Tepsick Insurance, Medicare Supplement Plan Vs Advantage Plan. The Villages, Fl

Medicare: A Supplement Plan Or An Advantage Plan?

Medicare:  A Supplement Plan or an Advantage Plan?

The job of an independent insurance agent is to help you make the best health insurance purchase decision given your unique health needs and your budget. Our job also includes periodic review of your situation as needs change to ensure you continue to have the best coverage.

For those turning 65 and new to Medicare one of the most important decisions to be made is whether to choose a Medicare Supplement Plan (Medigap) or a Medicare Advantage Plan. You cannot have both a Medigap and an Advantage Plan at the same time. You can switch from one to the other during special time periods if specified conditions are met.

Traditional Medicare (Part A + Part B) gives broad service coverage but does not pay 100% of approved charges.  The “gap” can be filled in part or whole by a Supplement plan. Supplement Plans generally do not cover vision or dental care, hearing aids, eyeglasses, or private duty nursing.

Supplement Plans:

To qualify for a Supplement Plan You must be enrolled in both Part A and Part B. There are defined time frames during which you are eligible to purchase these plans. Missing these opportunities could result in a plan no longer being offered at a future date. Late enrollees also risk being subject to underwriting criteria and higher premiums.

Supplement Plans are sold by private insurers. The plans are “standardized” and must conform to Federal and State laws. Supplement Plans are identified by the letters A through N.  There are 10 plans now offered. E, H, I and J are no longer available. Regardless of which insurer sells the plan, the same basic benefits must be offered. Cost is the only difference between plans of the same letter sold by different insurers. Medicare does not pay the cost of these policies; the beneficiary/subscriber pays the premium. This is in addition to the Part B premium that you pay to Medicare.

The differences among the lettered plans are best grasped in a table format. Suffice it to say that Plan F offers the most comprehensive gap fill. The percent of deductibles and coinsurance paid for you varies among the plans. Some plans do not cover certain services, such as foreign travel emergencies or skilled nursing facility coinsurance. To offset this Plans K and L have annual out of pocket expense limits. Supplement plans do not include a prescription drug benefit. A Prescription Drug Plan can be purchased separately.

Medicare Advantage Plans:

Advantage Plans are offered by private insurers who contract with Medicare to provide all your Part A and Part B benefits. Some offer vision and dental benefits as well. Many Advantage Plans include a prescription drug benefit.  Advantage Plans can be a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), a Private Fee-for-Service Plan(PFFS), or a Special Needs Plan or Chronic Care Plan… HMOs and PPOs are most common. They are assigned a quality rating (1-5 stars) based on a federally monitored program of performance standards. It is important to check the rating before purchase.

Advantage Plans have a Managed Care component to monitor and improve quality of care and to control costs by minimizing unnecessary duplication of services. Preventive care such as cancer screening and immunizations are encouraged. Usually, a primary care physician is selected. Some services may need prior approval. There are panels of in-network specialists. In general, the bigger the enrollment in the local or regional plan, the greater the number of specialists in the network. Out-of-network care may be partially covered. Some plans have maximums on out -of – pocket expenses.

Open Enrollment is coming soon, October 15-December 7, 2017

Medicare Donut Hole Explained, Tepsick Insurance, The Villages, Fl

Medicare Part D’s “Donut Hole” Coverage Gap

Medicare Part D’s “Donut Hole” Coverage Gap
By Yvonne Tepsick

To help Medicare users to handle the high cost of medications, Medicare offers prescription drug coverage, run by insurance companies or other companies that have been approved by Medicare. The plans these companies offer help you afford prescription drugs that you need for the treatment of illnesses or permanent medical conditions.

Some of the Medicare prescriptions plans may have a deductible of $405 in 2018. If your plan does have a deductible, you could pay the first $405 of your tier 3, 4 or 5 drugs. Once the deductible is met, it acts like any other plan that doesn’t have a deductible. This is called the initial coverage stage.

