Should You Consider a Switch to Medicare Advantage?

Most of us over 65 are familiar with Parts A and B of Medicare, but how much do you know about Medicare C, also called Medicare Advantage?

Medicare C plans are regulated by the government and run by private insurers. They offer coverage comparable to Medicare A (hospitalization) and B (doctors’ bills, medical tests and some screening procedures) and may include prescription drug coverage.

There are a number of Medicare C plans available, with differing premiums, copays and out-of-pocket limits. Some cost about the same as standard Medicare, while other plans have higher premiums.

But does a Medicare C plan make sense for you? It depends on your individual circumstances.
Here are some factors you may want to consider:

  • If you have standard Medicare, you don’t have a cap on out-of-pocket expenses. If these are mounting up, Medicare Advantage plans have a maximum cap of $6,700 a year, and many are much lower.
  • If your prescription costs are high but you don’t want to pay extra for the optional prescription coverage under standard Medicare, most Medicare C plans include this coverage. But consider this carefully: You may not be able to justify a higher-premium C plan just to obtain drug coverage.
  • Nursing home care and dental and vision care (not covered by standard Medicare) are covered by some Medicare C plans.
  • You have a better selection of providers with standard Medicare; Medicare C is not as widely accepted.

Wellness Counters Lifestyle-Related Illnesses

Fact: More than 30% of American adults are now obese. By 2030, unless something changes, this will rise to almost 45%.

Fact: Right now obesity is responsible for more than 25% of health care costs in America.

Fact: Approximately 58.5 million U.S. adults now smoke and are at increased risk of developing any of 30 different diseases.

Fact: Smoking-related deaths total 424,000 annually, and more than $172 billion has been spent on healthcare costs related to smoking.

No wonder more and more employers are establishing employee wellness programs and preventive care is incorporated into the mandate of the Patient Protection and Affordable Care Act (ACA).

The assumption is that an emphasis on wellness is likely the only way to stop the epidemic of lifestyle-related illnesses that are killing us. According to an October 2012 article in U.S. News, wellness is going mainstream.

“How Healthcare Is Changing – For the Better” makes the point that both the health insurance industry and Medicare now are “paying doctors and hospitals based on how successfully they treat patients and keep them out of the hospital.”

Already there are community health teams in Vermont that are transforming healthcare delivery, initiatives such as the Cleveland Clinic’s Heart Care at Home program, and hospitals that are focused on educating and listening to patients.

Medicare also has imposed financial penalties on hospitals when some patients are readmitted within 30 days, hoping to reverse trends like those of heart failure patients, one in four of whom is readmitted within 30 days of discharge.

You may find that your healthcare providers are faster in responding to your inquiries, and someday you may even have a personal health coach to keep you on the path to wellness.

It’s all part of a wellness revolution, which, if it succeeds, may make obesity and smoking deaths things of the past.

Reasonable Accommodations: a Business Necessity

As our population ages and older workers begin to deal with health issues that may make them more prone to being hurt on the job, employers are finding themselves faced with an increased need to accommodate injured workers. It’s not a matter of doing the right thing, it’s the law. Not a choice but a business necessity.

The Americans with Disabilities Act (ADA) applies to employers with more than 15 employees. It places a great deal of responsibility on the employer to accommodate applicants and workers with conditions that limit their ability to perform essential job functions unless doing so would create an “undue hardship” for the business entity. Generally, the larger an organization and the deeper its resources, the more difficult it is for a company to claim that a requested accommodation creates a hardship.

Just about any condition that substantially limits a life activity now protects an employee under the ADA. It affects hiring practices – the ADA now impacts employers in both their hiring and employment practices – but also defines how an organization manages its employees injured at work.

Sometimes employers refuse to accommodate an injured worker’s return to a modified position, demanding the worker wait until all their duties can be performed. This approach is no longer acceptable under the amended ADA and can generate intervention and fines by the Equal Employment Opportunity Commission (EEOC), the agency that oversees ADA violations. Employment actions taken by employees or the EEOC are expensive to defend and are not covered under an organization’s general liability coverage.

