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What Is Covered – Part C “Medigap” (Supplemental Insurance)

What Is Covered – Part C “Medigap” (Supplemental Insurance)

A Medigap policy is private health insurance sold by private insurance companies specifically designed to supplement the Original Medicare Plan. It Offers:

· Added Coverage – Medigap policies cover certain things that Medicare doesn’t cover.

· Lowers Deductibles & Co-Pays – It helps pay some of the health care costs (”gaps”) that the Original Medicare Plan doesn’t cover.

· Standardized Plans – By law, insurance companies can offer only 12 standardized Medigap benefit packages, referred to as Plans A through L. That means that the only difference in any standardized plan, such as Plan J, from one insurance company to another is the price. The benefits are identical.

· Guaranteed Issue Rights – If you are in your Medigap open enrollment period, insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, such as exclusions for or existing conditions, and can’t charge you more for a Medigap policy because of past or present health problems. You may also be able to buy a Medigap policy at other times, but the insurance company is allowed to deny you a Medigap policy based on your health. Also, in some cases it may be illegal for the insurance company to sell you a Medigap policy (such as if you already have Medicaid or a Medicare Advantage Plan).

· Guaranteed Renewable – Your insurance company must automatically renew or continue your Medigap policy, unless you make untrue statements to the insurance company, commit fraud, or don’t pay your premiums.

· Medigap policy only covers one person – If you and your spouse both want Medigap coverage, you each must buy separate Medigap policies.

· Every insurance company must make Medigap Plan A available if they offer any other Medigap policy.

· Not all types of Medigap policies may be available in your state. (e.g Massachussets, Minnesota, or Wisconsin).

· Medigap plans A – J must offer the following basic benefits:
Co-insurance for hospital days 61-90 – ($267/day in 2009) and
– Co-insurance for the 60 lifetime reserve days ($534/day in 2009).
– 100% of the cost of hospital care beyond 150 days covered by Medicare, up to a maximum of 365 lifetime days.
– 20% Co-insurance for Medicare approved charges after the $135 annual Part B Medicare deductible has been met.
– The first 3 pints of blood in each calendar year.
– Plan A has only the basic benefits.

The following Chart recaps Medigap coverage.

· If a check mark appears in the column, this means that the Medigap policy covers 100% of the described benefit.

· If the column lists a percentage, this means the Medigap policy covers that percentage of the described benefit.

· If no percentage appears or if the column is blank, this means the Medigap policy doesn’t cover that benefit.

· The Medigap policy covers coinsurance only after you have paid the deductible (unless the policy also covers the deductible).

Click Here for Medigap Plan A thru L Benefits info

*Medigap Plans F and J also offer a high-deductible option. You must pay the first $2,000 (high-deductible in 2009) in Medigap-covered costs before the Medigap policy pays anything.

** You must also pay a separate deductible for foreign travel emergency ($250 per year).

*** After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($135 in 2008), the plan pays 100% of covered services for the rest of the calendar year.

Medicare Advantage Plans

These Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits and must cover at least all of the medically necessary services that the Original Medicare Plan provides. Medicare Advantage Plans, like HMOs and PPOs, are another way to get Medicare benefits. These plans are health plan options approved by Medicare and run by private companies.

Medicare Advantage Plans may offer extra benefits, such as vision, hearing, dental, and/or health and wellness programs, and most include Medicare prescription drug coverage (usually for an extra cost). Medicare Advantage Plans generally have provider networks. This means you probably have to see doctors who belong to the plan or go to certain hospitals to get covered services. You may need a referral to see specialists.

Medicare Advantage plans include:

· Medicare Preferred Provider Organization Plans (PPO)
A PPO is a specific group of doctors and/or hospitals that provides medical services. PPO members pay for services as they are rendered.

Are prescription drugs covered?
In most cases, yes. Ask the plan. If you want drug coverage, you must enroll in a PPO plan that offers prescription drug coverage.

Do I need to choose a primary care doctor?
No.

Can I get my health care from any doctor or hospital?
Yes. PPOs have network doctors and hospitals, but you can also use out-of-network providers for covered services, usually for a higher cost.

Do I have to see a primary care doctor to get a referral to see a specialist?
In most cases, no. What else do I need to know about this type of plan? You may be able to get extra benefits for an additional premium.

· Medicare Health Maintenance Organization Plans (HMO)

HMOs provide medical treatment on a prepaid basis regardless of how much medical care is needed. HMOs provide a wide variety of medical services, from office visits to hospitalization and surgery. With a few exceptions, HMO members must receive their medical treatment from physicians and facilities within the HMO network.

Are prescription drugs covered?
In most cases, yes. Ask the plan. If you want drug coverage, you must enroll in an HMO plan that offers prescription drug coverage.

Do I need to choose a primary care doctor?
Yes. You generally must see a primary care doctor to get a referral before you see any other health care provider.

Can I get my health care from any doctor or hospital?
No. You generally must get your care and services from doctors or hospitals in the plan’s network (except emergency or urgent care). If the plan has a point-of-service option, you can go out-of-network, but it will cost more.

Do I have to see a primary care doctor to get a referral to see a specialist?
In most cases, yes. Exceptions include yearly screening mammograms and in-network Pap tests and pelvic exams (at least every other year), which don’t require a referral.

What else do I need to know about this type of plan?
– If your doctor leaves, your plan will notify you, You can choose another doctor in the plan.
– If you get health care outside the plan’s network, you may have to pay the full cost.
– It’s important that you follow the plan’s rules, like getting prior authorization when needed.
– You may be able to get extra benefits for an extra premium.

· Medicare Private Fee-for-Service Plans (PFFS)

PFFS is a Medicare Advantage health plan offered by a state licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services to provide beneficiaries with all their Medicare benefits plus any additional benefits the company decides to provide. In most cases, people who join a PFFS are not required to use a network of providers. Beneficiaries can see any provider who is eligible to receive payment from Medicare and agrees to accept payment from the PFFS MAO.

