Health Care Blog

 

Is a High-Deductible Supplement Right for you?

Last week I met with a lady in in Tipp City.  She turns 65 in November and wanted help deciding on a Medicare plan.  She already met with a broker in Dayton but wanted a second opinion and she saw my article in the newspaper. 
The broker in Dayton explained the difference between a Medicare Supplement and Medicare Advantage plan and she liked certain aspects of each.  The Medicare Supplement was more expensive but offered better coverage and she could see any doctor that accepted Original Medicare.  The Medicare Advantage was cheaper but limited her providers and had more out-of-pocket expenses.   She was very healthy and didn’t want to pay $150 for a Supplement but she lived in Florida for 4 months of the year and and the Medicare Advantage plan didn’t work there. 

I ended up signing her for a High-Deductible F plan that was about $50 per month.  The High- Deductible F plan is a Medicare Supplement that has a $2,180 deductible.  After the deductible doctors and hospitals are 100% covered.  It’s technically a Medicare Supplement so it works nation-wide but it’s cheaper than a traditional Supplement.  Also, her financial exposure was $2,180 instead of $5,000 with a Medicare Advantage plan.  It was the perfect compromise!

High-Deductible F Plans are great but they still haven’t caught on. Last year only one percent of the Supplements sold nation-wide were High-Deductible F plans.  I think that number will go up in the next couple years for several reasons.  Your Out-Of-Pocket expenses for Medicare Advantage plans are going up and your choice of providers are going down.  A High-Deductible Supplement could be the perfect compromise for you.  As always, if you have questions or want more information please call my office anytime.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com. You can also follow Michael on twitter @HealthcareMikeD.


 

9/22/2016

What is the Annual Enrollment Period?

 During the Annual Enrollment Period (AEP) Medicare-eligible beneficiaries can change plans.  The AEP is between October 15 and December 7 and it’s important to know what changes you can make.

 There are two types of plans that people can change during the AEP: Stand Alone Part D Prescription plans and Medicare Advantage plans.

 If you buy a stand-alone Part D prescription, like AARP, you can change to a different insurance company, like Silverscript.   It’s important to reexamine your prescription coverage every year because certain plans might cover your drugs better.  Also, if you started taking a new medication it’s a good idea to make sure your plan works with your new drug.

 You can also change your Medicare Advantage plan.  A Medicare Advantage plan is when someone gets insurance from a private insurance company instead of Medicare.  For example, if you get Medicare coverage from Anthem Blue Cross and Blue Shield you can change to a different insurance company like Premier.  The co-pays for Medicare Advantage plans change every year so it’s a good idea to reexamine your coverage. 

 Insurance companies cannot decline people based on preexisting conditions during the Annual Enrollment period.

 I’ve found that a simple change to your Prescription or Medicare Advantage plan can save some people a lot of money.  If you haven’t explored your options recently I recommend that you contact an agent, like me, to see if you can find a better plan.

 As always please contact my office if you have any questions.

 Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com. You can also follow Michael on twitter @HealthcareMikeD.


9/22/2016

The Doughnut Hole Explained

 This time of year I get calls from clients asking why they are paying more for prescriptions.  The story is always the same and so is my response: You’re in the Doughnut Hole!

The official name for the Doughnut Hole is the Medicare Part D Coverage Gap and many people enter the coverage gap in the last 4 months of the year. 

 So, what is the Doughnut Hole?

 The Doughnut hole is a system that incentivizes people on Medicare to use lower cost or generic medications.  The problem is that many drugs don’t have an alternative available. 

 Last week I talked to a lady in Troy who takes Lanuts Solostar to control her diabetes.  She only paid $42 for Lantus in July, then started paying $170 in August.  Unfortunately, there isn’t a generic available for Lantus so she was stuck paying the higher amount.  I did help her contact the maker of Lantus and we got her a savings card, which saved her about $50 per month.

 The other problem is that the Doughnut hole is confusing.  The easiest way to explain the doughnut hole is this; you get an allowance from Medicare to spend on prescriptions.  Once you exhaust that allowance you start paying for your drugs.

