E.R., Urgent Care Center or Other Choices.

Imagine. Your doctor’s office is closed for the weekend and you are hit with a sudden illness or a painful injury. The conventional choice has been to head for the hospital emergency room and plan on a long wait for treatment.

But, today, there is a shift away from using hospital emergency rooms for non-life threatening emergencies. Hospital costs are skyrocketing and insurers are passing a bigger portion of these costs on to the patients.

There are a growing number of good alternatives to the ER for those times when you need immediate attention, including:

Urgent Care Centers: Most urgent care are equipped to handle a wide array of non-life threatening health needs, including fevers, coughs, sprains and stitches. Some give you the option of checking in online so you can avoid long delays in crowded waiting rooms. Most urgent care clinics offer extended hours and are open seven days a week, including holidays.

Video visits with a physician: You can skip the waiting room completely by doing a video visit. Video visits provide access to board-certified doctors 24 hours a day, 7 days a week, all from the comfort of your home, office or anywhere you have an internet connection. Video visits are most often used for common complaints, such as upper respiratory infections, allergies, flu symptoms and coughs. The physician you chat with online is able to assess your condition and send prescriptions to your pharmacy, with some insurance plans covering 100% of the cost.

24/7 nurse line:  Many health insurance plans now have a 24/7 nurse line that you can call for help determining the severity of your symptoms and advice on where to go for care.

In non-emergency situations, it is best to call your doctor’s office first. They may want to see you or suggest their preferred alternatives to the emergency room.  Your insurance provider can also help you find a conveniently located, licensed and accredited care setting and determine whether your plan covers the alternative facility’s services.

I want to stress that you should always call 911 or go to the nearest emergency room in any life threatening situation including:

  • Chest pains, shortness of breath and signs of heart attacks
  • Signs of stroke
  • Poisoning
  • Severe cuts or limb threatening injuries
  • Suicidal or homicidal feelings


What is meant by ‘advance care planning’ and ‘advance directives?’

Advance care planning is the process of making decisions about the kind of care you would want to receive if you were unable to speak for yourself.  It is your wishes based on your personal values, preferences and thoughtful consideration of those closest to you.

Your wishes are then put into written legal documents called advance directives. It is up to you to share these documents with your family, your medical team and those who will be entrusted to carry out your directives.

In most cases, advance directives include the following types of documents:

  • A health care proxy,which may also be called a “Health Care or Medical Power of Attorney” or a “Durable Power of Attorney for Health Care.” This document names a specific person who will make the health care decisions for you if you are unable to make them yourself. A physician must conclude that the person is unable to make their own decisions and a second doctor must agree before the medical power of attorney goes into effect.
  • A living will.Living wills give directions about the kind of health care you want when you are not able to make a decision for yourself. Living wills state which medical treatments you would accept or refuse if your life was threatened and you were not able to express these wishes.
  • After-death wishes.These may include decisions such as organ and tissue donation.

Advanced care planning is important for people of all ages because anything can happen to anyone at any time and having a plan in place will help ensure that your healthcare wishes are known and honored in any situation. In fact, today most hospitals will ask if you have advance directives any time you are admitted to the hospital.

If you have Medicare, Part B covers voluntary Advance Care Planning as part of the Medicare Yearly Wellness Visit. You can talk about an advance directive with your health care professional, and he or she can help you fill out the forms.You can also download advance directive forms online or contact your local office on aging, your state health department or an attorney to learn more about advance directives.

What if I don’t enroll in Medicare

Delaying your enrollment in Medicare can have a lasting impact on your future health-care costs. Before you put off enrolling, be aware of the consequences.

Let’s begin with Medicare Part A. Part A is premium-free if you or your spouse worked and paid taxes for ten years or more. If you are not eligible for premium-free Part A and you delay enrolling, you will be assessed a 10% penalty. You will be charged the penalty for twice the number of years you could have had Part A, but didn’t sign up.

Not enrolling in Medicare Part B when you first become eligible will result in a penalty of 10% of the Part B premium for every 12 months you put off signing up. In most case, you will pay the penalty as long as you have Part B coverage.

There is an exception. You are not required to take Part B if you or your spouse is still working and you have coverage as a result of that employment. Once this qualifying insurance ends, you and your spouse would be able to enroll without penalties.

The late enrollment penalty for Medicare Part D depends on how long you go without Part D or other creditable prescription drug coverage. Medicare calculates the penalty by multiplying 1% of the ‘national base beneficiary premium’ ($35.63 in 2017; $35.02 in 2018) times the number of full, uncovered months you did not have Part D or creditable coverage. You will pay this penalty for as long as you are enrolled in a Medicare Part D plan.

It is important to understand the period when you first become eligible for Medicare so you can avoid these penalties. If you qualify for Medicare by age, it starts three months before you turn 65 and lasts for a total of seven months.

Does Medicare Open Enrollment apply to Medicare Supplements?

The Open Enrollment Period does not apply to Medicare Supplements. You are permitted to purchase this type of insurance or make changes to your Medicare Supplement at any time throughout the year.