Are prescription drugs covered?
Sometimes. If your PFFS Plan doesn’t offer drug coverage, you can join a Medicare Prescription Drug Plan to get coverage.

Do I need to choose a primary care doctor?
No.

Can I get my health care from any doctor or hospital?
In most cases, yes. You can go to any Medicare-approved doctor or hospital if they agree to the plan’s terms and conditions of payment before treating you. Not all providers will accept the plan’s payment terms or agree to treat you.

Do I have to see a primary care doctor to get a referral to see a specialist?
No.

What else do I need to know about this type of plan?
PFFS Plans aren’t the same as the Original Medicare Plan and they have different rules from other Medicare Advantage Plans.
– PFFS Plans are offered by private companies. The private company, not Medicare, decides how much the plan will pay and how much you pay for services.
– You may be able to get extra benefits for an extra premium.
– Before you join a PFFS Plan, make sure you find doctors, hospitals, and other types of providers willing to contact the plan for payment information and accept the plan’s payment terms.

· Medicare Special Needs Plans (SNP)

SNPs serve certain people with Medicare who are chronically ill with specific diseases or conditions (such as diabetes, congestive heart failure, mental illness, or HIV/AIDS), who live in institutions like nursing homes, or who have other special needs.

Are prescription drugs covered?
Yes. All SNPs must provide Medicare prescription drug coverage. Formularies may be designed to cover the drugs members need most.

Do I need to choose a primary care doctor?
In some cases, yes, or you may need to have a care coordinator help you develop personal care plans and coordinate your care.

Can I get my health care from any doctor or hospital?
You generally must get your care and services from doctors or hospitals in the plan’s network (except emergency or urgent care). Plans typically have specialists for the diseases or conditions that affect their members.

Do I have to see a primary care doctor to get a referral to see a specialist?
In most cases, yes. Yearly screening mammograms and an in-network Pap test and pelvic exam (at least every other year) don’t require a referral.

· Medicare Medical Savings Account Plans (MSA)

MSAs are two-part health insurance programs consisting of a high-deductible health insurance policy and a tax-free investment account set up to fund medical costs not covered by the policy.

Are prescription drugs covered?
No. You can join a Medicare Prescription Drug Plan to get drug coverage.

Do I need to choose a primary care doctor?
No.

Can I get my health care from any doctor or hospital?
Yes. Some plans may have network doctors and hospitals you could go to for a lower cost.

Do I have to see a primary care doctor to get a referral to see a specialist?
No.

What else do I need to know about this type of plan?
– if the year is added to your next deposit.
– Medicare MSA Plans have two parts: a high-deductible health plan and a bank account. Medicare gives the plan an amount each year for your health care, and the plan deposits a portion of this money into your account.
–You can use the money in your account to pay your health care costs. When you use account money for Medicare-covered Part A and Part B services, it counts toward your plan’s deductible. After you reach your deductible, your plan will cover your Medicare-covered services.

· If You Join a Medicare Advantage Plan:

You are still in the Medicare Program.You still have Medicare rights and protections, including the right to appeal.

You still get Part A and Part B coverage.

You generally still pay the monthly Part B premium. You also pay the Medicare Advantage Plan’s premium (if they charge one) that includes coverage for Part A and Part B benefits and prescription drug coverage (Part D, if offered), and any extra benefits (if offered).

You may have to use providers who belong to the plan. If you use providers who aren’t in the network, you may have to pay the entire cost of the covered service.

You must follow plan rules, like getting a referral to see a specialist or getting prior authorization for certain procedures. Check with the plan.

You usually will have to pay some other costs (such as copayments, deductibles, or coinsurance) for the services you get. Out-of-pocket costs in these plans cary by the services you get. Check with your plan before you get a service to find out what your costs may be.

You don’t need to (and can’t) buy a Medigap policy . It won’t cover your Medicare Advantage Plan deductibles, copayments, or coinsurance.

If you see a doctor who doesn’t belong to the plan, your services won’t be covered, or your costs could be higher.

The plan will send you an Evidence of Coverage each year. This document gives you details about what benefits the plan will cover, how much you pay, how to file an appeal, and more. Plan benefits may change each year. The plan will send you an Annual Notice of Change each fall. This notice has information about any changes in benefits, costs, or service area that will be effective in January. If the plan covers prescription drugs, the notice will include changes to the formulary. You should review this notice carefully to learn about changes for the upcoming year to decide if you want to look at other plans in your area.

Medicare offers prescription drug coverage for everyone with Medicare. This coverage is called “Part D”.

· To get Medicare drug coverage, you must either join a Medicare drug plan adding on to your Original Medicare Plan, or join a Medicare Advantage Plan that includes Part D.

· Medicare drug plans are run by insurance companies and other private companies approved by Medicare.

· Each plan can vary in cost and drugs covered.

· If you decide not to join a Medicare drug plan when you are first eligible, you may pay a late-enrollment penalty if you choose to join late.

· If you qualify for extra help and don’t choose a plan yourself, Medicare will enroll you in one.

All Medicare drug plans must generally cover at least two drugs in each category of drugs, but plans can choose which specific drugs are covered in each category. Plans are required to cover almost all drugs in six classes that include anti-psychotics, anti-depressants, anti-convulsants, immunosuppressants, cancer, and HIV/AIDS drugs.

There are certain drugs that Medicare drug plans aren’t required to cover, such as benzodiazepines, barbiturates, drugs for weight loss or gain, and drugs for erectile dysfunction. Some plans may choose to cover these drugs as an added benefit. In addition, drug plans generally aren’t allowed to cover over-the-counter drugs. Some states may cover these drugs if you have Medicaid.

Plans may also exclude certain drugs from coverage. Although your Medicare drug plan may not have a certain drug on its list of covered drugs (formulary), a different drug that is safe and effective for the same purpose will be covered. This may be a generic version of the drug, or it may be another brand-name drug that may provide the same benefit as the drug that isn’t on the plan’s formulary. All plans must have a process for you to ask them to pay for a drug you need that isn’t on their formulary. They may or may not agree to cover the drug.

