Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Before I get into the question, I want to say how happy I am to be once again running Ask the Medicare Specialist in the Trib. It will appear every Sunday on Page C2. The columns are designed to help educate those already or soon to be on Medicare. Unfortunately, with all the television advertising, phone calls, solicitations in the mail, choosing a plan that meets one's needs as far as coverage, cost, access to doctors and care, can be overwhelming. Medicare plan advertising and sales tactics have also become extremely deceptive, especially in the past two or three years. The goal of Ask the Medicare Specialist is to enlighten people on all the facets and intricacies of Medi- care, to help clear up the confusion and make sure seniors don't fall victim to bad advice or misleading information. QUESTION: Question from John: I was separated by my employer in January after 31 years of service. I have employer paid health coverage through March 31st of 2024. At that point I will be 63 and need to acquire another policy until I qualify for Medicare. Are you able to help me do this? And when is the best time to begin my search to bridge the gap in coverage? ANSWER: Let me first explain there are only two companies who offer individual "major medical health insurance in Western Pennsylvania, Highmark and UPMC. Major medical limits how much one can be billed for medical services and pre- scription drugs in a calendar year. I can't stress how important that is. Companies not named Highmark or UPMC do not sell Major Medical policies. They offer either indemnity plans, which pay on a schedule and rarely cover anywhere near the full cost of services, or faith-based plans which also cannot guarantee full payment for care. DO NOT BUY THESE TYPES OF PLANS! Those who do are putting themselves at risk of tens, if not hundreds of thousands of dollars in bills in the event of cancer, a lengthy hospital stay, complications from surgery, the need for expensive medications, and other high dollar services. Individual health plans through the ACA are surprisingly affordable for most people because as of March 2021, removed and subsidies that help pay for premiums increased. Let's use John as an example. I'm going to assume he's married, and his wife is also 63. If their Modified Adjusted Gross Income is going to be $80,000 in 2024, their premiums would be between $0/month for a high deductible Bronze level plan, to $481/ month for a $0 to $1000 deductible Gold level plan. ACA premiums are almost 100% determined by income. If John's in come were going to be lower in 2024, so would his premiums for a Gold plan, the most popular choice among our clients. If his income is going to be larger than 80K, the premiums would be as well. John asked when is the best time to begin his search? For those considering retirement before turning 65, doing so at the end of a year is usually a good idea if possible, and the planning should start around six months prior to the last day employer coverage ends. Although he doesn't need the new insurance until April 2024 and he can't apply for coverage until February 1, we scheduled his appointment for the end of Septem- ber. We did so because there are legal loopholes we can use to limit income in the years he's going to need coverage which can possibly save him thousands of dollars in premiums as well as co-pays and deductibles. I want to go over some scenarios and premiums based on different income levels to give him plenty of time to talk with his tax preparer and financial advisor. I wish I had the space to explain this in more detail. But as I wrote above, it's all very complicated. If you have questions, reach out to one of our offices or email me personally. One other very important fact I want to mention and something that is making headlines is that up to a million Pennsylvanians and 14 million Americans income limits to receive tax credits were are expected to lose Medical Assistance Answer: John, helping those like yourself who retire prior to going on Medicare, the self-employed, or em- ployees who don't get coverage through their job get health insurance is one of our areas of expertise. We've been doing it since we opened in 2008 and under- stand the Affordable Care Act (ACA), aka Obamacare, better than anyone. It's very confusing and there are many pitfalls for those who aren't careful. Trying to choose a plan and enroll on one's own or over the phone is not wise. And there's no reason to attempt it because just like with Medicare, all consultations with me or another agent at The Health Insurance Store are no cost and premiums are no different when using our services versus going straight through an insurance company. (MA) in the coming year due to the COVID State of Emergency ending. These people wouldn't have qualified to stay on Medical Assistance had it not been for COVID. Those who are currently on, but no longer meet the criteria will get notice in the mail about two weeks prior to their renewal date stating that if they no longer qualify or do, but don't send in the necessary documentation, they will lose coverage at the end of the following month. It's so important that those who don't qualify apply for an ACA health insurance prior to that MA end date. If you know anyone who is currently on MA, please remind them to watch out for this letter or call their caseworker to see what month they are scheduled to renew. If they will indeed be losing coverage, they need to call us so we can help them choose a plan. So many people have become used to getting MA without needing to reapply. they're being caught off guard and end up without insurance. Those who no longer qualify need not worry, especially households who are just over the income limit for MA, which is 138% of the Fed- eral Poverty Level. Plans for those under 200% have low premiums and little or no deductibles along with very affordable co-pays for medical services. A reminder to those of you who enjoy the columns, we have a Facebook group with the same name. Those who join will have access to exclusive content, Truths, Tips, and Tricks where we briefly go over rules, regulations, and intricacies of Medicare and how to navigate them so not to waste money, and Feel Good Friday's where we describe an issue one of our clients had and how we fixed it to remove that stress and financial burden. Go to our website and click on the ban- ner at the top of the page to join. Thanks for reading everyone! The Health >>> 724-603-3403 Connellsville 412-349-8818 Forest Hills Insurance Store.r No-cost, unbiased Medicare plan review and consultation with local, licensed agents Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com Paid Advertisement Ask the Medicare Specialist by : Aaron Zolbrod Before I get