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Medicare Insurance

Medicare Advantage

What is Medicare Advantage?

Medicare Advantage plans are some of the most talked about kinds of plans in the world of Medicare. Between the nonstop television commercials promising free stuff, to the endless pieces of mail that rain down on Medicare beneficiaries boasting $0 premium insurance plans, they certainly have become popular, but also very controversial.

The way that Medicare Advantage plans can easily be defined would be all-in-one comprehensive plans that provide a person on Medicare medical coverage, prescription coverage, as well as additional benefits that could include dental, vision, and hearing benefits, as well.

The person purchasing this plan essentially has their Medicare ran through a private insurance company, to which the private insurance company comes in and takes over the risk of covering that individual.

How much does Medicare Advantage cost?

What is the cost? In order to understand the price and cost of Medicare Advantage plans, you must first understand the funding they receive! You see, since these private insurance companies take on all the responsibility in terms of a person's claims, this takes a huge burden off of Medicare's shoulders. Because of this, they agree to fund the private insurance company every month to take care of the person's needs.

Since they receive all this funding, typically the cost of an Advantage plan is very low. In fact, many areas have Medicare Advantage plans available that have no premium at all! That is where all the $0 premium talk comes from. The person that enrolls into a Medicare Advantage plan must still keep their Medicare Parts A & B active in order for their Advantage plan to work (that includes paying their Medicare Part-B premium).

While Medicare Advantage plans do have a lot be excited about, they do have some important downsides that people need to be aware of. Unlike original Medicare with a supplemental plan, you do not have the freedom to go to any doctor in America that accepts Medicare assignment when you are on a Medicare Advantage plan. You are typically assigned a network of hospitals and doctors and either get decreased benefits when going outside of this network, or none at all.

So...What's am I missing?

Medicare Advantage plans also can come with more restrictions, such as referral programs and prior authorizations on certain treatments and/or procedures. Characteristically, they have a larger portion out of pocket expense because Advantage plans typically charge copays for most services provided. Copays can add up! The two most common network types for Medicare Advantage plans are the HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). Your professional insurance agent with Johnson Insurance Co will discuss the differences and what options you may have with your particular situation.

Medicare Advantage is the core Medicare product and we can explain all the details of how it may work for you

Medicare Supplement
or Medigap

Medicare Supplement is becoming very important because it covers medical needs that you may not have any coverage for

What is a Medigap? (Medicare Supplement)

Medigap plans (also known as Medicare Supplement plans) have been around for a long time. These are the types of plans we hear so many tell us, "I think that is what my parents had!" Medigaps have changed quite a bit over the last 20+ years, but the basic principle remains the same. Medicare Supplement plans pay as a secondary insurance after Medicare has paid. Medicare pays 80% of a person's medical bills, and the supplement plan (purchased through a private insurance company) comes in and pays afterward.

The rules are simple: as long as Medicare pays first on a claim, the supplement will pay afterward. On the flip side, if Medicare does not cover something, neither will the supplement plan. This means that since Medicare does not cover things like Part-D prescription drugs, dental, vision, and hearing, neither will the supplement plan. These things must be picked up separately in the forms of Part-D prescription drug plans and Dental, Vision and Hearing plans.

What Kinds Of Medigap Plans Exist?

Medicare Supplement plans are designed by Medicare and then given to private insurance companies to market. This means that the insurance company has actually no say in what the coverage will look like. They take the plans as they are. The two things that the insurance company does control is how much they will charge for monthly premiums and what the rate increases will be going forward.

So the answer to what you've been thinking is... YES! Every insurance company that offers Medicare supplement plans offer the same coverage, just for different prices. The Supplement plans are designed based on what they will cover depending how much Medicare leaves behind. They are all named after letters. The most popular Medicare Supplement plans on the market today are by far the Plan G and the Plan N. Here is a chart of the available plans below.

Medicare Supplement comparison helps to see whats covered

What Plans Are Good?

Today and going forward, it is all about Plans G and N. Plans F and C are no longer able to be purchased due to the MACRA bill that took effect on January 1, 2020. The bill states that any person who was eligible for Medicare before January 1st of 2020 will still have the option of purchasing a Plan F or Plan C with any insurance company. Plan G is the closest thing to Plan F with it only leaving behind the Medicare Part-B deductible which is charged once per year.

