From the Society of Certified Senior Advisors

Busting the Top Five Medicare Myths

Provided by Francie Stavish, Francie Stavish Associates. Senior Move Manager and Estate Cleanout

Avoid becoming a victim of what you think you know about Medicare.

Nearly everyone over the age of 65 depends on it, but myths and misconceptions around Medicare persist. The government-funded health insurance program for seniors will provide more cumulative lifetime benefits to average earners than Social Security by 2055, according to a study by the Urban Institute, but its complexities inspire a host of misconceptions.

Whether you will be new to Medicare or have gone through the process many times before, here’s how to navigate around unnecessary penalties, bad timing and costly stays you only thought were covered.

Myth 1: I can enroll any time I want to.

If only it were that easy. While there are large windows of opportunity, if you miss them, you’ll hit a wall.

First time enrollees have three months both before and after their 65th birthday for their initial enrollment period (IEP). The annual enrollment period (AEP) is October 15 through December 7, when you can make changes to your Medicare coverage.

Participants in traditional Medicare can switch to a Medicare Advantage plan during the open enrollment period, and seniors with Medicare Advantage can return to a traditional Medicare plan or change to a different Medicare Advantage plan without getting hit with a penalty.

Retirees can also switch from one Part D prescription drug plan to another, or add Part D to their coverage (although a late enrollment penalty may apply).

What you can’t do during open enrollment is switch from Medicare Advantage to Medigap (see sidebar) or switch Medigap plans without answering medical questions. You also can’t join Part B, which covers outpatient care, preventive services, ambulance services, and durable medical equipment, unless you have a qualifying event.

Myth 2: Medicare pays for long-term care.

Many seniors are shocked to find out that Medicare is not going to pay for their golden years in a retirement home or assisted living facility. It will cover the first 20 days in a skilled nursing facility, if and only if the need is due to a hospital stay of at least three days. (Some Medicare Advantage plans will waive this requirement under certain circumstances). As of 2017, days 21 through 100 are no longer fully paid, and require a copay of $164.50 per day.

Why are so many seniors taken by surprise, given how common long-term care has become? Experts speculate that it’s because they confuse Medicare and Medicaid, a needs-based alternative that kicks in when assets are depleted. Even then, Medicaid probably won’t cover the swanky place you’ve got your eye on; it is only available for eligible facilities.

Myth 3: Medicare covers all my health expenses.

“People usually think Medicare will cover everything, and that doesn’t work out well for clients who aren’t healthy,” says Joanne Giardini-Russell, Medicare advisor with Financial Architects Inc.

Medicare generally covers 80 percent of costs, and that 20 percent that isn’t covered can add up faster than you can slip on a banana peel. Consider the additional financial burden of dental, vision and hearing coverage, and it explains why so many seniors get supplemental insurance.

It’s important to realize, however, that you have a choice in additional insurance. Don’t just roll from the insurer you had at work into the Medicare Advantage plan the same insurer offers. You can choose between any Medicare Advantage plan offered, as well as Medigap. (See our guide, right) However, you can’t enroll in both.

Myth 4: Medicare is free.

Most people get hospital insurance (Part A) for free, but are surprised that medical insurance (Part B) and prescription drug coverage (Part D) require a premium payment, which is dependent on their income. For 2017, the standard premium per month for Part B is $134, but most people with Social Security end up paying $109 a month on average, according to the U.S. Centers for Medicare and Medicaid Services.

Check if you may be eligible for the Limited Income Newly Eligible Transition (LINET) program, which is a temporary prescription drug plan for low-income Medicare beneficiaries who don’t have other prescription drug coverage. It helps get rid of gaps in coverage for those who aged into Medicare without getting a Part D plan.

The Affordable Care Act added coverage for an annual wellness exam, and covers 100 percent of most preventive services such as cancer and diabetes screens, mammograms, bone mass measurements and more. Many seniors don’t realize these services are now free.

Myth 5: I don’t need to enroll in Medicare.

Even if you have other insurance, it could be crucial to enroll – and timing matters.

If you work in a company that employs fewer than 20 workers, the employer-sponsored health plan automatically becomes secondary to Medicare at age 65, and the Part B penalty kicks in. That penalty means premiums can go up almost 10 percent for every month you are eligible for Medicare but not enrolled. In addition, you can get hit with a similar penalty for Part D that costs 1 percent of the base cost, multiplied by the number of complete months you’re not covered.

Seniors covered by COBRA have no longer than eight months to sign up for Part B without incurring a penalty, even though COBRA may provide secondary coverage for a year or more after retirement.

Likewise, small business owners and seniors who are self-employed have to enroll in Medicare during their IEP, regardless of whether or not they buy insurance privately.

If your employer has 20 or more employees, it’s usually a good idea to at least sign up for the free Medicare Part A as soon as you’re eligible. But before you do, find out whether that will trigger a change in your current coverage.

Should I Choose Medigap or Medicare Advantage?