Depending upon the amount you pay for drugs covered under your Part D plan, you may experience a temporary coverage limit, also known as the “donut hole”. In 2018, this gap starts after the cost of your medications to the insurance company reaches $3,750 on covered drugs and Catastrophic Coverage begins after you have paid $5,000 for your covered drugs.

After you reach the “donut hole,” you’ll pay more of the drug costs from your own pocket. For brand-name prescription drugs, you may pay 15% of your plan’s cost and 44% for generic drugs.

The Coverage Gap Doesn’t Affect Everyone

Some Medicare recipients may not experience the coverage gap. Healthier individuals or people who purchase generic drugs may not spend up to $3,750 on prescription drugs, while others may have Extra Help. Extra Help is a specialized federal program that helps people living on a limited income.

If you qualify, Extra Help eases the costs of coverage. “Full” Extra Help provides you with insurance coverage throughout the year (with no gap) and you’ll pay much less for prescriptions. “Partial” Extra Help offers coverage through the year, as well as a reduced deductible and premium. Partial Extra Help will also pay up to 15% of the cost of your prescription drugs.

How To Leave The Coverage Gap

What you pay in out-of-pocket costs will help you eventually exit the coverage gap. While you’re in the “donut hole,” Medicare has a predetermined limit to what you pay from your own wallet. Medicare not only notes what you’re paying for prescription drugs but also counts your yearly deductible, your co-insurance and your co-payments toward this out-of-pocket limit.

Also, catastrophic coverage begins automatically when you reach the out-of-pocket limit of $5,000 during the coverage gap. When catastrophic coverage is in effect, you have a smaller amount to pay in co-insurance or co-payments for the remaining months of the year.

Open Enrollment Has Started

If you want more information about the “donut hole” coverage gap or you’d like to change to a different Medicare plan, open enrollment is a good time. Please make an appointment by calling 352-350-6663. As an independent insurance agent, I’ll help you to examine your current coverage and find a good plan for your health needs.

Tepsick Insurance, ABCD Of Insurance, The Villages, Fl



Thomas J. Flannery, MD MBA, a Tepsick Independent Insurance Agent

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) or ALS (Lou Gehrig disease).

Every day 10,000 baby boomers turn 65. Those with their 65th birthday this July were only 13 years old on July 30, 1965 when President Lyndon B. Johnson signed Medicare into law in Independence, Missouri and made former President Harry Truman the very first Medicare enrollee. In its first year Medicare had 19 million enrollees.  There are now 50 million+ enrollees.

Over the years Medicare has evolved as Congress has added new benefits and modified how hospitals and practitioners are reimbursed for their services.

There are four parts to Medicare:

Part A (Hospital Insurance) pays for part of an inpatient stay in a hospital or in a skilled nursing facility following a minimum 3 day hospital stay. If you receive or are eligible to receive Social Security Benefits, you can obtain Medicare Part A coverage at age 65 at no cost. We recommend that you sign up for Medicare Part A three months before your 65th birthday even though the Social Security full retirement age is no longer 65.  If you have employer provided health insurance, Medicare Part A can serve as a secondary insurer.

Part B (Medical Insurance) helps pay for physician services and services of other health care providers. Medicare Part B also provides benefits for outpatient care, home health care, durable medical equipment and some preventive services. Medicare Part A plus Medicare Part B are sometimes referred to as “Original Medicare.”  Since neither Part A nor Part B pay 100% of allowed charges, private insurers offer Medicare Supplemental Insurance to fill the gaps.

Part B enrollees pay a premium. Enrollment in Part B is limited to designated enrollment periods. If you do not enroll in Part B during the Initial Enrollment Period (3 months before, during, and 3 months after your birthday month) you will have later opportunities to enroll, but will be subject to a late enrollment penalty that lasts as long as you have Part B coverage. For those who still work and have employer based insurance, you can postpone enrolling in Part B and you will not be subject to a late enrollment penalty.