What Is Not Covered

Items and services that Medicare doesn’t cover include, but are not limited to the following:

· Acupuncture,

· Chiropractic services (with some exceptions),

· Cosmetic surgery,

· Custodial care (such as help with bathing or using the bathroom), except when you also get skilled nursing care in a skilled nursing facility, at home, or in a hospice,

· Deductibles, co-insurance, or co-payments when you get certain health care services,

· Dental care and dentures (with only a few exceptions),

· Eye care (routine exam), eye refractions (exam that measures your ability to see at specific distances), and most eyeglasses (with some exceptions),

· Foot care (routine) like cutting corns or calluses (with few exceptions), Hearing aids and exams for the purpose of fitting a hearing aid, Hearing tests that haven’t been ordered by your doctor,

· Laboratory tests for screening purposes (with some exceptions), Long-term care, for example, if you only need custodial care in a nursing home,

· Orthopedic shoes (with few exceptions),

· Physical exams (routine or yearly). Medicare will cover a one-time physical exam within the first 6 months of enrolling in Part B (co-insurance and Part B deductible applies),

· Prescription drugs. Most precription drugs aren’t covered by Part A or Part B, Shots to prevent illness (with some exceptions),

· Syringes or insulin, unless the insulin is used with an insulin pump, but it may be covered by Medicare Prescription Drug Coverage (Part D), and

· Travel (health care while you’re traveling outside the United States… with some exceptions).

Medigap policies don’t cover long-term care (like care in a nursing home),

Jim Bigelow 918-640-4657

www.jimbigelow.com jim@jimbigelow.com

Coldwell Banker Select

What Is Medicare ? Part 3

What Is Covered – Part B

· Abdominal Aortic Aneurysm Screening (Preventive Service): A one-time screening ultrasound for people at risk (like people who have smoked). Medicare only covers this screening if you get a referral for it as a result of your “Welcome to Medicare” physical exam. You pay coinsurance.

· Ambulance Services: When you need to be transported to a hospital or a skilled nursing facility for medically necessary services, and transportation in any other vehicle would endanger your health. You pay coinsurance, and Part B deductible applies.

· Ambulatory Surgery Center Fees: Facility fees for approved services at an Ambulatory Surgery Center (facility where surgical procedures are performed, and the patient is released the same day). You pay coinsurance, and Part B deductible applies.

· Blood: Pints of blood you get, starting with the 4th, as an outpatient or as part of a Part B-covered service. The first three pints aren’t covered. You pay coinsurance, and Part B deductible applies.

· Bone Mass Measurement (Preventive Service): To help see if you are at risk for broken bones. This service is covered once every 24 months (more often if medically neccessary) for people who have certain medical conditions or meet certain criteria. You pay coinsurance, and Part B deductible applies.

· Cardiovascular Screenings (Preventive Service): To help prevent a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels. No cost.

· Chiropractic Services (Limited): To correct a subluxation (when one or more of the bones of your spine move out of position) using manipulation of the spine. You pay coinsurance, and Part B deductible applies.

· Clinical Laboratory Services: Including certain blood tests, urinalysis, some screening tests, and more. No cost.

· Clinical Research Studies: To help doctors and researchers find better ways to prevent, diagnose, or treat diseases. Clinical research studies test new types of medical care, like how well a new cancer drug works. Usual patient care costs are covered if you take part in a qualifying clinical research study. If the item or services isn’t covered outside of a clinical research study, the cost of the investigational item or service may nor be covered. You pay coinsurance, and Part B deductible applies.

· Colorectal Cancer Screenings (Preventative Service): To help find precancerous growths and help prevent or find cancer early, when treatment is most effective. One or more tests may be covered…talk to your doctor.

· Diabetes Screenings (Preventive Service): To check for diabetes. These screenings are covered if you have any of the following risk factors: high blood pressure (hypertension), dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Tests are also covered if you answer yes to two or more of the following questions: • Are you age 65 or older? • Are you overweight? • Do you have a family history of diabetes (parents, siblings)? • Do you have a history of gestational diabetes (diabetes during pregnancy) or did you deliver a baby weighing more than nine pounds? Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. No cost.

· Diabetes Self-Management Training (Preventive): For people with diabetes. Your doctor or other health care people must provide a written order. You pay coinsurance, and Part B deductible applies.

· Diabetes Supplies: Including glucose testing monitors, blood glucose test strips, lancet devices and lancets, glucose control solutions, and therapeutic shoes (in some cases). Syringes and insulin are only covered if used with an insulin pump, but may be covered by Medicare prescription drug coverage (Part D). You pay coinsurance, and Part B deductible applies.

· Doctor Services: Services that are medically necessary or covered preventive services. Doesn’t cover routine physical except for the one-time “Welcome the Medicare” physical exam. You pay coinsurance, and Part B deductible applies.

· Durable Medical Equipment: Items such as oxygen, wheelchairs, walkers, and hospital beds needed for use in the home. For certain equipment, such as wheelchairs and hospital beds, Medicare pays rental fees for up to 13 months (36 months for oxygen). After this, you own the equipment, and Medicare pays for maintenance. For Medicare to cover your equipment, you must go to a supplier that is enrolled in Medicare. You pay coinsurance, and Part B deductible applies. In some cases, if you buy the equipment without renting it first, Medicare pays no part. New: In 2008, you may have to use certain Medicare-contract suppliers to get certain durable medical equipment in some geographic areas. Call 1-800-633-4227 for more information. TTY users should call 1-877-486-2048.

· Emergency Room Services: When you believe your health is in serious danger. You may have a bad injury, a sudden illness, or an illness that quickly gets much worse. You pay coinsurance, and Part B deductible applies.

· Eye Exams: For people with diabetes to check for diabetic retinopathy once every 12 months. You pay coinsurance, and Part B deductible applies.

