Medicare insurance broker Andrew Vasta remembers well the widow on a limited income who could not afford to pay for groceries, her 10 medications, and the four doctors she had to see multiple times a year.
Andrew’s research and guidance led her to enroll in the appropriate Medicare supplement plan. He also completed the application for drug assistance programs. As a result, she is able to see any doctor who accepts Medicare with no copay and also gets some of her most expensive medications mailed to her for free. Plus, she is eligible for a 50 percent discount at her local pharmacy for any of her other medications.
Andrew says wins like this make his career fulfilling. He enjoys helping individuals find and choose the Medicare plan that best suits their needs. “There are so many [insurance] options available that it is confusing for individuals to weed through the material and make decisions.” Plus, previously, as employees, these individuals may have had to choose between only one or two health plans.
Though Traditional Medicare is the fee-for-service program offered directly through the federal government, it typically is partnered with one of many Medicare supplemental, also called Medigap, insurance plans sold by private health insurers. According to Andrew, there are 17 companies in New Jersey which offer Medigap insurance and each offers a choice of 6 or more plans. Medigap insurance provides coverage for many of the co-pays and some of the co-insurance related to Medicare-covered hospital, skilled nursing facility, home health care, ambulance, durable medical equipment and doctor charges.
Though the plans are fairly standard, the qualifying criteria may differ from company to company as does the cost, Andrew says. People who choose Traditional Medicare with a Medicare supplement plan typically also elect a Part D prescription plan to round out their coverage.
Medicare Advantage plans afford an alternative to Traditional Medicare plans. These plans provide managed care—usually a health maintenance organization (HMO) or a preferred provider organization (PPO) that is paid based on a monthly capitated fee. Medicare Advantage plans have more predictable copays than Original Medicare, include prescription drug coverage, oftentimes limited dental, vision and hearing coverage and sometimes fringe benefits like wellness and/or gym membership.
Everyone’s situation is different, emphasizes Andrew. His goal is to divide the information overload into understandable bite-sized pieces. He thoroughly gathers data from each client, covering issues such as qualifying health conditions and the medications and medical care required for specific health conditions. Using this data, he makes clients aware of plan options and aids them by explaining which plan is most appropriate for their particular needs.
Unfortunately, there are a lot of misconceptions about the type of service Andrew offers, not the least of which is the presumed expense. In fact, there is no direct client cost and people of all income levels use his service. The cost goes with the plan and the insurers pay the brokers commissions which are relatively consistent across the board. When it comes to premium cost, nothing changes whether a person buys directly from an insurer or turns to a Medicare insurance broker like Andrew who is licensed by all Medigap insurers and serves his clients with deep knowledge and expertise.
There is also the plus of personalized service. Each year, prior to the annual enrollment period, which is October 15th to December 7th, Andrew recontacts his clients to make sure they are happy with their plans and discusses any changes in their health or medications. A change in prescription medication or of a drug company’s formulary, for example, can skyrocket the expense for one drug from say seven dollars to $60.
“People in the Medicare age group are more vulnerable than those in other age groups, and they may not have the tools or know-how to research on their own,” he says. “What’s more, they are bombarded by mailings from each Medicare and Medicare Advantage provider as the annual enrollment period comes around again.
“My mission is to help Medicare eligible individuals understand their choices with compassion, integrity and knowledge” Andrew says. “I want to do right by my clients.”
And to that end, he adds, “Clients feel comfortable calling me with questions and turn to me for assistance year after year.”
Medicare and Medigap are not one-size-fits-all programs.
At age 65, individuals are entitled to enroll in the federal health insurance program Medicare. Medicare comprises several different coverage components, some that work together to provide you with more robust protection. It can be confusing sometimes for individuals to weed through all the material.
Learn the ABC’s of Medicare and Out With the Overwhelm
When you’re bombarded with insurance options as you turn 65, Medicare Insurance Broker Andrew Vasta can help you decipher the information overload. Andrew will educate you on the A, B, C and D of Medicare, discuss additional options for your specific needs, and determine your eligibility for financial medication assistance. Andrew’s focused Medicare expertise, his no-cost service, and his ongoing assistance and annual review of your coverage can help you transition into and manage your Medicare coverage.