The Plan N also charges this Medicare-Part B deductible, but it also does not cover what is known as Medicare Part-B excess charges. It also charges up to a $20 copay for each doctor visit and a $50 copay for an emergency room visit. The appeal of Plans G and N over a Plan F (even before it was grandfathered away) was they both are much cheaper in terms of monthly premium, with N being cheaper than F and G in most areas.

Medicare Part - D

What Is Medicare Part-D?

Medicare Part-D can best explained as Medicare drug coverage. We often tell our clients that Part-D stands for drugs. D for drugs! Pretty simple? Yes, that part is easy, but knowing everything that is needed to make a good selection with your Medicare Part-D plan can be a bit more complex than just knowing what it does. There are two ways a person can get Part-D coverage:

They can purchase what is known as a Stand Along Part-D Plan or PDP (Prescription Drug Plan). This typically is purchased to pair with a Medicare Supplement.
They can purchase a Medicare Advantage plan that includes Part-D coverage with the plan.

Whether you get your Part-D plan included with an Advantage plan or on its own with a stand alone plan, they both are structured in the same format and work relatively the same way. Let's dive into that a bit further!

The Tier System & Formulary

Part-D plans determine their coverage by having unique formularies. A formulary can best be explained as a large list that is made up of hundreds (and maybe even thousands) of medications. This formulary is going to determine what medications the plan will cover, and how well it will cover them. In the Medicare world, they have a tier system. Tiers can be explained as categories that different medications are placed into to determine how well the plan will cover said drug. Typically, plans will have tiers 1-5, with 1 being the lowest and 5 being the highest. The higher the tier, the higher the copay. It is common for tiers 1 and 2 to be your generic medications, and for tiers 3 and 4 to be your brand name medications, with tier 5 being your specialty medications.

One important element that can make a difference between one Part-D plan opposed to another, is that different Part-D plans can determine which tier they are going to place a certain prescription into. For example, company A can decide to place a medication in their tier 2. Company B can decide to put the exact same prescription into tier 3, causing the cost to dramatically increase in comparison to company A.

Medicare Part D is available through Johnson Insurance Co in the Hart County, Franklin County and Elbert County area

Health Insurance

Affordable Care Act
(Marketplace)

What Are ACA Plans?

The Patient Protection and Affordable Care Act, more commonly referred to as the ACA, was signed into law during President Obama’s term in 2010. This is why so many people also refer to these plans as Obamacare. The goal of the ACA was to improve the accessibility, affordability, and quality of health insurance across the country. Prior to the ACA, many Americans struggled to afford or even obtain health insurance because of pre-existing medical conditions. Obamacare significantly reduced the number of uninsured people in the U.S. ACA plans are sold on the Marketplace or Exchange. Individuals and families can enroll in an ACA plan rather than an employer-sponsored or private plan. Pre-existing conditions won’t prevent you from enrolling in an ACA plan. In addition, many people receive tax credits and subsidies to reduce their premiums.

Every ACA plan must include the ten Essential Health Benefits (EHBs). These ten benefits include:

Hospitalization
Emergency services
Ambulatory services
Prescription drugs
Maternity and newborn care
Mental health and substance abuse services
Lab tests
Chronic disease management, preventive, and “well” services
Pediatric dental and vision care
Rehabilitative services

HMO vs PPO: Which Insurance Plan Is Right for You?

You’ve got options when it comes to health insurance. The most important thing is to understand the type of plans available, so you can pick the one that fits your and your family’s needs. Two of the most common plan types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

- HMO Insurance Plans

HMO insurance plans require members to get care within their network of doctors and hospitals. You will only have coverage if you stay within the network. You’ll select a primary care physician who will coordinate all the care you receive, even from specialists. Usually, the premiums and out-of-pocket costs for HMO plans are cheaper than those of PPO plans.

- PPO Insurance Plans

PPO insurance plans also use networks but give members more flexibility. You can receive care outside the network, though you might pay more if you choose to do so. You won’t have to choose a primary care physician or obtain referrals to see specialists.

How Much Do ACA Plans Cost?

The Affordable Care Act did more than just provide us with new health insurance options. It also included many provisions that expanded eligibility for Medicaid, prohibited discrimination based on pre-existing conditions, and allowed for premium subsidies for individuals and families with limited incomes. Premium tax credits reduce the premium you pay for an insurance plan purchased through the ACA. Not everyone will qualify for a tax credit as they are based on your household income. You’ll answer questions about your income during the application process. At that time, you’ll find out if you’re eligible for subsidies.