· Eyeglasses (Limited): One pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. You pay coinsurance, and Part B deductible applies.

· Flu Shots (Preventive service): To help prevent influenza or flue virus. This is covered once a flu season in the fall or winter. The flu is a serious illness. You need a flu shot for the current virus each year. No cost.

· Foot Exams and Treatment: If you have diabetes-related nerve damage and/or meet certain conditions. You pay coinsurance, and Part B deductible applies.

· Glaucoma Tests (Preventive service): To help find the eye disease glaucoma. This is covered once every 12 months for people at high risk for glaucoma. You are considered high risk for glaucoma if you have diabetes, a family history of glaucoma, are African-American and age 50 or older, or are Hispanic and age 65 or older. Tests must be done by an eye doctor who is legally authorized by the state. You pay coinsurance, and Part B deductible applies.

· Hearing and Balance Exams: If your doctor orders it to see if you need medical treatment. Hearing aids and exams for fitting hearing aids aren’t covered. You pay coinsurance, and Part B deductible applies.

· Hepatitis B Shots (Preventive service): To help protect people from getting Hepatitis B. This is covered (three shots) for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (permannt kidney failure requiring dialysis or a kidney transplant), or a condition that lowers your resistance to infection. Other factors may increase your risk for Hepatitis B, so check with your doctor to see if you are at high or medium risk. You pay coinsurance, and Part B deductible applies.

· Home Health Services: Limited to reasonable and necessary part-time or intermittent skilled care or continuing need for physical therapy, occupational therapy, or speech-related pathology ordered by a doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, home health aide services or other services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies for use at home. No cost for home healh services. You pay coinsurance, and Part B deductible applies for dirable medical equipment.

· Kidney Dialysis Services and Supplies: Either in a facility or at home when your doctor orders it. You pay coinsurance, and Part B deductible applies.

· Mammograms (screening) (Preventive service): A type of x-ray to check women for breast cancer before they or their doctor may be able to feel it. Screening mammograms are covered once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between age 35 and 39. You pay coinsurance.

· Medical Nutrition Therapy Services (Preventive service): Medicare may cover medical nutrition therapy if you have diabetes or kidney disease and your doctor refers you for the service. You pay coinsurance, and Part B deductible applies.

· Mental Health care (outpatient): To get help with mental health issues such as depression or anxiety. Includes services generally given outside a hospital or in a hospital outpatient department, including visits with a doctor, clinical psychologist or clinical social worker, and lab tests. Certain limits and conditions apply. You pay coinsurance, and Part B deductible applies. Note: Talk to your doctor if you feel sad, have little interest in things you used to enjoy, or have thoughts about ending your life.

· Occupational Therapy: Services to help you return to usual activities (such as bathing) after an illness when your doctor orders them. You pay coinsurance, and Part B deductible applies.

· Outpatient Hospital Services: Services you get as an outpatient as part of a doctor’s care. You pay coinsurance, and Part B deductible applies.

· Outpatient Medical and Surgical Services and Supplies: For approved procedures. You pay coinsurance, and Part B deductible applies. Pap Test and Pelvic Exam (includes clinical breast exam) (Preventive service): To check for cervical and vaginal cancers. Medicare covers these screening tests once every 24 months for women at low risk, and once every 12 months for women at high risk and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past three years. No cost for the Pap lab test. You pay coinsurance for Pap test collection, and pelvic and breast exams.

· Physical Exam (One-time “Welcome to Medicare” Physical Exam) (Preventive service): A one-time review of your health, and education and counseling about preventive services, including certain screenings and shots and referrals for other care if needed. Important: You must have the physical exam within the first 6 months you have Part B for it to be covered by Medicare. You pay coinsurance, and Part B deductible applies.

· Physical Therapy: Evaluation and treatment of injuries and disease using various procedures, such as exercises and testing, when your doctor orders it. It may also include heat, light, and ultrasound therapy. You pay coinsurance, and Part B deductible applies.

· Pneumococcal Shot (Preventive service): To help prevent pneumococcal infections (like certain types of pneumonia). Most people only need this preventive service once in their lifetime. Talk with your doctor. No cost.

· Practitioner Services: Such as services provided by clinical social workers, physician assistants, and nurse practitioners. You pay coinsurance, and Part B deductible applies.

· Prescription Drugs (limited): Includes certain injectable cancer drugs or immunosuppressive drugs. You pay coinsurance, and Part B deductible applies. Note: See Part D for additional Medicare prescription drug coverage.

· Prostate Cancer Screening (Preventive service): These tests help detect prostate cancer. Medicare covers a digital rectal exam (You pay coinsurance, and Part B deductible applies for the exam) and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50. No cost for the PSA test.

· Prosthetic/Orthotic Items: Including arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); breast prostheses (after mastectomy); prosthetic devices needed to replace an internal body part or function (including ostomy supplies, and prenteral and enteral nutrition therapy). For Medicare to cover your prosthetic or orthotic, you must go to a supplier that is enrolled in Medicare. You pay coinsurance, and Part B deductible applies.

· Rural Health Clinic and Federally-Qualified Health Center Services: A broad range of primary care services usually provided on an outpatient basis. You pay coinsurance, and Part B deductible applies for rural health clinic services.

· Second Surgical Opinions: Covered in some cases for surgery that isn’t an emergency. in some cases, Medicare covers third surgical opinions. You pay coinsurance, and Part B deductible applies.

· Smoking Cessation (counseling to stop smoking) (Preventive service): Covered if your doctor orders it. Includes counseling for 2 cessation attempts within a 12 month period if you are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco. Counseling for each cessation attempt includes up to four face-to-face visits. You pay coinsurance, and Part B deductible applies.

· Speech-Language Pathology Services: Treatment given to regain and strengthen speech skills when your doctor orders it. You pay coinsurance, and Part B deductible applies.

· Surgical Dressings: For treatment of a surgical or surgically-treated wound. You pay coinsurance, and Part B deductible applies.

