Medicare can stop paying for skilled nursing care; it never has been. A 2011 federal class action lawsuit against Medicare was filed to help clarify coverage for millions of seniors. The government settled the case in 2012 by agreeing that under federal law people cannot be denied coverage for skilled care just because they have reached a plateau and are not improving.

Coverage is necessary if the person needs skilled care to maintain his or her condition, prevent complications or to not backslide. This is a maintenance standard, not an improvement standard.

Medicare also was required to educate all seniors receiving Medicare and all Medicare skilled care providers about the corrected policy. The Centers for Medicare and Medicaid (CMS) agreed to do so.

In 2014, they released instructions and updated Program Manuals for Medicare billing and appeals agencies. They issued a fact sheet to inform providers and the public about the change. They were supposed to spot check nursing homes, home health care agencies and other providers to make sure they were using the correct standards.

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It’s that Time, Again – Medicare Open Enrollment: Make the Most of It

You signed up for Medicare when you turned 65. Like most people, you probably breathed a sigh of relief, thankful that your health insurance decisions were settled.

But wait — not so fast. Didn’t any- one tell you about Medicare Open Enrollment?

Confused? So is everyone else.

Never heard about Medicare’s Open Enrollment period? If you are over age 65, you’ll soon find your mailbox jammed with official-looking envelopes from insurance companies competing for your attention. While it might be bewildering, it can also mean good news for you.

Many people find their initial enrollment in Medicare to be overwhelming. They often make mistakes. They may pick a plan that doesn’t cover the doctors or hospitals they prefer. Maybe there is a change in health or they chose a prescription drug plan that doesn’t cover their prescriptions. For whatever reason, they find they are locked into insurance coverage that simply does not fit their needs.

Medicare’s open enrollment is a chance for a do-over. It is an annual opportunity to take a close look at all the other Medicare health insurance options. It’s your chance to make changes that benefit you. Medicare’s open enrollment period begins every year on Oct. 15 and closes Dec. 7. During this period, people who have previously signed up for Medicare can:

• change from Original Medicare to a Medicare Advantage plan

• change from a Medicare Advantage plan back to Original Medicare

• switch from one Medicare Advantage plan to a different Medicare Advantage plan

• join a Medicare prescription drug plan

• switch from one Medicare prescription drug plan to a different Medicare prescription drug plan

• drop Medicare prescription drug coverage completely

Any changes made during this open enrollment take effect Jan. 1 of the following year.


Those covered by a Medicare Advantage plan or Prescription Drug plan will receive an Annual Notice of Change from their insurer outlining changes to their plan for the following year.

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