 Most people get confused because they feel like they’re paying for drugs from day 1.  But your co-pay doesn’t cover the full cost of drugs.  If you take a drug that costs $100 and your co-pay is $45 Medicare pays the remaining $55.  $100 comes out of your allowance.

 The other confusing part is that you don’t pay the full cost of drugs when you’re in the doughnut hole.  In 2016 you pay 45% of the drug and in 2017 you will pay 40%.  Many times the co-pay for the drug is actually more than the discounted cost.  So that $100 drug might have a $45 co-pay but after you enter the Doughnut Hole you only pay $40.

 Remember, it’s always good to reexamine your Part D Prescription or Medicare Advantage Plan during the Annual Enrollment Period, which is between October 15 through December 7.  If you have questions about your specific situation, please call or email me anytime.

 Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com. You can also follow Michael on twitter @HealthcareMikeD.

 


 

 9/22/2016

It’s OK to Disclose your Budget

 Many times getting information out of a potential client is like pulling teeth.

They expect me to sell them an unnecessary product so they don’t tell me anything at all.

 To be honest, I don’t blame them.  I’m the same way when I go into a car lot.  Not because I don’t trust car salesman but I’m clueless about cars. I never disclose my budget.  That might work in a car lot but it can be harmful in an insurance office because you want to make sure you are covered for the things you need.

 I want to prepare you to buy insurance but I’m not going to tell you what to ask your insurance advisor.  I’ll explain how I get paid then you can decide.  Please keep in mind I’m a health insurance broker and I help people with group, individual and Medicare health insurance.  Agents that sell other insurance products probably get paid differently than me.

 First, most insurance companies pay me a dollar amount per policy and not a percentage of the price.  Many times people are taken aback when I recommend they sign up for the cheapest plan.  Unlike other commission based jobs, I get paid regardless of the price of the plan.

 Second, most insurance companies pay me about the same. The government regulates commissions for Medicare products but even non-Medicare products are very similar.  The largest difference among the insurance companies I sell is $2.00 per month.

 Third, I only get paid if you keep your plan.  I get my commissions from insurance companies every month so if you drop your plan or change brokers I stop getting paid.  I have every incentive to sell you a plan that will be good long-term.

 Finally, the price of the insurance is the same if you buy from a broker or directly from an insurance company.  I can’t say that my services are free because my commissions are built into the price of your plan.  But if you buy a plan directly from a 1-800 number or online it will be the same price from a broker.  I recommend using a broker because he or she can show you multiple insurance companies.

 I recommend being up front with your insurance advisor because you want to make sure you are covered for the things you need.  Hopefully you will now that you understand how we get paid.  As always, if you have any questions please reach out to my office.

 Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.


  


 

InHealth Mutual

The name InHealth Mutual might not ring a bell to a lot of people in Miami County.  But it should.  InHealth Mutual is a health insurance company that insured more than 22,000 Ohioans.  Nearly a quarter of those people lived in the Miami Valley.  However, it’s the amount of people that InHealth doesn’t insure that is more important.

InHealth Mutual went out of business just over 2 months ago and it was barely reported in the news.  In fact, some people who have InHealth might be finding out from this article.  The Department of Insurance sent notices to members but I think we know what happens to that kind of mail.

There are still more questions than answers regarding InHealth but I can explain what options we have as consumers.

When an insurance company like InHealth goes out of business the Department of Insurance becomes the superintendent for that company.  The benefits and deductible are not interrupted.  Medical claims are sent to the Department of Insurance instead of the insurance company.  However, the Department of Insurance will only pay up to $500,000 in claims per person per year.  That means if you have a large claim that exceeds $500k you can be on the hook.  It also means that your coverage doesn’t meet the federal minimum requirements for health insurance, which brings us to your other option.  You can change plans.

Unfortunately, the time to change plans ended for most people on July 26. But if you have a claim that exceeds $500,000 you get a special enrollment period to find another plan because you will have lost coverage.  You can also change plans during the Open Enrollment period, which starts November 1, 2016 and your new plan will be effective January 1, 2017.