The EEOC is diligent in its pursuit of disabled workers rights. As recently as December 2012, the EEOC filed a lawsuit alleging a woman was wrongfully fired because she had a prosthetic leg. The case is currently in the courts.

It is now a business necessity to make reasonable accommodations, defined in the ADA as follows: “In general, an accommodation is any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.”

Here is a partial list of some accommodations you can make to ensure injured workers return to productivity and you do not violate the ADA.

  • Modifications to the work environment like purchasing ergonomic equipment or rearranging how and when the job is performed. For example, you may change work hours to allow an employee who is on medication to arrive later.
  • Providing access to your facility so that someone with a disability may apply for a position.
  • Providing the employee with readers or interpreters.
  • Job restructuring or reassignment.
  • Allowing an employee to work from home when feasible.

In March 2012, the federal government introduced updates to the ADA that included changes to further remove barriers and that may affect employers planning new construction in 2013 and on.

Note that this is a very basic discussion of the ADA and its updates. For specific advice, contact your employment lawyer or other ADA expert.

Don’t Gamble by Underinsuring your Business Properties

This may not be on your radar, but underinsuring your property could result in serious problems for your business.

Insurance companies base premiums on an amount of insurance that is 80% to 100% of your property’s total value. This is referred to as “insurance to value,” and insurance underwriters are concerned that you may be underrating the value of your property to keep premiums low or are unaware that property improvements and the state of the real estate market have increased the value of your building. In these instances you may be underinsured.

Some people gamble they won’t suffer a large loss. Because most losses are partial, you would normally recover in full on most of your losses. However, if insurers set your rates assuming they are based on insurance to value, they might not collect sufficient premiums. So in the event of a large or total loss, you won’t have been adequately insured.

The “coinsurance condition” addresses this issue. You must agree to carry insurance at least equal to a specified percentage of your covered property’s value. The coinsurance percentage normally used is 80%, although percentages of 90% and 100% are sometimes available for a reduced premium.

The coinsurance condition penalizes you if you do not insure to at least an agreed-upon percentage of value. If you have a loss and are underinsured, insurers reduce payment on your losses based on the actual building’s insurance to value.

Don’t gamble. Discuss your current insurance to value with your insurance professional.

RVing This Spring? Review Your RV Insurance Now

Increasing numbers of Americans are setting out to see their country in recreational vehicles (RVs). Just as RVs demand special handling, RV owners have special insurance needs. Whether you are an experienced RV owner or are just beginning to shop for your RV, consider these insurance options to protect your family and your investment.

  • Buying a new RV is expensive, and once you drive it off the lot, it depreciates. Some carriers offer additional upgraded protection with Total Loss Replacement coverage that will provide a new RV if your newer-model RV is totaled.
  • Everyone wants an event-free trip, but breakdowns can strand you in out-of-the-way places. You may want to investigate 24/7 Roadside Assistance for towing, lockout protection, battery replacement, flat tire repair, fuel delivery, and removal from mud, snow or sand.
  • Vehicle add-ons need special insurance protection. Antennas, satellite dishes and other post-purchase additions can be expensive to replace. Accessories coverage protects your add-ons, and additional coverage is available for awnings and other extras.
  • Some travelers decide to live in their RVs full time. However, they still need liability coverage. Imagine if your on-board canine companion bites someone or someone falls near your RV. Full-Timer coverage can help you protect your assets while enjoying a traveling lifestyle.

RVs Good Sam Club has a million-plus members, so RVing is clearly a lifestyle choice for many. Do it safely; discuss insurance options with your insurance professional for the RV coverage that’s right for you.

Shopping Online for Car Insurance? Read this First

Every day we’re bombarded with advertising for auto insurance. According to a recent U.S. survey, car insurers alone spent $5.3 billion on advertising in 2011 – an increase of 15% over 2010.