To be clear, a Medicare Supplement, sometimes referred to as Medigap Insurance, is not the same as a Medicare Advantage plan. Advantage plans are plans that provide Medicare benefits while a Medigap policy only supplements your Original Medicare benefits. It helps pay some of the health care costs not covered by Original Medicare such as copayments, coinsurance and deductibles. Medicare Supplements generally do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

You will pay a separate premium in addition to your Medicare premiums and you will also need to purchase a separate Prescription Part D plan as this coverage is not usually included with these plans.

The best time to buy a Supplement policy is during your 6-month Medicare Supplement open enrollment period. During that time you can buy any policy sold in your state, even if you have health problems. This period automatically starts the month you turn 65 and are enrolled in Medicare Part B (Medical Insurance). After this enrollment period, if you are able to buy one, it may cost more.

You cannot have a Medicare Advantage Plan and a Medicare Supplement. In fact, it is  illegal for anyone to sell you a Medicare Supplement policy unless you’re switching back to Original Medicare.

If you are interested in learning more about Medicare Supplements, please contact me after January 1 when information on new rates should be available.


New Medicare Cards to be Issued

Medicare will mail new Medicare cards to all Medicare beneficiaries between April 2018 and April 2019. Your new card will have a new number that’s unique to you using a combination of eleven letters and numbers, replacing your Social Security number. The new card will not change your coverage or benefits.
This change in ID numbers is required by a law enacted two years ago and will help to reduce identity theft. You do not need to take any action to get your new Medicare card. Until you receive a new card in the mail, you should take steps to protect your current card. Do not carry your Medicare card unless you are on your way to a health care appointment. Instead, make a copy and black out all but the last four digits.
Be wary that scammers may devise ways to take advantage of you during the transition to the new cards. Do not be fooled if someone calls or visits you demanding you allow them to switch out your card. Medicare will not send someone to your home or phone you asking for personal information such as your Medicare number. Other points to remember:
• Medicare does not email or visit homes unannounced to “update’ or “verify” data that it already has.
• Medicare will never threaten you with a loss of your benefits for not making an immediate change.
• If you receive a phone call about this, ignore that your caller-id may show that the call is from Medicare or CMS. This is likely a phony caller-id that helps the scammers look more believable.
• When in doubt, contact the Medicare helpline, available 24 hours a day, 7 days a week at 1-800-633-4227.

If you would like to learn more about Medicare, please join me for my class, Getting Started with Medicare. You will find a list of upcoming classes at www.mutskoinsurance.com/seminars. For all other questions on insurance, including life, health, dental, vision and Medicare Advantage plans, contact me at 440-255-5700. I look forward to helping you.

Look who’s turning 65 in 2017

April 10 – Steven Seagal, actor

May 2 – Christine Baranski, actress

May 15 – Chazz Palminteri, actor

May 18 – George Strait, country music singer

May 21 – Mr. T, actor and professional wrestler

June 7 – Liam Neeson, actor

June 18 – Isabella Rossellini, actress, and Carol Kane, actress and comedian

June 20 – John Goodman, actor

July 1 – Dan Aykroyd, comedian and actor

July 17 – David Hasselhoff, Baywatch actor

Sept. 9 – Angela Cartwright, The Sound of Music actress

Oct. 22 – Jeff Goldblum, actor

Nov. 3 – Roseanne Barr, comedian and actress

Nov. 8 – Alfre Woodard, actress

Nov. 30 – Mandy Patinkin, actor, Homeland star

Are you insured through a Union or Former Employer?

If you are insured through a former employer or union please read all mail concerning your insurance coverage as soon as you receive it. Your dates for making changes may not be the same as Medicare’s open enrollment. Always talk to your benefits administrator before making changes because it can be difficult to get this type of coverage back once it is dropped.

Please explain more about the Medicare Current Beneficiary Survey (MCBS).

The Medicare Current Beneficiary Survey (MCBS) is a survey of people who currently have Medicare. It is used to provide feedback to the Centers for Medicare and Medicaid Services on how people get their health care, the rising cost of health care, and how satisfied people are with their care. The information is used to help CMS better understand the needs of Americans on Medicare.
You may be selected to be a part of the sample group of 16,000 individuals who are asked to participate in this survey each year. Letters from Medicare go out to potential participants in late summer explaining that someone from NORC at the University of Chicago will be in touch to set up an interview.
A professional interviewer will contact you in person or by phone to setup a visit. If you agree to participate in the study, the interview will take about one hour. Your participation in the survey is strictly voluntary.
Those selected to participate represent thousands of other people similar to them. If you are selected, literally no one else can take your place in the study. All of your information will be strictly confidential as prescribed by The Federal Privacy Act of 1974. Your participation is voluntary and your Medicare benefits cannot be affected in any way by the answers that you provide, or by whether or not you choose to participate.
If you are invited to participate and would like to verify your selection in this study, please contact NORC toll free at 1-877-389-3429. You can also visit the respondent website at www.mcbs.norc.org for more detailed information.
The Medicare Current Beneficiary Survey is important to the future of Medicare. Please consider helping in this national effort to improve your Medicare program.