Again, we don’t know all the details about the InHealth Mutual liquidation so I recommend focusing on what we do know.  As always if you have questions about your specific situation please reach out to my office.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.


 

8/31/2016

Obamacare is in Trouble.

This might come as a surprise but Obamacare is in trouble- big trouble.

The most recent proof is that AETNA announced they will stop selling Obamacare plans in 11 of the 15 states they are in, including Ohio.

Aetna joined United Healthcare and Humana, which means that three of the four largest insurers in the country will not participate in Obamacare.  The other large insurer, Anthem Blue Cross and Blue Shield, will sell plans but they are very limited.  For example, if you buy an Anthem Obamacare plan in Miami County you are limited to providers in the Kettering network.

It’s ironic because many of the large insurers, including United Healthcare, were in favor of the new health care law before it was implemented.  However, the support was based on subsidies from the government.  Unfortunately, the subsidies were less than promised and were not enough to combat the high claims.  United Healthcare said they will lose about $1 billion from Obamacare in 2015 and 2016 combined.

That means individuals and families who purchase health insurance in Miami County will have very limited choices in 2017.  At this point it looks like there will be 2-3 insurance companies to choose from. 

It also means you will have to buy a plan with a limited network.  For example, one of the plans that will be available is Premier Health Plan.  Premier Health Plan is great but it only works with Premier Health Partners medical providers.  That means if you see a doctor in the Kettering or Wilson network they will not be covered by your insurance and you might have to pay out-of-pocket to see that doctor.

Many people will have to choose a new plan for 2017 so I recommend marking your calendar for November 1, 2016.  That’s when people like me can help you find a new plan for 2017.  The open enrollment period starts November 1 and ends January 31, 2017.

As always, please call or email me if you have questions about your specific situation.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 

 


 

8/31/2016

The Need for Reform 

The Obama administration pushed the narrative that most people who have pre-existing medical conditions were left out to dry by insurance companies. 

While that is partially true and politically popular, I think it was intentionally overblown as a way to gather support for Obamacare.   The problem that needed to be reformed was the price of health care- not the pre-existing conditions clause.

The fact is most people in America were able to get insurance before Obamacare and the amount of people who couldn’t buy insurance because of a medical condition was very small- maybe 5% of the population.  I think that number should be 0% but we could have found a cheaper way to make it happen.  In fact, tax payers could have paid for health care for those 5% and it would have been a drop in the bucket compared to the cost of Obamacare. 

Here are the numbers: 49% of Americans get insurance from an employer, 32% get insurance from the government and 8% buy insurance for themselves.  That leaves about 10% who are uninsured and we are finding out that many of those people chose to be uninsured and not denied because of a pre-existing medical condition.

Many people don’t realize that the two most common sources of health insurance, employer coverage and the government, already had laws that prevented insurance companies from denying people based on medical conditions.  Government programs like Medicare and Medicaid are based on age and income- not preexisting medical conditions.  Also, State Insurance Commissions already had laws in place that prevented insurance companies from denying employers health insurance.  Unfortunately, the cost of government programs and group health plans is very high.  Tax payers end up paying for the cost of government insurance and employees end up paying the cost for group health insurance.

The U.S health care system needs to be reformed, yes.  But it should be reformed in a way that lowers the cost of care not eliminates the pre-existing condition clause.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com. You can also follow Michael on twitter @HealthcareMikeD.

 

 


 

 

When will I have to Comply with Obamacare?

The Affordable Care Act was signed into law more than 6 years ago but many people still haven’t felt the effects.  The rules changed many times so I will try to clear the confusion.

The original intent of ObamaCare was for everyone to have have a standardized health insurance plan starting January 1, 2014.  There was an exception for people who bought insurance before the law was signed March 23, 2010.  Those were grandfathered into the old system.  That means if you bought or changed your plan after March 23, 2010 you should have been required to get an Affordable Care Act-compliant plan January 1, 2014, the start of Obamacare. 