Part C (Medicare Advantage) provides all the services and benefits of Medicare Parts A and B. Some plans include prescription drug coverage and additional services and benefits. A variety of such plans are available.

Part D (Medicare Prescription Drug Coverage) helps defray some of the cost of prescription drugs. The Prescription Drug Benefit can be part of an Advantage Plan or added to “Original Medicare.” If you do not join a Prescription Drug Plan when eligible you may be subject to a penalty unless you have creditable drug coverage from another plan.

As an Independent Insurance Agent we can help you determine which mix of these options best suits your unique health needs and your health care budget.

If you need more information about the different health care options available, or if you are looking to make any changes in your health care plan, feel free to contact me at 607-346-6676 or tom@tepsickinsurance.com.

Tepsick Insurance, Annuity

Is An Annuity Right For You?

By Yvonne Tepsick

If you want to enjoy a financially comfortable retirement, saving early and often is a smart decision. There are a variety of retirement savings products on the market, such as 401(k)s, Roth IRAs (Individual Retirement Accounts), and SEP (Simplified Employee Pension) IRAs. These retirement products enable you to put away your savings and withdraw them later as needed, subject to various conditions.

There is another savings vehicle that is equally useful for ensuring that you have regular income later: the annuity. An annuity is an insurance product where you can invest your money regularly without a limitation on how much you can invest. For people who are behind on their retirement savings, an annuity helps them to save more money toward retirement without the annual contribution restrictions of IRAs.

Another advantage to an annuity is that your money grows on a tax-deferred basis. When you make withdrawals from the annuity, your withdrawals are not taxed but the earnings generated from the investment are subject to taxes.

A third advantage to annuities is that you can structure your payments. You can receive your payments monthly, quarterly or annually, or receive them in one lump sum.

So is an annuity the right choice for you? There are several circumstances where investing in an annuity is a wise option:

You’ve already maxed out annual contributions to your 401(k) or IRA.

  • You need to catch up on your retirement savings.
  • You can afford to allow the money to remain in the annuity for several years before making withdrawals.
  • You want to make sure your beneficiaries will be covered in the event that something happens to you.

There are two main types of annuities available – fixed or variable. Depending upon the type of annuity, you can receive payments soon after your initial investment or you could choose to receive payments later and give your investment the opportunity to grow further.

If you’re interested in investing in an annuity, contact us. We’ll be happy to match you with an annuity to suit your financial needs and explain everything you’ll need to know.

The Differences Between HMOs And PPOs In Medicare Advantage

Differences Between HMOs And PPOs In Medicare Advantage Plans

If you choose a Medicare Advantage Plan (Part C) rather than Original Medicare (Part A and B), this plan involves Medicare-approved private insurance companies. This type of Medicare typically includes the same hospital and medical insurance coverage as Original Medicare, but the plan is commonly an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization).

There are several differences between HMOs and PPOs. With HMOs, you choose a primary care physician (PCP) from a network of healthcare providers, and insurance coverage is available if you select a provider who is in-network. If you visit a specialist or a special test is needed, the PCP gives you a referral. In addition, if the physician you see is outside of the network, your HMO plan will not pay for the visit or medical services that result from the visit.

PPOs offer more flexibility. While they also have a network, PPOs permit you to see the healthcare provider you prefer without a PCP referral. Depending upon your plan, treatment from an out-of-network doctor or medical care facility might be covered, but coverage is better if you remain in the PPO’s network.

You should also consider the cost of your premium and potential medical costs. HMOs are often easier on your budget but there are more restrictions on them. PPOs are less regimented when it comes to using out-of-network healthcare providers and facilities, but they are more costly. It’s also important to note that most Medicare Advantage plans offer prescription drug coverage (Part D of Medicare).

There are only certain times of the year when you can make changes to your Medicare coverage. Between October 15 and December 7 open enrollment, any person with Medicare can join, switch or get out of a Medicare Advantage Plan. There are also special enrollment periods that let you change your plan under certain circumstances.