· Telemedicine: In some rural areas, under certain conditions and only in a provider’s office, a hospital, or a federally-qualified health center. You pay coinsurance, and Part B deductible applies.

· Tests: Including X-Rays, MRIs, CT scans, EKGs, and some other diagnostic tests. You pay coinsurance, and Part B deductible applies.

· Transplants: Including doctor services for heart, lung, kindey, pancreas, intestine, and liver transplants under certain conditions and only in a Medicare-certified facility. Bone marrow and cornea transplants are covered (under certain conditons. Immunosuppressive drugs are covered if Medicare paid for the transplant, or and employer or union group health plan that was required to pay before Medicare paid for it. You must have been entitled to Part A at the time of the transplant and Part B at the time you get immunosuppressive drugs, and the transplant must have been performed in a Medicare-certified facility. If you join a Medicare Advantage Plan, check with the plan for information on transplant coverage. You pay coinsurance, and Part B deductible applies. Note: Medicare drug plans may cover immunosuppressive drugs, even if Medicare or an employer or union group health plan didn’t pay for the transplant.

· Travel (health care needed when traveling outside the United States): Limited to medical services provided in Canada when you travel on the most direct route through Canada between Alaska and another state. Medicare also covers hospital, ambulance, and doctor services if you are in the U.S., but the nearest hospital that can treat you isn’t in the U.S. (The “U.S.” includes the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). In some limired cases, Medicare may pay for services you get while on board a ship within the territorial waters adjoining the land areas of the U.S. You pay coinsurance, and Part B deductible applies.

· Urgently Needed Care: To treat a sudden illness or injury that isn’t a medical emergency. You pay coinsurance, and Part B deductible applies.

Jim Bigelow 918-640-4657

www.jimbigelow.com jim@jimbigelow.com

Coldwell Banker Select

What is Medicare? Part 2

What is Medicare?

What Is Covered – Part A

This and succeeding sections outline the coverage for “Original Medicare” Part A (Hospital Insurance), Part B (Medical Insurance); Part C (”Medigap”/Supplemental Insurance); Part D (Prescription Drugs); and common Medicare Advantage Plans.

Since the topic includes many details and options we have presented the basics to help you understand the coverage. Please research all the details applicable to your location, in more depth, before selecting and enrolling in a specific Plan.

Part A (Hospital Insurance) Covered Services

·         Blood: Starting with the 4th pint of blood you get at a hospital or skilled nursing facility during a covered stay. The first three pints are not covered.
 

·         Home Health Services: Limited to reasonable and necessary part time or intermittent skilled care or continuing need for physical therapy, or speech-related pathology, ordered by the doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), and medical supplies for use at home.
 

·         Hospice Care: For people with a terminal illness who are expected to live 6 months or less if the disease runs its normal course. Coverage includes drugs, medicinal and support services from a Medicare approved hospice, and other services not otherwise covered by Medicare (such as grief counseling) for terminal and related conditions. Hospice care is usually given in your home (or other facility where you may live). Medicare covers some short-term inpatient stays (for pain and symptom management) and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).
 

·         Hospital Stays: Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient you get in acute care hospitals, critical access hospitals, inpatient care as part of a clinical research study, and mental health care. This doesn’t include private-duty nursing or a television or telephone in your room. It also doesn’t include a private room unless medically necessary. Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.
 

·         Skilled Nursing Facility Care: Semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a 3-day minimum inpatient hospital stay for a related illness or injury) for up to 100 days in a benefit period. To get care in a skilled nursing facility, you must need skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care in this setting. 

 

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

What is Medicare? PArt 1

What is Medicare?

Medicare is a United States Government-sponsored health insurance program available to people in the following categories:

·         age 65 or older; OR

·         under age 65 with certain disabilities; OR

·         any age with End-Stage Renal Disease
     (permanent kidney failure requiring dialysis or a kidney transplant).

Most people get their coverage through the ORIGINAL MEDICARE PLAN. (Unless you choose otherwise, this is the plan you will be enrolled in.)

 

How It Works

Sign Up for Either Original Medicare  OR  A Medicare Advantage Plan

Original Medicare Plan has four (4) Parts:

Part A: Hospital Insurance helps cover the following:

·         Inpatient Care In Hospitals,

·         Includes Critical Access Hospitals and In-patient Rehabilitation Facilities,

·         Inpatient Stays In A Skilled Nursing Facility
     (not custodial or long-term care),

·         Hospice Care Services,

·         Home Health Care Services,

·         Inpatient Care In A Religious Non-Medical Health Care Institution
     (coverage is related to non-medical, non-religious parts of care).

Part B: Medical Insurance helps cover medically necessary services like:

·         Doctors’ Services,

·         Outpatient Care,

·         Other Medical Services That Part A Doesn’t Cover
      (such as Physical and Occupational Therapists),

·         Some Home Health Care,

·         Some Preventative Services

Part C: Medigap -or- Supplemental Insurance Plans, and

Part D: Prescription Drugs.

Medicare Advantage Plans are a package providing the same services as the Original with added services and options.

As an alternative to the Original Medicare Program, Medicare Advantage Plans are a package providing the same services as the Original with added services and options.

 

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

 

 

 

Dining Out

Dining Out

Enclose a list of restaurants that offer senior discounts

Good morning Again!

One thing that is common to people of all ages is our love of fine food. As a Tulsa Realtor® and a Senior Real Estate Specialist, I have had lunch or dinner in just about every fine restaurant in town.

I thought that a list of those tried and true restaurants might be of interest to you. I would like to start a list and keep it updated for those Resturants that offer discount times or meals for SENIORS. Many also have special considerations for those of us with handicaps or disabilities. If you know of any please send me an email so I may start this list to share with all seniors in the Tulsa metro area.

As your Seniors Real Estate Specialist®, my goal is to provide you with the best service possible—which includes some of the best places to eat here in Tulsa. Please let me know about the service and food as well as any discounts they may offer. With your assistance, I will keep this restaurant list up to date.