However, in October of 2013 Obama said that people who bought a plan after March 23, 2010 could keep that plan.  Obama gave the extension for several reasons.  First, no one understood the rules (including Congress!).  Second, no one could enroll in a new plan because Healthcare.gov didn’t work.  So if you bought a plan after 2010 and before 2014 you have a grandmothered plan.  At this point you can keep your grandmothered plan until December 31, 2017.  Many people think that date will change and might not happen at all.

So, we have three types of plans; ACA-Compliant (purchased after Jan 1, 2014), Grandmothered (purchased between March 23, 2010 and Jan 1, 2014) and Grandfathered (purchased before March 23, 2010).  The plans I described are for people under the age 65 and companies that sponsor insurance and have less than 50 employees.

There are many things to consider when you change from a grandfathered or grandmothered plan to an ACA-Compliant plan so I recommend working with a broker, like me.  Please call or email my office if you have questions.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 


The Narrow Network Dilemma

What is a narrow network?

A Narrow Network describes a health insurance plan that only works with a single medical provider.  For Example, in Miami County we have Premier Health Plan.  Premier Health Plan is the name of an insurance company that only works with Premier Health Partners medical providers.

Insurance company’s use narrow networks to save money.  It’s easier for an insurance company to negotiate lower prices with a single provider than it is multiple providers. 

ThoseUsually Narrow Network plans are cheaper than traditional plans.  For example, in Miami County you can save about 20% on your monthly cost by signing up for a narrow network plan. 

What if I am traveling and have to use a provider outside the narrow network?

Most narrow network plans, like Premier, cover you in case of an emergency.

How can I find out if my Doctor is in a narrow network plan?

I recommend working with someone that understands the differences in the local networks.  Feel free to call my office if you need help with your specific situation

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 


 

7/26/2016

Tips for Picking a Health Insurance Plan. 

The Affordable Care Act was supposed to simplify the health insurance purchasing process but most people say the process is more confusing than it was five years ago.

I am a health insurance broker so it’s my job to simplify the process and I want to share some tips for picking a good plan.

First, understand the terminology.  When you buy a plan on your own it can be like a foreign language.  I am going to explain the terminology to you exactly how I explain it to my clients.

The deductible is the amount you pay before the insurance kicks in- similar to car insurance. For example, if you have a $5,000 deductible it means that you go into your doctor or hospital and show them your insurance card.  The doctor or hospital processes the claim then you get a bill in the mail.  You pay the bill and that money chips away at your deductible throughout the year.  Your deductible starts over in January every year.

If you pay $5,000 in that calendar year the insurance company starts paying a certain percentage of your medical bills, which is called co-insurance.  The Max out-of Pocket is the most you can pay in medical bills in one calendar year.  That includes the $5,000 you paid in deductible and the money you paid in co-insurance after your deductible was met.  In my opinion the Max out-of pocket is more important than the deductible because it describes the amount you have to pay if something bad or expensive happens.

Most people know what a co-pay is.  However, it’s important to know that you usually have a co-pay before your deductible is met (from day-1).  Also, the co-pays don’t chip away at your deductible but they do chip away at your Max out-of pocket.

Second, make sure your doctors and hospitals are covered.  Always check with an insurance agent or the insurance company directly to make sure your doctors are covered.  Many individual plans, like Anthem Blue Cross and Blue Shield, have a narrow network or HMO, which means the insurance only works with a single hospital network like Kettering Health Network.  Miami County has been particularly affected by narrow networks like Blue Cross and Blue Shield.

Third, take advantage of any tax subsidies you are eligible for.  Tax subsidies are pretty much a discount on your insurance bill.  Many people think they make too much money for a subsidy but always check with an insurance agent or online to see if you qualify.  For example, a four-person family with income of $97,000 can still get help paying for insurance.

Buying the right health insurance plan is important so the purchasing process can seem overwhelming.  If you ask the right questions and understand the basic terminology you can find a plan that fits you and your family.  You can also contact me or my office for help.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 


 

7/26/2016

When can I Sign up for Health Insurance?