Yes, plans change every year. At the end of September your current plan will mail you an Annual Notice of Change booklet which highlight how your current plan will change in the upcoming year. These changes include deductibles, copays, coinsurance, list of medications covered, and network of doctors/pharmacies. You can compare your current coverage vs. other options between October 1st – Dec. 7th. Don’t assume everything will be the same and get surprised in January when you pick up your medications!
Our services are no charge to you. We are compensated by the insurance companies if you enroll in a plan with us and there is no difference in price of the plan whether you enroll with us or directly with the company. For most products we are paid the same by every company for the plan, therefore there is no incentive for us to sell one plan over another on our end.
We make a meeting convenient for you. We can come to your home, a local coffee shop, or you can come to our office in Orange, NJ. We can work with your schedule and meet any time between 8 AM and 8 PM.
There are many insurance agents who sell Medicare plans, however most sell additional products such as life and/or auto insurance and do not specialize in Medicare. Additionally, most agents only represent one or two companies. Medicare is all we do and we represent all the highly-rated companies in the state to help you find the plans that are right for you.
Medicare Advantage plans are not for everyone. These plans are typically network based (HMO) or (PPO) and if your doctor or hospital is not covered you may have to change your doctor to someone in network. Medicare Advantage plans typically have a lower monthly fee compared to Medicare Supplement but have a copay for every service used. It’s important to ensure your doctors and hospitals are covered and you understand what your out of pocket responsibility can be with a Medicare Advantage plan before enrolling.
The ACA helped Medicare and Medicare beneficiaries in several ways which could be eliminated with a repeal however Medicare itself is not largely affected by the ACA. The parts of the ACA that improved Medicare include giving preventive care to everyone at no charge, reducing your out of pocket mediation costs while you are in the coverage gap or “donut hole”, and reducing Fraud, Waste, and Abuse by implementing new oversight and fines for Medicare providers.
How do I apply for Medicare? When should I set up a meeting to discuss my supplemental and medication options?
Medicare will start the 1st day of the month you turn 65 for most people. If you were born the 1st day of the month Medicare will begin the month before you turn 65 e.g. Your birthday is May 1st, Medicare will start April 1st. You can also get Medicare after you are on Social Security Disability for two years.
If you are collecting Social Security you will automatically be enrolled in Medicare Parts A (Hospital) and B (Doctor) three months before your birthday month. For those still working you can decide to delay Medicare Part B until after you retire. Medicare Part B’s premium will be deducted from your Social Security income.
If you are not collecting Social Security you will be automatically enrolled in Medicare Part A (Hospital), but must apply for Medicare Part B (Doctor) if you elect to take Part B. Social Security handles enrollments in Medicare Part B and you can enroll through their website, at your local Social Security office, or over the phone. Social Security will bill you quarterly for Medicare Part B’s fee.
We can meet to discuss additional Medicare options three months prior to your Medicare Part B effective date.
If you delay enrolling in Medicare Part B without other credible coverage you will be penalized for not having coverage and are limited on when you can apply for Medicare Part B in the future.
If you or your spouse have worked in the country for a total of 10 years you will not owe a monthly fee for Medicare Part A (Hospital) coverage. Medicare Part B (Doctor) costs $134 per month for anyone new to Medicare in 2017 and with an income below $85,000 as a single or $170,000 as a couple. If your income is above this amount Medicare has multiple income brackets which determine your monthly fee.
From there additional coverage can range from $0 per month with some Medicare Advantage plans to over $200 per month for a Medicare supplement and drug plan.
Option 1 – Medicare + Medicare Supplement + Prescription drug coverage (Part D)
- Medicare is primary.
- Medicare Supplement will pay part or all of the remaining costs the doctor hospital charges.
- Your responsibility depends on your Medicare Supplement plan choice.
- See any doctor who accepts Medicare.
- A separate plan for your Prescription Drug coverage is needed.
Option 2 – Medicare Advantage (Medicare Part C)
- All in one package, you get all your Medicare through the Medicare Advantage plan.
- Includes medication coverage and can include additional benefits such as gym membership, limited dental, or vision.
- Copay or coinsurance for each service used, “Pay as you go”.
- Restrictions on doctors and hospitals which accept the insurance.
On top of our NJ Insurance license every carrier we sell requires new testing each year to sell their plans. We also annually pass the American Health Insurance Plans exam and testing on Fraud, Waste, and Abuse.