You’ll also have deductibles, coinsurance, and copayments, all based on which plan you choose. Plans are categorized by metal tiers. Platinum plans offer the most coverage, with Gold, Silver, and Bronze following.

When Can I Enroll?

The Affordable Care Act has an annual open enrollment period that begins November 1 and ends January 15 in most states. Some states enjoy longer enrollment periods. If you enroll in Obamacare by December 15, your coverage will begin on January 1. If you enroll after December 15, coverage begins on February 1. However, many people qualify for a Special Enrollment Period. If you’ve had a sudden life change, you can enroll in an ACA plan at any time of the year. Some qualifying life events include a change in employment, marriage, divorce, moving to a new city, and having a child.

Get Help Choosing Health Insurance

Health insurance is confusing. The good news is that you don’t have to do it alone! The independent insurance agents at Johnson Insurance Co will guide you during your selection, taking the time to understand your health needs and budget.

Even if it’s not Open Enrollment, we can still start looking at ACA health insurance options for you. Remember, you may qualify for a Special Enrollment Period and might be able to get the coverage you need sooner than you think. Call us today to get started!

Dental, Vision
and Hearing Insurance

Why Dental Is Important!

According to the Kaiser Family, 2 out of 3 people on Medicare have no dental coverage. This is a major problem. Dental care is truly a medical need. Studies show that when a person has no dental coverage, they are far more likely to put off routine dental visits and checkups strictly because they dread having to pay for the entire visit out of pocket.

It's true that certain Medicare Advantage plans can come with some dental coverage, but in many cases, what they provide simply is not enough for someone with substantial dental expenses. Having dental insurance can be a significant asset. Its most valuable purpose isn't for the expected routine checkups, it's for the unexpected big expenses.

Are Dental Vision & Hearing Plans Worth It?

Truth be told, Dental Vision & Hearing insurance or DVH plans, can be a bit polarizing. Sometimes they do not look like people expect them to look. At times, people can be underwhelmed with the benefits they actually provide. However, I feel if they are put into proper context as to what they actually do vs what they do not, you can find that they can be very good programs for certain people if they have the needs that a DVH plan can fill.

First things first, it is important to understand that Medicare by itself typically does not cover dental vision or hearing needs. This causes a fairly large hole in terms of what a person might need when they retire. DVH plans can be a great solution to that. Plans exist that act as dental-only insurance plans and plans exist that act as all three built into one plan. Options do exist! First thing we can do here is to understand the characteristics of a DVH plan.

What Do These Plans Look Like?

It is common for DVH plans to typically have limitations in the first year of coverage. There are some exceptions to this, but normally, a DVH plan will have waiting periods in the first 12 months of coverage. It is common for a plan to include coverage immediately for things like preventative dental (cleanings, x-rays, and exams), while major dental work like bridges, crowns, and root canals will come with a typical 12 month wait before any coverage will be provided. Some plans will offer same day coverage on these major services but at a reduced percentage.

Normally DVH plans will have a maximum benefit payout amount per year. What this means is that once the plan has paid out this maximum payout amount per year, the plan will not pay any more claims until the next policy year. These maximums, depending on insurance company and part of the country, can be anywhere between $1000-$5000. Plan availability will certainly vary.

Short Term Health Plan

Short Term Medical Insurance Is An Alternative To The Marketplace

Few people know about insurance polices known as Short Term Medical plans. They have a pretty interesting history and they actually can be good fits for the right situation. However, they are not a fit for everybody. Short Term plans originally were created to cover an individual that needed insurance on a very short term basis (hence the name Short Term Medical). At their birth, they would cover somebody for usually a few months at a time often times in a situation like if someone was in-between jobs and had a gap of insurance for possibly a few months.

For the longest time they were never looked at as anything more than that. In the last 5 years plus however, they have started to be looked at as a viable long term insurance option for people who meet certain parameters and find themselves in certain situations. What we are seeing now is plans in some areas that will cover people for up to 2-3 years at a time and provide much more of a long term solution if work insurance isn't an option and a subsidy is not possible on the marketplace under the ACA (affordable care act).

When Are Short Term Plans A Good Option?