Why? The industry is changing. Vehicle registrations are down, and most North Americans now keep their cars longer due to the economy. Many are even dropping physical damage coverage. And insurance companies are feeling the pinch.

A large number of auto insurers are competing intensely for your premium dollar. The majority of auto premiums go to the top insurance companies, and particularly if you have a stellar driving record, these insurers want your business badly.

To get it, most provide quotes online. Shopping online for auto coverage may seem like a good alternative; you can receive a quote in less than five minutes. However, unbiased experts (those not involved in the auto insurance industry) offer the following cautions:

First, to obtain an accurate quote you must be prepared to give out sensitive information, such as your Social Security number, online.

Second, you may not get the details you need to compare policies from one company to another. Often coverage options are vague, using terms like “standard coverage,” which does not fully explain what you will receive for your hard-earned premium dollar.

Last, and probably most important to the consumer, you usually aren’t provided with information on how the insurance company you choose online will handle a claim.

Your independent agent can provide you with all the same information websites offer. And more. Instead of hours of Web searching and DIY comparisons, why not discuss your individual circumstances with your insurance professional, who can tailor coverage to your needs?

Auto insurance is more than a commodity. It protects your family from liability arising from the use of your car. Why buy something that important from an unknown source?

Newly Insured May Face Doctor Shortages

When 2014 rolls around, almost 50 million Americans will be seeking health insurance coverage and primary care physicians.

That’s when the Affordable Care Act (ACA) requires virtually every American to have health insurance. The problem is they may not be able to find a primary care physician.

According to a study out of the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH), many primary care doctors don’t plan to accept new patients.

The MGH study builds on earlier research by the Institute of Medicine that found that there were insufficient “safety net” physicians – unofficially referring to those physicians who deliver care to persons on Medicaid and uninsured people – in the period under study (2000). With the large number of previously uninsured individuals entering the system in 2014, it will be further stressed, the MGH research indicates.

The ACA, as part of its mandate toward affordable health care for almost everyone, has called for an expansion of eligibility for Medicaid.

Many of the newly insured will seek out safety net physicians, who are already stretched thin. They may or may not be able to find a primary care physician who is able to take them.

One solution suggested by the MGH research involves recruiting additional primary physicians with traits that are consistent with current safety net physicians.

According to MGH, women, minorities and graduates of foreign medical schools are most likely to have become safety net doctors, and to expand the numbers, the recommendation is to make a focused effort to bring more of these physicians into primary care.

The research also noted that safety net physicians now operate with limited resources. This “too” will need to be changed along with the income gap between safety net and non-safety net primary care physicians, if newly insured people are to be able to find physicians to care for them.

Will You Lose Your Health Coverage After a Divorce?

Are you considering divorce? Unfortunately, there’s one more thing to add to your list of concerns: the state of your health insurance after you split.

If you are now receiving health care coverage under a spouse’s plan, you likely won’t qualify as a dependent under that plan after a divorce. That means you will need to get a private health insurance plan. Otherwise you may lose your coverage.

Although both men and women can be cut off their spouses’ plans after divorce, a study published in December 2012 indicates that women most commonly lose their insurance or have to settle for lower coverage.

According to a University of Michigan study, found in the December Journal of Health and Social Behavior, about 115,000 women lose their private health insurance after a divorce.

Other findings include:

  • Women’s overall insurance coverage remains lower for at least two years after a divorce.
  • Middle-class women are most impacted: They tend to lose coverage more than women with higher incomes, yet their incomes aren’t low enough to make them eligible for public insurance.
  • Even when women are covered by their own employers’ plans, they may have difficulty paying their share of the premiums because of financial hardship after a divorce.

The Affordable Care Act includes provisions that could help remedy this situation for both sexes, including tax credits in 2014 for people with incomes of 100% to 400% of the poverty line who don’t qualify for other affordable programs.

Is it Time to Revisit Your Decision on Life Insurance?

Chances are, if you have a comprehensive financial plan, you have considered life insurance. However, if you decided you don’t need it, you may want to revisit that choice.