Remember, I am here to help. Whenever you need any real estate advice or questions answered, call me at (918) 640-4657 or e-mail me at (jim@jimbigelow). I will be happy to help. Or just visit my website at www.jimbigelow.com

Bon Appetite!

Jim Bigelow

Seniors Real Estate Specialist®

www.jimbigelow.com

Coldwell Banker Select

Credit Crunch & Reverse Mortgages

Marketing Letter: Property Preparation

Marketing Letter: Property Preparation

 

  

Good morning!

 

One of the questions I am asked after a client decides to place their property on the market is, “What should I do to get ready?”  The first thing to remember is that we all have different tastes.  So don’t make a lot of major changes that might suit you but not the new buyers.  A buyer will make changes according to their own decorating preferences.

 

The key is to keep things simple.  The less clutter the better.  If things seem crowded, think about storing items or use this opportunity to make a donation to your favorite charitable foundation. 

 

Do make minor repairs such as leaky faucets.  

 

The overall first impression is most important to a prospective buyer. Outside, landscaping can make a dramatic difference.  Often something as simple as flowers lining a front walkway can make a more inviting entrance.

 

DON’T go to any great expense. 

 

One of the aspects of my assistance is that I can provide you with a list of qualified people to assist you in readying your property for sale.  The excellent team of painters, handymen, gardeners and cleaning services can assist you and often at special senior prices.

 

Let me take the worry out of preparing your property for sale.  I’ll help you organize the necessary work from start to finish, allowing you to concern yourself about more important things.  Call me at (918) 640-4657 or e-mail me at jim@jimbigelow.com for a FREE consultation and specific information about my services.

 

Sincerely,

 

 

Jim Bigelow

Seniors Real Estate Specialist®

www.jimbigelow.com

 

Creating Your Financial Team

Creating Your Financial Team

 

 

 

Good morning Again!

 

Most of us don’t want to face the reality that someday we might need more than our current income or even worse, out live our assets.  A support team of top financial advisors can help SENIOR homeowners eliminate or at least minimize the possibility of out living our assets.

 

The equity in your property may be the most valuable asset you possess.  The team you create; legal, accounting, financial and real estate are most critical.

 

The advice of a real estate trust attorney and CPA is worth more than any expense incurred.  These professionals are really needed in today’s sophisticated times, whether your estate is worth $100,000, $1,000,000, or more.

 

The financial part of this team includes both a real estate specialist and an investment advisor.  As your Seniors Real Estate Specialist®, I can provide you with all of the real estate knowledge and experience that I have amassed over the many years of working for clients just like you. 

 

My Services also offers you peace of mind and could create real saving in expenses when you are ready to sell.  Call me at (918-640-4657) or e-mail me at ( jim@jimbigelow.com ) now for a consultation.

 

A support team like this will save and protect your equities for your future security.  Do you have all these people in place?

 

 

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

ONE IN FOUR BOOMERS PLAN MOVE, NEW SURVEY REPORTS

One In Four Boomers Plan Move, New Survey Reports

One in four baby boom generation households (26%) expects to move from their current home in the future, with the majority looking for a single-level home that is more comfortable or convenient, according to a new survey prepared for AARP.   Echoing past surveys, most boomers (79%) say they would like to stay in their current home for as long as possible.  Some – less than 10% — said they would like to stay in their current home but don’t think they will be able to do so.   Many of those who expect to move said they will be looking for a better house, a better climate or a home that is closer to family and friends. More than half of those boomers (age 45-64) planning to move expect to look for a home that’s all on one level (59%).  About half said they will look for a newer home (50%) or a smaller home (49%).   The poll conducted by Opinion Research Corporation for AARP * was released to coincide with the announcement of the 2008 Livable Communities Awards from AARP and the National Association of Home Builders (NAHB) honoring innovative thinking in the field of home and community design.    Older boomers are significantly more likely than younger boomers to think that they will move into a single level home (68% vs. 54% of those planning to move), but age is not the only factor that affects expectations.  Boomer men are more likely than women to believe they will move into a newer home (61% vs. 42%) or move into a home in a warmer or better climate (41% vs. 25%)  Boomer women are more likely than men to think they will move into a smaller home (54% v. 41%).   “While boomers will reflect the patterns of earlier generations and mostly age in place,” said Elinor Ginzler, Senior Vice President of AARP, “the sheer number of boomers will increase demand for a whole variety of home and community options. The 2008 Livable Communities Award winners offer some great examples of appealing, user-friendly design.”  The number of persons age 65 and older is expected grow to 70 million by 2030.

 

 

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

 

 

 

 

EQUITY OPTIONS

EQUITY OPTIONS

 

When you decide to sell your home in order to down size or move into an independent or assisted living community, NO Realtor should ask about your finances or retirement accounts.

They should only show you SOME OPTIONS and WAYS the equity in your home & monthly costs (i.e. Insurance, Repairs, Maintenance, Utilities, Lawn care, Landscaping, Etc…) to achieve your dreams. Like Traveling or visiting the Grand Kids more frequently.

Your next step should be to take the options the Realtor left with you and review each option with your Financial Advisor, CPA, Estate Attorney or family along with ALL of your other finances and retirement accounts – - but NEVER with your Realtor. If you need referrals for the professionals mentioned above your Realtor should be able to help you with that.

Senior Real Estate Specialists (SRES) trained Realtors WILL be able to help you.

For more information about this call me even if you are not in the Tulsa, Oklahoma area. I can refer you to a SRES in your City and State.

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

 

Selling Your Home?

Selling Your Home?