When you’re ready to seek advice about Medicare, remember that Tepsick Insurance is here to help. Contact us for assistance in choosing the type of Medicare plan that fits your needs.

Hours & Info

352-350-6663 (Office) – 202-439-2530 (Cell)
Office Hours, 8:00 am to 6:00 pm


medicare's parts B and D, Tepsick Insurance, The Villages, Fl

Delaying Your Enrollment In Medicare’s Part B And D May Be A Smart Choice

For many people, dealing with Medicare is confusing. Some of the typical questions are: “How does Medicare work?” “What am I responsible for and what is the government responsible for?” “What are my deadlines?”

Original Medicare consists of several parts. Part A is hospital insurance, helping to cover the expenses of inpatient care in hospitals, skilled nursing facility care (custodial and long-term care are not included), hospice care and home health care.  Part B is medical insurance. Part B assists with the costs of outpatient care, home health care, services

Part B is medical insurance. Part B assists with the costs of outpatient care, home health care, services from doctors and other health care providers, durable medical equipment, and some preventative services.

Part C is the Medicare Advantage plan, which is either an HMO or PPO. This plan includes both Part A and Part B, and the coverage is provided through private insurance companies that have been approved by Medicare.

Part D is Medicare prescription drug coverage so that you can obtain prescription drugs when you need them.

With these plans, the premiums, copayments and coverages vary, depending what plan you choose. However, there is a circumstance where putting off getting Part B and Part D could be an advantage for you.

For example, if you have an HSA (Health Savings Account) from your current employer and you want to keep enjoying an HSA’s tax advantages, you have the option of delaying enrollment in Part B and Part D at age 65. However, it’s only wise to delay if you meet the following criteria:

  • You currently have primary coverage through a company with 20 or more employees (or your spouse’s insurance covers you).
  • The coverage you have now covers what you need, including prescription drugs.
  • You can obtain written proof that your employer will cover your outpatient costs first. (You must show this evidence of “creditable coverage” to Medicare later.)

With Medicare, it’s important to carefully assess your medical needs as well as your income now and in the future. Tepsick Insurance can act as your experienced guide through the Medicare maze – we’ll help you choose the plan that is best for you.

5 Important Reason To Have Life Insurance

Life Insurance

As we start to grow older and realize that the things we dreamed about are beginning to happen, it’s time to think about protection of our life style and family members. If you have a business that provides an income for your family, it’s important that you protect yourself and your family to make sure they can continue on in case something happens to you. Consider the five points below:

 1. To Protect Your Family And Loved Ones

If you have loved ones that depend on your support then it is paramount that you find a way to provide for them. This is especially important if you have young ones that depend on you. You also need to consider covering the costs of providing help when you are gone. Life insurance is a critical part of your financial planning.

2. To Leave An Inheritance

Life insurance is a great way to provide an inheritance to leave for your family. If the other members of your family do not work, then what you provide as a life insurance plan may be their only hope to maintain their current life style.

3. To Pay Off Debts And Other Expenses

Life Insurance also provides funds to pay off existing debts and any burial expense related to your death. While we don’t like to think about these types of life changing events, they are very important to plan for when building your Life Insurance plans.

4. To Improve Your Financial Security

Passing away and knowing that your children will still be able to attend college and have the basic needs you would have taken care of is very important. As parents we want our children to have a better life than the one we lived. Life Insurance helps guarantee that is possible.

5. To Bring Peace Of Mind

No amount of money can ever replace a person. But more than anything, life insurance can help provide protection for the uncertainties in life. Without a doubt, having life insurance coverage will bring you and your family peace of mind. It’s one thing you can be sure of and no longer question if they’ll be taken care of when you’re gone. None of us know when we’ll pass away. It could be today, tomorrow, or 50 years into the future, but it will happen eventually. Life insurance protects your heirs from the unknown and helps them through an otherwise difficult time of loss.