Provided by Francie Stavish, Francie Stavish Associates. Senior Move Manager
From the Society of Certified Senior Advisors

One of the most confusing choices retirees must make is picking between supplemental Medigap and a Medicare Advantage health plan that covers Part A and B benefits.

Medigap (Medicare Supplement)

With a Medigap policy, seniors have more physicians to choose from. All Medicare providers participate in Medigap. Out-of-pocket costs are low to none, but average premiums run about $150 to $200 a month and vary by age and health history.

Medigap policies come in 10 variations, no matter where you live. But they don't include any coverage for Part D, so additional coverage for prescriptions is necessary. And while you'll have to tote three cards in your purse or wallet (one for Medicare, one for Medigap and one for Part D coverage), payment is a snap. Medigap almost always cuts a check directly to providers after Medicare pays its share.

Medicare Advantage

Medicare Advantage programs require the use of plan providers only (HMO) or charge you extra for out-of-network services (PPO). Plans charge copays and carry deductibles of several thousand dollars per year. Premiums run from negligible to more than $100 per month, but all enrollees pay the same regardless of health history or age.

Most Medicare Advantage plans cover prescription drugs, and they are rated with a five-star system. Seniors only have to carry around their Medicare Advantage card for services, but there's the additional hassle of paying copays and deductibles to providers.

The result: Medigap usually costs less for someone with major health problems. Despite higher premiums, out-of-pocket costs are typically much lower. However, if your prescription costs are high, you should factor in the additional cost of Part D coverage before making a decision. Healthier individuals can save money with Medicare Advantage's lower premiums.

Hint: It's important to review your choice every year at open enrollment, October 15 to December 7. At this time, Medicare Advantage and Part D plans can change or drop coverage for certain drugs or alter pricing on the same drug. Your Medicare Advantage plan can also change their network of doctors and facilities, adjust the way they cover a medical service, and/or drop additional benefits such as hearing, vision and dental.

ALERT: BlueCross leavingSHOP


Our Blue Cross General Agent says: "Group health insurance sold directly through BCBS and its agents is still going strong."

There are even new opportunities for the self-employed and small business owner to choose health insurance plans for themselves and their employees:

  • during Group Special Enrollment (Nov. 15 – Dec. 15) enroll with no employer contribution, no minimum enrollment.
  • more network options including BCBS large PPO network
  • possible premium and tax savings including HSA plans

As individual/family policy premiums increase and access to hospital/doctor networks decrease, many very small businesses are looking to group health insurance.

Employers currently contributing to their employees' individual plans should consider forming a group during Group Special Enrollment. Group premiums are tax deductible for the group.

Click Here to learn more about qualifying for Small Group Health Insurance.

Or call us at 847-362-8888 to start a conversation about your situation and opportunities.

ALERT: U.S. Treasury to Retire the myRA Program

Created just a few years ago in 2014, the My Retirement Account (myRA) program will end, according to the U.S. Department of the Treasury. As part of the Trump Administration's effort to slim down wasteful spending where possible, the Treasury has decided this short-lived Roth IRA backed by the government isn't cost effective.


In 2014, myRAs became available through employers, backed and administered by the U.S. government. MyRAs were described as being simple, safe and affordable starter savings accounts to help low-and moderate-income taxpayers save for retirement. Based on a directive from then-President Obama, the Treasury introduced the myRA program.

A myRA is a Roth IRA authorized to hold only one type of investment, that is, a U.S. Treasury security which earns interest at the same variable rate as investments in the government securities fund for federal employees. The same rules that apply to private Roth IRAs also apply to myRAs, including the MAGI-based eligibility for contributions, maximum annual contributions and tax treatment of distributions.

MyRA participants have been permitted to save up to $15,000, or for a maximum of 30 years, in a myRA account. When either of these limits is reached, the account must be rolled over to a private sector Roth IRA. This rollover allows savers to continue to grow their savings past the maturity of their myRA starter savings account.

The Retirement Account Will Retire

A recent review of the overall success of the myRA program shows that while demand for – and investment in – these accounts has been extremely low, the cost to taxpayers for managing the accounts has been nearly $70 million. On that basis, the Treasury announced on July 28th that the myRA program will phase out over the coming months.

As a result, new enrollments are no longer being accepted. At this time, existing myRAs remain open and accessible, and individuals can continue to manage their accounts until further notice. Individuals can make deposits and their accounts will continue to earn interest. Funds in myRAs remain in an investment issued by the Treasury Department.

Participants are encouraged to visit or call their myRA customer support numbers if they have questions. Notices from the Treasury Department will be going out to account owners, detailing the coming changes and providing the necessary information on the next steps account owners should take and relevant deadlines for the transfer and closure of their accounts.

U.S. Treasurer Jovita Carranza, sought to assure accountholders, saying "[w]e will be communicating frequently with participants to help facilitate a smooth transition to other investment opportunities." She added that ample private sector investments exist that offer no account maintenance fees, no minimum balances and safe investment opportunities.