into the question , I want to say how happy I am to be once again running Ask the Medicare Specialist in the Trib . It will appear every Sunday on Page C2 . The columns are designed to help educate those already or soon to be on Medicare . Unfortunately , with all the television advertising , phone calls , solicitations in the mail , choosing a plan that meets one's needs as far as coverage , cost , access to doctors and care , can be overwhelming . Medicare plan advertising and sales tactics have also become extremely deceptive , especially in the past two or three years . The goal of Ask the Medicare Specialist is to enlighten people on all the facets and intricacies of Medi care , to help clear up the confusion and make sure seniors don't fall victim to bad advice or misleading information . QUESTION : Question from John : I was separated by my employer in January after 31 years of service . I have employer paid health coverage through March 31st of 2024. At that point I will be 63 and need to acquire another policy until I qualify for Medicare . Are you able to help me do this ? And when is the best time to begin my search to bridge the gap in coverage ? ANSWER : Let me first explain there are only two companies who offer individual " major medical health insurance in Western Pennsylvania , Highmark and UPMC . Major medical limits how much one can be billed for medical services and pre scription drugs in a calendar year . I can't stress how important that is . Companies not named Highmark or UPMC do not sell Major Medical policies . They offer either indemnity plans , which pay on a schedule and rarely cover anywhere near the full cost of services , or faith - based plans which also cannot guarantee full payment for care . DO NOT BUY THESE TYPES OF PLANS ! Those who do are putting themselves at risk of tens , if not hundreds of thousands of dollars in bills in the event of cancer , a lengthy hospital stay , complications from surgery , the need for expensive medications , and other high dollar services . Individual health plans through the ACA are surprisingly affordable for most people because as of March 2021 , removed and subsidies that help pay for premiums increased . Let's use John as an example . I'm going to assume he's married , and his wife is also 63. If their Modified Adjusted Gross Income is going to be $ 80,000 in 2024 , their premiums would be between $ 0 / month for a high deductible Bronze level plan , to $ 481 / month for a $ 0 to $ 1000 deductible Gold level plan . ACA premiums are almost 100 % determined by income . If John's in come were going to be lower in 2024 , so would his premiums for a Gold plan , the most popular choice among our clients . If his income is going to be larger than 80K , the premiums would be as well . John asked when is the best time to begin his search ? For those considering retirement before turning 65 , doing so at the end of a year is usually a good idea if possible , and the planning should start around six months prior to the last day employer coverage ends . Although he doesn't need the new insurance until April 2024 and he can't apply for coverage until February 1 , we scheduled his appointment for the end of Septem ber . We did so because there are legal loopholes we can use to limit income in the years he's going to need coverage which can possibly save him thousands of dollars in premiums as well as co - pays and deductibles . I want to go over some scenarios and premiums based on different income levels to give him plenty of time to talk with his tax preparer and financial advisor . I wish I had the space to explain this in more detail . But as I wrote above , it's all very complicated . If you have questions , reach out to one of our offices or email me personally . One other very important fact I want to mention and something that is making headlines is that up to a million Pennsylvanians and 14 million Americans income limits to receive tax credits were are expected to lose Medical Assistance Answer : John , helping those like yourself who retire prior to going on Medicare , the self - employed , or em ployees who don't get coverage through their job get health insurance is one of our areas of expertise . We've been doing it since we opened in 2008 and under stand the Affordable Care Act ( ACA ) , aka Obamacare , better than anyone . It's very confusing and there are many pitfalls for those who aren't careful . Trying to choose a plan and enroll on one's own or over the phone is not wise . And there's no reason to attempt it because just like with Medicare , all consultations with me or another agent at The Health Insurance Store are no cost and premiums are no different when using our services versus going straight through an insurance company . ( MA ) in the coming year due to the COVID State of Emergency ending . These people wouldn't have qualified to stay on Medical Assistance had it not been for COVID . Those who are currently on , but no longer meet the criteria will get notice in the mail about two weeks prior to their renewal date stating that if they no longer qualify or do , but don't send in the necessary documentation , they will lose coverage at the end of the following month . It's so important that those who don't qualify apply for an ACA health insurance prior to that MA end date . If you know anyone who is currently on MA , please remind them to watch out for this letter or call their caseworker to see what month they are scheduled to renew . If they will indeed be losing coverage , they need to call us so we can help them choose a plan . So many people have become used to getting MA without needing to reapply . they're being caught off guard and end up without insurance . Those who no longer qualify need not worry , especially households who are just over the income limit for MA , which is 138 % of the Fed eral Poverty Level . Plans for those under 200 % have low premiums and little or no deductibles along with very affordable co - pays for medical services . A reminder to those of you who enjoy the columns , we have a Facebook group with the same name . Those who join will have access to exclusive content , Truths , Tips , and Tricks where we briefly go over rules , regulations , and intricacies of Medicare and how to navigate them so not to waste money , and Feel Good Friday's where we describe an issue one of our clients had and how we fixed it to remove that stress and financial burden . Go to our website and click on the ban ner at the top of the page to join . Thanks for reading everyone ! The Health >>> 724-603-3403 Connellsville 412-349-8818 Forest Hills Insurance Store.r No - cost , unbiased Medicare plan review and consultation with local , licensed agents Email your question to : aaron@getyourbestplan.com www.getyourbestplan.com