When you put your home on the market  I would invite the opportunity to discuss some marketing issues I have already noticed concerning the marketing of your home in the past. It is a fact that all agents and companies are not the same. I would like to discuss with you how Coldwell Banker Select (The Number 1 ranked Oklahoma Real Estate company for closings in Tulsa, Oklahoma area) and The Bigelow Group may make the difference for you and your home sale. Some of the quick differences is that I personally advertise all my listings on 34 different websites, as well as social media marketing on MySpace, YouTube, Twitter, Facebook & daily Blog just to mention a few.  We must get your home to everyone everywhere that is even thinking about buying a home in the Tulsa Metro area. Eighty (80%) percent of ALL homebuyers start their search on the internet in the comfort and safety of their home or office.  How was your home marketed? Remember the Agent and company you choose is probably the most important decision you will make.

Before choosing your next agent, make sure they are a full time professional Realtor or Realtor Associate and make sure they know what the difference is between the two. Be sure to ask the following questions:

1)      What strategies will you use to find a buyer for my home?

2)      How do you help me determine the correct asking price for my home?

3)      What type & frequency of communications can I expect from you?

If you would like to discuss any of this further please call me Jim Bigelow at (918)640-4657 or email me at jim@jimbigelow.com or just check me out at www.jimbigelow.com to evaluate just one phase of my marketing.

Thank you, for your time and consideration.

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

Senior Sunday – Discounts

Good morning Again!

 

One thing that is common to people of all ages is our love of fine food.  As a Tulsa Realtor® and a Senior Real Estate Specialist, I have had lunch or dinner in just about every fine restaurant in town.

 

I thought that a list of those tried and true restaurants might be of interest to you.  I would like to start a list and keep it updated for those Restaurants that offer discount times or meals for SENIORS.  Many also have special considerations for those of us with handicaps or disabilities. If you know of any please send me an email so I may start this list to share with all seniors in the Tulsa metro area.

 

As your Seniors Real Estate Specialist®, my goal is to provide you with the best service possible—which includes some of the best places to eat here in Tulsa.  Please let me know about the service and food as well as any discounts they may offer.  With your assistance, I will keep this restaurant list up to date.

 

Remember, I am here to help.  Whenever you need any real estate advice or questions answered, call me at (918) 640-4657 or e-mail me at (jim@jimbigelow). I will be happy to help. Or just visit my website at www.jimbigelow.com

 

Bon Appetite!

 

Jim Bigelow

Good morning Again!

 

One thing that is common to people of all ages is our love of fine food.  As a Tulsa Realtor® and a Senior Real Estate Specialist, I have had lunch or dinner in just about every fine restaurant in town.

 

I thought that a list of those tried and true restaurants might be of interest to you.  I would like to start a list and keep it updated for those Restaurants that offer discount times or meals for SENIORS.  Many also have special considerations for those of us with handicaps or disabilities. If you know of any please send me an email so I may start this list to share with all seniors in the Tulsa metro area.

 

As your Seniors Real Estate Specialist®, my goal is to provide you with the best service possible—which includes some of the best places to eat here in Tulsa.  Please let me know about the service and food as well as any discounts they may offer.  With your assistance, I will keep this restaurant list up to date.

 

Remember, I am here to help.  Whenever you need any real estate advice or questions answered, call me at (918) 640-4657 or e-mail me at (jim@jimbigelow). I will be happy to help. Or just visit my website at www.jimbigelow.com

 

Bon Appetite!

 

Jim Bigelow

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

Helpful Websites

Helpful Websites

General: www.seniors.com

US Census: www.census.gov

                  www.usadata.com

Partnerships:

Client Assurance: www.squaretrade.com/sres

Moving for Seniors: www.movingforseniors.com

Home inspections: www.usinspect.com/sres

Retirement Housing: www.retirementhousingonline.com

Buyers Home Warranty: www.buyershomewarrenty.com

SAREC: www.seniorsrealestate.com

Long Term Care Planning—price quotes: www.itcq.net

Medicare Info-National Council on the Aging: www.noca.org

Talking with Parents about Health Coverage—The Kiaser Family: www.kff.org

Home Maintenance: www.theinspector-home.com/life

Kipler’s Your Family Records Organizer: www.kipler.com/organizer

The Five Wishes: www.agingwithdignity.org

AARP: www.aarp.org

National Association of Elder Law Attorneys: www.naela.org

Area agencies on aging: www.eldercare.gov

American Institute of Financing Gerontology: www.aifg.org

American Association or Daily Money Managers: www.aadmn.com

Reverse Mortgage: www.reversemortgage.org

Estate Planning Links: www.estateplanninglinks.com

National Center on Elder Abuse: www.elderabusecenter.org

National committee for prevention of elder abuse: www.preventelderabuse.org

Help Victims: http://preventelderabuse.org/help/help.html

The Directory of Crime Victim Services: http://ovc.ncjrs.org/fiindvictimservices

American Psychological Assn.: www.apa.org/pi/aging/eldabuse.html

 

Oklahoma:   1-800-522-3511

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

 

 

 

Marketing Letter: Current Market Updates

Marketing Letter: Current Market Updates

Good morning!

 

My clients always want to know what is happening in the real estate market.  As part of thier financial team it is my responsibility to keep them informed as to the general and specific real estate market conditions, good or bad.

 

For most of us our equity may be the most valuable asset we have. Unlike stocks and securities, whose current value can be determined daily, real estate values are created over a longer time span.  We need to regularly review the recent market sales of similar properties and the trends in the neighborhood to bring your equity value current.

 

Most of us love where they live and don’t plan to move.  However, if unforeseen circumstances force a decision, it is important to have a good plan that will protect as much of your equity as is legally possible.

 

My services are a wonderful tool to give you the peace and security of having something in place for just such a contingency.  If we haven’t already discussed your specific situation, please call me at (918-640-4657) or email me at (jim@jimbigelow.com) for a private consultation.

 

You have worked hard for your equity.  I will work hard to help you keep it and use it wisely.