            Yesterday I got a call from a lady that wanted to sign up for health insurance for her and her 12-year-old son.  She was 41 years old and lived in Troy.  She was self-employed and wanted to make sure she had something to protect her business.  She also mentioned that her son started playing hockey and needed a sports physical- and Emergency Room coverage, obviously.

I got some basic information from her and we were both disappointed when I told her that I couldn’t sell her a plan.  She was outside the open enrollment period and didn’t have a Special Enrollment Period.  Now she has to wait until January 1, 2017 to get a plan.  The only recommendation I could give her was to buy her son a set of golf clubs…

On the surface it seemed like a great opportunity for me. I sell health insurance and I love helping people.  However, I get calls every day from people I simply can’t help.

If you buy insurance on your own, please keep reading.

There are two times of the year that you can sign up for insurance- the open enrollment period and a Special Enrollment Period.

The open enrollment period is between November 1, 2016 – January 31,2017.  During that time any U.S. citizen that is under the age 65 and not enrolled in Medicare can sign up for health insurance.  The insurance company cannot decline you regardless of your medical conditions.  You can either sign up for insurance through a broker, like me, or a public exchange, like Healthcare.gov.  The price is the same if you use a broker or buy it from Healthcare.gov

You can also buy a plan during a Special Enrollment Period (SEP).  A Special Enrollment Period happens when you lose insurance from an employer or have a qualifying life event like the birth of a child.  Most of the time you have 60 days from the qualifying event to sign up.  Again, you can either work with a broker or sign up on a public exchange.

Sometimes you can purchase a Short-Term plan if you don’t have a Special Enrollment Period.  Short-Term plans can be helpful but there are limitations so contact my office for more information.

Unfortunately, the lady I talked to is not alone.  Most people don’t understand the new rules when it comes to signing up for insurance.  If you have questions about your specific situation, please reach out to my office.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 

 

 

 


 

7/26/2016

What is a Health Insurance Subsidy?

The term health insurance subsidy was tossed around during the health care reform debate.  Still, most people don’t understand what that term means.

 A health insurance subsidy is pretty much a discount on your health insurance bill. It is paid by the government to the insurance company.  For example, if you buy a plan for $500 per month and you receive a $200 subsidy, you will get a bill in the mail for $300 from the insurance company.

 The amount of subsidy is based on your total household income and your family size.  If you are below 400% of the Federal Poverty level, you might qualify for a subsidy.

Many people think they make too much money to get a subsidy but I recommend checking with a broker or online to see if you qualify.

Last week I helped a guy who lives in Covington, OH that needed insurance for himself and his family.  He was 44 years-old and had a wife and two children.  His total household income was about $85,000 per year and he got a subsidy of $480 per month.  The actual price of his insurance was $1,059 but he only paid $579 because of his subsidy.

It’s easy to find out if you qualify for a subsidy so please call my office if you have questions about your specific situation.

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 


 

 Healthcare Blog 7/26/2016

 

Can I Change my Medicare Plan?

 

That is one of the most common questions I get from people on Medicare. Unfortunately, the answer isn’t as simple as the question because it depends on what type of plan you have.

For example, this week I got a call from a gentleman who lives in Piqua, OH that wanted to change his Medicare Supplement to a new insurance company.  His current plan was increasing by about $20 per month.  He thought that he could change plans because there is a new law that says insurance companies cannot decline people based on pre-existing conditions.  Unfortunately, I told him, the pre-existing condition clause only applies to people who are under the age 65 and not on Medicare.  He could change his plan but the new insurance company would make him answer health questions and they could decline him coverage.  Luckily, he had no medical conditions and I found him a new plan.

So what are the rules for Medicare?

 You have two periods of time that you can enroll in a Medicare plan; The Initial Coverage Election Period (ICEP) and the Annual Enrollment Period (AEP). 