Life insurance is a contract between an insurance policyholder and an insurance company. The policyholder pays a premium, either regularly or as a lump sum. In exchange, the insurance company promises to pay a designated beneficiary a sum of money (called benefits) upon the policyholder’s death. Depending on the contract, events such as terminal illnesses may also trigger benefit payments.

Life insurance offers the policy holder peace of mind, assuring him or her that death will not lead to financial hardship for loved ones. Life insurance, then, is usually purchased by individuals with dependents: spouses, children, even pets.

As your life circumstances change, it’s a good idea to reconsider whether you need life insurance and how much.

A remarriage, for example, might lead to more child dependents; a spouse losing a job or retiring might create a spousal dependent.

Before deciding if you need life insurance, it’s a good idea to discuss your individual circumstances and options with your advisor.

There are many types of life insurance, the most basic being term insurance, with coverage that lasts for a set period of time provided you pay the monthly premium.

Other types are more complicated. For example, whole-life policies combine life insurance with an investment fund; your beneficiaries receive a fixed amount on your death, and part of your premium is invested and used to build cash.

Others include universal, variable and variable universal – the list goes on and on, and you have a myriad of choices.

One important point: If you decide you do need life insurance, don’t delay. Premiums are less expensive when you’re younger but tend to rise steadily as you age.

Small Business Should Consider the ERM Approach

Current economic conditions are driving changes to companies’ risk management strategies, and even smaller companies are being forced to take a more strategic approach to managing risk. One way to take this strategic approach to risk management is with enterprise risk management (ERM) – a business strategy gaining widespread acceptance in businesses across the country.

The ERM process allows organizations to better manage their risk. But is it appropriate to your small or medium-sized business? Almost certainly.

Until recently, this system has been implemented primarily in large corporations. But, according to Jay Vadiveloo, actuary and ERM specialist, it may be time for the small-business sector to adopt the ERM approach: “With all of the uncertainty and turbulence in today’s economy, positioning small businesses to mitigate risks and maximize opportunities has become key to their survival and success,” he suggests in a Huffington Post blog posting.

ERM helps businesses of all sizes manage an organization’s key business risks and opportunities. Whether the threats are internal like auto losses or external like supplier problems, business owners must recognize and manage forces that could disrupt their companies.

Opportunities must be managed, as well. ERM is set up to ensure that everyone in your company has access to important information relating to potential problems and opportunities.

Why is this information flow important? In many organizations – even smaller ones – everyone is too preoccupied with getting the job done to make a point of sharing information. As a result, vital information ranging from financial concerns to corporate strategies and employee relations is centralized with a few of your key people. It may even reside exclusively with you, never reaching your employees.

This means that essential decisions are often made without adequate information. Employees don’t always intend to hoard information, but even in a smaller organization, there may be personality conflicts and disagreements that limit sharing of information. It’s incumbent on you as the boss to ensure that information is shared.

With an ERM approach, your employees are encouraged to identify roadblocks or hazards that could interfere with your strategic goals.

The same is true of opportunities. For example, if one employee learns of a way your inventory management can be improved but doesn’t think to share this information with his or her supervisor, your business may lose out on a system that could have helped floor the competition.

Strong communication is the basis of ERM. Every one of your employees – salespeople and supervisors alike – should be empowered to consider and discuss ways of identifying potential problems and taking advantage of opportunities.

If, as the owner of a small business, you decide to implement a formal enterprise risk management system, you may need the services of a consultant. However, companies of all sizes can benefit from the approach without signing up for a full-fledged implementation.

Ensure every employee has access to information, and empower each one to look for both problems and opportunities and share his or her findings with a supervisor. Risks will be controlled and opportunities acted upon.

Why You Can Smile as You Write Your Premium Check

No one likes writing checks for insurance premiums. However, insurance provides business owners with many benefits, including peace of mind. Here’s a list of benefits that may make you feel a little better the next time you write that premium check.