 

Sincerely,

Jim Bigelow Realtor

 

Seniors Real Estate Specialist®

SRES, GRI, CHMS, Epro, CRS

www.jimbigelow.com

 

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

 

 

 

 

 

 

EQUITY OPTIONS

EQUITY OPTIONS

When you decide to sell your home in order to down size or move into an independent or assisted living community, NO Realtor should ask about your finances or retirement accounts.
They should only show you SOME OPTIONS and WAYS the equity in your home & monthly costs (i.e. Insurance, Repairs, Maintenance, Utilities, Lawn care, Landscaping, Etc…) to achieve your dreams. Like Traveling or visiting the Grand Kids more frequently.
Your next step should be to take the options the Realtor left with you and review each option with your Financial Advisor, CPA, Estate Attorney or family along with ALL of your other finances and retirement accounts – - but NEVER with your Realtor. If you need referrals for the professionals mentioned above your Realtor should be able to help you with that.
Senior Real Estate Specialists (SRES) trained Realtors WILL be able to help you.
For more information about this call me even if you are not in the Tulsa, Oklahoma area. I can refer you to a SRES in your City and State.

YOUR SRES Specialist

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

Senior Real Estate – Professional Realtor Jim Bigelow 918-640-4657

Senior Real Estate – Professional Realtor Jim Bigelow 918-640-4657

You’ve lived in your home for 30 years. Now, the kids have grown and moved away, the neighborhood is changing and you’d like to move to a smaller home where you can enjoy an active retirement.
The problem is you’re not sure what your house is worth, you’re concerned about TAX and / or ESTATE planning plus you do not know what your options are in terms of what or where to buy.
You might want to consider hiring a Seniors Real Estate Specialist (SRES).
An SRES Realtor cannot give legal or tax advice. But we maintain referral relationships with accountants, real estate attorneys and other professionals so we can refer our clients to those professionals as needed.
While some of our clients are moving to find camaraderie or to be closer to kids, others need help finding assisted-living arrangements. We see our role as an SRES as part counselor and part confidante, handling the details and informing our clients about all the options.
While any licensed Realtor can handle a transaction, it is the wise senior who seeks out someone with experience in the 55-plus marketplace.
While helping with navigating the paperwork is one of the benefits seniors can realize with a trained SRES Realtor, another is finding out about recent laws and options that apply to seniors that might not apply to other property owner.
There are many designations in the real estate industry, but I would consider the SRES to be on of the most important.
To obtain senior-specialist credentials, Realtors must complete a training course given by the Senior Advantage Real Estate Council. The course covers, among other things, tax laws and probate and estate planning and teaches Realtors how to work with professionals specializing in these areas. It also explores generational differences and ways to market to segments of the population like the so called G.I. Generation, born 1901-24, the silent generation, 1925-45; and the baby boomers, 1946-64.
I believe the demand for age-specific services – like finding second homes that can be turned into primary residences or using home equity to finance retirement – will only grow.
Call or email Jim Bigelow at 918-640-4657 or jim@jimbigelow.com
To find out more about SRES Realtors call 1-800-500-4564, or log onto www.seniorsrealestate.com
Our Mission and Vision Statements
Vision Statement
SRES® is a community of REALTORS and related professional dedicated to serving the real estate needs of the senior consumer.
Mission Statement
The mission of SRES® is to promote member
success by providing high quality training and tools necessary to position the SRES® designee as the
Trusted real estate resource for the senior market.
A trusted Network of professionals has been assembled by Jim Bigelow to meet and hopefully exceed client expectations.
Why use SRES® ?
A Senior Real Estate Specialist® is experienced and knowledgeable in meeting your specific needs. And that can make all the difference in the world.
As we age, we demand specialists in our health needs, so why not in our housing and equity needs as well? An SRES brings:
~ A Customized approach to your situation; an SRES works with how your living situation fits into your overall plan.
~ Expertise and patience without condescension.
~ An awareness of options and solid, reliable referrals for specific situations to explore those options.
~ A variety of choices to reduce out of pocket expenses, gain cash, or create or defer income streams to either stay
independent or finance assistance.

Jim Bigelow    918-640-4657

www.jimbigelow.com                jim@jimbigelow.com

Coldwell Banker Select

Senior Sunday

Hello Again Everyone:

 

 Has the listing on your home has expired.  Did you know that a few of the reasons a property doesn’t sell may include the following:

 

1)      Lack of marketing

2)      Over Pricing

3)      Improper Staging

4)      Inconvenience of Showing

5)      Lack of communications

 

I would like the opportunity to meet, with no cost or obligation to you.  I have a few marketing ideas & Concepts to help sell your home.  In addition, I would like to offer my services to conduct a Comparable Market Analysis (CMA), showing you the current housing market activity in your area. 

 

If you are interested in continuing the efforts to sell your home, please contact me at your earliest convenience.  I look forward to showing you how I can help! 

 

SRES – serving the real estate needs of the 50 & beyond consumer

 

Senior Sunday – Property Preparation

Property Preparation

Good morning!

One of the questions I am asked after a client decides to place their property on the market is, “What should I do to get ready?” The first thing to remember is that we all have different tastes. So don’t make a lot of major changes that might suit you but not the new buyers. A buyer will make changes according to their own decorating preferences.

The key is to keep things simple. The less clutter the better. If things seem crowded, think about storing items or use this opportunity to make a donation to your favorite charitable foundation.

Do make minor repairs such as leaky faucets.

The overall first impression is most important to a prospective buyer. Outside, landscaping can make a dramatic difference. Often something as simple as flowers lining a front walkway can make a more inviting entrance.

DON’T go to any great expense.

One of the aspects of my assistance is that I can provide you with a list of qualified people to assist you in readying your property for sale. The excellent team of painters, handymen, gardeners and cleaning services can assist you and often at special senior prices.

Let me take the worry out of preparing your property for sale. I’ll help you organize the necessary work from start to finish, allowing you to concern yourself about more important things. Call me at 918-640-4657 or e-mail me at jim@jimbigelow.com for a FREE consultation and specific information about my services.

Sincerely,

Jim Bigelow
Seniors Real Estate Specialist®
SRES, Epro,CHMS, GRI, CRS
www.jimbigelow.com

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