I would describe the best candidate for a short term medical plan as follows:

High income: Why does this matter? It is actually quite simple. The higher the income, the less likely someone is to qualify for a premium subsidy under a Marketplace plan with the Affordable Care Act guidelines. In most areas, if you compare a marketplace plans monthly cost without assistance with that of a Short Term Medical Policy, it is usually more favorable on the Short Term policy. Marketplace plans without subsidy's can often times be rather expensive. If you qualify for a premium subsidy however and are not in a higher tax bracket, a marketplace plan would likely make more sense for you.
Good health: Why does this matter? Well, Short Term Medical plans do come with some kind of health questions and underwriting so it can affect your eligibility. On top of that, Short Term Medical plans also have more limitations on covering things such as pre-existing conditions, preventative care, and more. If you have lingering health concerns, you are likely going to be better off on a marketplace plan because they do not have these limitations and are not allowed to ask you health questions.

Life Insurance

Life insurance is an important investment to make, and Johnson Insurance Co. is here to make sure you get the coverage you need. Our experienced team, including independent licensed insurance agents, will work with you to find the right plan for your unique situation.

Your family is important to you. You want to do everything you can to protect their future. Proper planning with a life insurance agent can help you and your family avoid financial issues after the death of a family member.

Whether you just got married, divorced, started a family or purchased a home, consider your individual circumstances and the standard of living you wish to maintain for those who may depend on you.

TERM LIFE INSURANCE

Term life insurance protects you for a specified period of time – ranging from one to 30 years – and pays a death benefit only if you die during that specified term of the policy. That's why it's commonly referred to as temporary life insurance.

You may benefit from buying term life insurance if you:

Need coverage only for a specific period of time
Need more coverage but have a limited budget
Have limited funds

PERMANENT LIFE INSURANCE

Permanent life insurance, which includes whole life and universal life, is an appropriate way to meet long-term needs. Over time, it may be the least expensive form of life insurance since premiums are fixed and the policy accumulates cash value on a tax-deferred basis.

You may benefit from buying permanent life insurance if you:

Have a high net worth and are seeking a tax-advantaged product
Understand that permanent insurance is a long-term commitment
Need insurance for estate planning purposes
Want guaranteed life insurance for life

Universal Life Insurance - Life can be unpredictable — we'd do anything to help protect our family after we're gone. Universal life insurance provides the death benefit protection you need with cash value growth potential. It also gives you the option to access your death benefit early in the event of a qualifying chronic, critical, or terminal illness.

Whole Life Insurance - Whether you are just starting out or planning for retirement, Guaranteed Whole Life insurance is designed to protect you and your family for your entire life. You will gain a sense of security knowing this permanent life insurance can never be canceled as long as you pay the premiums.

Guaranteed whole life insurance offers a wide range of additional guarantees:

Guaranteed premiums remain level and will not increase while the policy is in force.
Guaranteed cash values accumulate on a tax-deferred basis allowing you to start planning right away.
Guaranteed insurability means that once the policy is in force, your classification will never change, unless it is to your advantage.
Guaranteed paid-up values are stated up-front for each policy year so you know where you stand if you should decide to stop paying premiums.

Annuities

One to Grow On

Investor's today want the potential to capture investment growth and protection against the market moving in a downward path. But low-risk strategies like bank deposit accounts have offered historically low yields for a very long time, leaving few options outside of equity markets. Annuities can help! They are long-term solutions designed for investing and retirement, and their many options and benefits can make them an important part of any financial strategy.

Structured Annuities

Also known as registered index-linked annuities (RILAs), structured annuities offer investors balance, control, and flexibility to help make their financial future more predictable.

Upside potential
Downside protection
Pay less

Variable Annuities

Variable annuities are long-term, tax-deferred vehicles designed for retirement purposes and are subject to investment risk, including possible loss of principal. Variable annuities also offer greater opportunity to share in potential market gains along with these four main features:

Wide selection of investment options
Tax-deferred earnings accumulation
Guaranteed death benefit options
Guaranteed lifetime payout options

Our Products

Medicare Insurance

Medicare Advantage

What is Medicare Advantage?

How much does Medicare Advantage cost?

So...What's am I missing?

Health Insurance

Affordable Care Act (Marketplace)

What Are ACA Plans?

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HMO vs PPO: Which Insurance Plan Is Right for You?

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- HMO Insurance Plans

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- PPO Insurance Plans

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How Much Do ACA Plans Cost?

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When Can I Enroll?

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Get Help Choosing Health Insurance

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Life Insurance

Life Insurance

TERM LIFE INSURANCE

PERMANENT LIFE INSURANCE

Annuities

Annuities

One to Grow On

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Structured Annuities

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Affordable Care Act
(Marketplace)