  • Few business owners can afford to rebuild a building or replace damaged merchandise.
  • Insurance companies provide expert loss prevention assistance to help you solve loss exposure problems you may face.
  • Insurance allows you access to credit so you can expand your business.
  • If you can’t continue operations after a loss like a fire, insurance is available to provide you with continuing income.
  • Insurance provides expert medical treatment to your employees if they are injured after an accident.
  • Insurance can help smooth out difficulties you may experience if you or your business partner becomes disabled or dies.
  • Insurance provides your family with an income if you die.
  • Insurance allows you to comply with state regulatory agencies.
  • Insurance can protect your products when they are shipped.
  • Insurance helps to protect you from legal liability if you are faced with a lawsuit from an angry customer, competitor or group.

When you write your next premium check, consider the many benefits of insurance. You want to spend your time growing your business and spending time with your family; enjoy the peace of mind insurance offers.

How to Avoid Possible Risks and Travel Safely

Americans love to travel, but there are risks in traveling, whether at home or abroad. Here are some tips to help keep you and your family safer when traveling.

On the road

  • If you must carry cash, carry it concealed in a money belt or similar case.
  •  Keep photocopies of important documents like your passport, driver’s license and credit cards. Record your traveler’s check numbers and keep them separate from the checks.
  • Store an emergency contact in your cell phone under “Emergency.” This is where first responders will look if you cannot communicate.
  • Do not post your travel plans on social media. Burglars watch social media for opportunities to steal.
  • Have a mechanic evaluate your car’s roadworthiness prior to travel.
  • Carry a first-aid kit, plus extra clothes, snacks and water, in your vehicle.
  • If your car does break down, keep everyone together. Don’t split up to go for help.

In your hotel

  • Ask for a room above the first floor and below the fourth.
  • Determine the most direct route from your room to fire escapes. Count doors so you know how far you are from the exit in case you must exit when visibility is low.
  • Do not open the hotel room door if you’re not expecting anyone.
  • Do not travel with jewelry or other valuables. Use the room safe if you do have valuables.

When you sightsee

  • Ask hotel staff for directions before you go out.
  • Vary the times you leave and exits you use. Kidnappers watch for patterns.
  • Ask hotel staff which parts of town you should avoid.
  • Keep a closer-than-normal watch on children.
  • Trust your instincts. If something doesn’t feel right, leave or go into a crowded building until you can decide your next step.

Take These Steps So Your Home Doesn’t Shout, ‘We’re Away’

Whether you’re taking off for a holiday in the sun or a visit with relatives out of town, here’s something you don’t want to forget. An unoccupied home is subject to many hazards, so to avoid an insurance claim, take preventive measures before you leave. Below are some things to do to protect your house while you’re gone:

  • Ask a neighbor to watch your home for damage or suspicious activity. Make sure you leave a spare key and a phone number where you can be reached in an emergency.
  • If you live in one of the cooler parts of the country, keep the heat on in your home in winter to avoid frozen pipes. Letting pipes drip slightly in freezing weather can help prevent them from bursting.
  • Unplug electrical appliances and computer equipment to protect against power surges. If you use a surge protector, ensure it’s sufficient.
  • Stop mail delivery and newspapers. Nothing shouts “We’re away” like papers piling up on your porch.
  • If your home is in or near a flood zone, put important papers and electronics out of harm’s way.
  • Trim trees and bushes from doorways and windows. Potential thieves will feel exposed. Also trimming branches may prevent wind damage to your property and others’. You can be held responsible if your neighbors allege that your lack of maintenance caused damage to their property.
  • Ensure you purchase enough insurance to cover any possible claim. No one expects to have a loss, but if you do, you want to be adequately protected.

The ACA Gears Up for Major Changes in 2014

The health care landscape changed for Americans with the signing into law of the Patient Protection and Affordable Care Act (ACA). When it was introduced in 2010, the ACA brought with it a new approach to health care and a commitment to affordable health care for everyone.