The Initial Coverage Election Period (ICEP) happens when you first sign up for Medicare.  During ICEP you can sign up for a Medicare Supplement and Part D Plan or a Medicare Advantage plan.  The insurance company cannot decline you. 

The Annual Enrollment Period (AEP) is between October 15- December 7 every year.  During the AEP you can change your Medicare Advantage plan or your Part D Prescription plan.  You can also change from a Medicare Supplement to a Medicare Advantage Plan. 

There are also Special Enrollment Periods for people in unique situations.  If you have questions about your specific situation feel free to reach out to my office.

 Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 

 


 4/05/2017

Do I have Silver Sneakers?

 

One of the most common questions I get is, “Do I have Silver Sneakers”?

 

Silver Sneakers is a free fitness program included in many health insurance plans.  It gives members free access to fitness facilities like the YMCA.  You can go as often as you want and there is no charge.

 

It’s one of the most popular features of many health plans but only certain plans offer it. 

 

Right now, almost every Medicare Advantage plan in Miami County offers some fitness benefit.  Aetna and Premier offer a program called Silver and Fit- which is almost exactly like Silver Sneakers.  Anthem, Medical Mutual of Ohio, and AARP offer Silver Sneakers.  That means if you live in Miami County and you have a Medicare Advantage plan you probably have a free gym membership to the YMCA!

 

There are only 3 Medicare Supplement plans that offer Silver Sneakers- Medical Mutual of Ohio, Anthem, and AARP.  Also, only Medical Mutual of Ohio Supplements that were sold after January 1, 2016 have Silver Sneakers.  So, if you bought a Medical Mutual plan before 2016 you don’t have that benefit.

 

Also, there are no health plans for people under the age 65 that offer Silver Sneakers, hence the term “Silver.”

 

If you have a Medicare Advantage plan or a supplement from one of the three carriers- just go into the YMCA and show them your card and they will enroll you in the program.

 

I’m a broker for Medicare Advantage and Supplement plans so if you have questions about Silver Sneakers or your plan please call or email me anytime.

 

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

 

 


 

What’s the Advantage of a Supplement?

 

There are 2 types of Medicare products that help people pay for out-of-pocket expenses at the doctor and hospital.  Most people who have Medicare have either a Medicare Supplement or a Medicare Advantage plan.  Many people get the two terms confused so- what’s the difference?

 

A Medicare Supplement is more expensive but covers more.  For example, if you have a Medicare Supplement with AARP you will pay very little or nothing at the doctor or hospital. Your monthly premiums are higher- maybe between $150-$200 per month- but your out-of-pocket expenses are lower.  A Medicare Supplement also lets you see any provider in the nation that accepts Medicare.  You pay more but you get more.

 

A Medicare Advantage Plan is less expensive- sometimes $0 per month- but you pay more when you go to the doctor.  For example, if you have an Anthem Medicare Advantage plan you would pay $10 at the doctor, an emergency room $75, and a hospital stay is $350 per day.  You always have a maximum out-of-pocket limit with Medicare Advantage plans that might be around $5,000 per year.  You also must see doctors within your specific network like the Anthem Mediblue HMO- which is more limited than original Medicare.

 

Also- prescription coverage is usually bundled into a Medicare Advantage plan but you must purchase a stand- alone Part D plan if you have a Medicare Supplement.  The prescription coverage for people on Medicare is very similar whether you buy it stand-alone or it’s bundled into your Medicare Advantage plan.

 

I’m a broker for Medicare Advantage and Medicare Supplement plans and I see the value in both.  The plan you choose should depend on your financial and health situation.  You should also understand the rules regarding your options to change plans in the future.

 

If you have any questions about your current situation or the difference between a Medicare Advantage and Medicare Supplement please call my office anytime.

 

Michael Dugan is a representative of Benefits Analysis Corporation, an independent health insurance agency in Troy Ohio. Michael Dugan is a licensed health insurance broker with an MBA in Health Care Management.  Benefits Analysis Corporation can be reached at 937-335-5751 or This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.BenefitsAnalysis.com.

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