Over the past three years a number of important initiatives have been taken. For example, people with pre-existing conditions, who previously had found it very difficult to obtain coverage if they had cardiovascular disease, diabetes or many other chronic illnesses, now have access to coverage through temporary Pre-Existing Condition Insurance Plans (PCIP). In 2014, these programs will end, as those suffering chronic conditions will be guaranteed coverage in the open insurance market.

Actions undertaken in 2012 include:

  • In August of last year, more than 12 billion Americans received insurance premium rebates of approximately $150 per family.
  • A new user-friendly form was introduced, making it easier for consumers to compare co-pays and out-of-pocket costs for different insurance plans.

For 2013, the Act is implementing:

  • Improved coverage for preventive care through the provision of extra funds to Medicaid programs that support preventive care programs at minimal cost. This took effect on January 1, 2013.
  • Also effective January 1, the government is funding an increase to primary care doctors, who will now receive no less than 100% of Medicaid rates for primary care services.
  • The Children’s Health Insurance Program (CHIP) will provide states with two additional years of funding for coverage of children who are not eligible for Medicaid, effective October 1, 2013.

In 2014, several major changes will be implemented, including the requirement that most Americans will have to have health insurance or pay a tax penalty. The act allows for health care exchanges that offer affordable private insurance coverage to individuals and small businesses, expanding everyone’s options.

Start 2013 Off Right With a Health Insurance Checkup

Why not start off this new year with a health insurance checkup?

Over the past few years, there have been significant changes in our approach to health care. The Patient Protection and Affordable Care Act (ACA) was passed into law in 2010, and some provisions have already been implemented, but there are many ACA changes still to take effect.

Most important, the majority of Americans will be required to have some form of health insurance by January 1, 2014.

You may want to start now to investigate your options and become aware of the ACA provisions that are relevant to you and your family. (For example, one key provision may make it easier to obtain coverage with pre-existing conditions.)

So step one in your review is to examine the impact of the ACA. Set up a time to consult with your insurance professional, who can help guide you through the complexities, or research the ACA yourself at www.healthcare.gov/law/features.

As part of your review, you may also want to revisit your health insurance plan. If your marital status has changed or your family has expanded, you should look closely at the benefits and make changes as required.

Also ensure your insurance company or employer has your updated information on file (including your new address, if you’ve moved).

While the ACA changes the approach to health care, it’s clear there’s a place for individual responsibility. Start the new year off right and make sure your health insurance plan still works for you.

Change in Procedure Is Good News for Beneficiaries

Nationwide Financial Services Inc. and several other major insurance companies, including MetLife, Prudential Financial and Manulife Financial’s John Hancock division, committed to changing practices after an investigation established that many insurance policy beneficiaries did not receive the death benefits they were owed. And this will come as welcome news to individuals who have or are considering life insurance.

Nationwide and other major insurers agreed to change the way they previously identified deceased policy holders and to actively seek out beneficiaries who, because of a long-standing insurance industry practice, failed to receive death benefits. Nationwide also paid $7.2 million to the insurance departments of seven states participating in the investigation.

A death benefit is the amount a life insurance company pays a policy holder’s beneficiary upon the policy holder’s death. In the past, most life insurance policies made it clear that beneficiaries are responsible for notifying the insurer when an insured person dies. However, many beneficiaries didn’t realize this. As a result, thousands of people did not receive benefits.

A task force led by Florida Insurance Commissioner Kevin McCarty found that a number of life insurance companies failed to pay out more than $1 billion in death benefits as a result of the procedure that required a policy holder’s beneficiaries to file a claim after his or her death.

Nationwide, as well as other major insurance companies, will now check their lists of policyholders against the U.S. government’s death database and have committed to tracking down beneficiaries of customers who have died. From the end of 2011 to mid-October 2012, Nationwide had identified 4,747 unclaimed death benefits and paid out $144 million to beneficiaries.

Individuals with life insurance policies – or those contemplating the purchase of policies – can now be certain that their beneficiaries will receive the death benefits they are entitled to … whether or not they file a claim.