A better alternative: our "15 for Life" platform.

  • Guaranteed earnings at 4% and more
  • Cash growth + Death benefit + Long-term Care benefit in one plan
  • Available at any age without penalty
  • Not subject to federal taxes

Call us to see how 15 for Life fits you: 847-362-8888.

Why Is Lake Forest Hospital Closing Its Long-term Care Unit?

It’s 3am when the couple is awakened by someone calling “Can you give me a push? I need a push!” outside their window.

“Aren’t you going to go help?’ asks the wife.

“Not at this hour”, says the husband. “Besides, the guy sounds drunk.”

“Dave, says the wife, “Remember that night we broke down in the pouring rain on the way to pick the kids up from the baby sitter and you had to knock on that man’s door and he helped get us started again? What would have happened if he’d told us to get lost?”

“I still think the guy’s drunk”, says Dave. But he gets out of bed, throws on a robe and goes downstairs. He opens the door, and not being able to see the stranger anywhere shouts, “Hey, if you still need a push, tell me where you are.”

He hears a voice cry out, “I’m over here, on your swing set.”

Why Is Lake Forest Hospital Closing Its Long-term Care Unit?

According to Crain’s Chicago Business August 21, 2017 edition, the first reason cited is “increased operating costs”.

The second is patient preference for non-nursing home care.

Jason Lundy, partner of the health practice group at the law firm Posinelli, says most people want in-home care or assisted living over hospital care. Northwestern announced an investment in a new home health training program in early August.

How will this care be paid for?

Medicare? It’s health insurance, not designed for long-term care.

Medicaid? It’s income/asset based with a 5-year look-back. According to federal data, Illinois has the second lowest Medicaid reimbursement rate in the nation.

Traditional Long-term Care Insurance? It pays facilities and providers. These policies weren’t designed to put money in the hands of the patient to use as wanted.

It’s time to look at what is new to get you the care you want.

  • Find out what care costs. (A recent survey says most people underestimate by 2/3.)
  • Find the best insurance to cover those costs.
  • Find a plan that fits your budget now and over time.
  • Find out what happens if you have insurance and are among the 30% of the population who won’t use Long-term Care.

35 isn’t too early to look. After 55, affordability and acceptance may become issues.

We offer the free presentation: Long-term Care: Who Pays for What. Click Here for more information.

Or call us at 847-362-8888. It’s never too early to start. Don’t wait until it’s too late. Sees Signs of Sham Plan Sales

ALERT: Sees Signs of Sham Plan Sales

Agents may have enrolled some consumers in health coverage through for 2016 or 2017 without the consumers' permission, according to officials at the Centers for Medicare and Medicaid Services. (Source: Welltheos, a private exchange platform designed for consumers, brokers, and agencies.)

Online applications make it easier for unscrupulous agents do this mischief. More consumers and agents may be using online Direct Enrollment for 2018 plans since Open Enrollment is limited to only 45 days this year: November 1-December 15, 2017.

The Affordable Care Act makes it very difficult to undo problems and almost impossible to buy different health insurance after Open Enrollment closes.

Choose a licensed and certified health insurance agent. Get in touch with them in October to share your information, get advice and make certain your application is properly filed during Open Enrollment (Nov.1 – Dec. 15, 2017).

An agent's services should be free.

Jerry S. Pearlstein Insurance LTD, licensed and certified Affordable Care Act Experts.


Open Enrollment 2018

We've just completed all the training and have been certified by the federal government to serve you during Open Enrollment for 2018 Health Insurance.

Open Enrollment this year begins November 1 and ends December 15, 2017.

That's half the time allotted in previous years.

Who needs to act during these 45 days?

  • People who want to change their current plan.
  • People who may be notified their current plan is not available in 2018.
  • People who are receiving premium assistance and must re-certify with the government to continue it.
  • People who are receiving premium assistance but will not be eligible in 2018.
  • People who have not previously qualified for premium assistance but will in 2018.
  • People who may be eligible to form a small group

Blue Cross will notify you if your plan will automatically re-up for 2018. We expect their letters to get to you in the next week or two. And we expect premium increases. If you want to change to a plan with a lower premium, you must do it within the Open Enrollment Period.

Except in clearly defined circumstances, 2018 Affordable Care Act health insurance cannot be bought or changed after December 15, 2017.

If you do not act between November 1 and December 15, you will be stuck with what you have for all of 2018.

We certified as early as we could to help you as early as we could. Please watch our emails. Let us know when you get your letters. We'll be setting up appointments with those clients receiving premium assistance.

We're here to take care of you.

Jerry Pearlstein   Rebecca Bloomfield

Why Your 18+ Child Needs a Power of Attorney for Health Care

Mrs. Applebee, the 6th grade teacher, poses the following problem to one of her math classes: "A wealthy man dies and leaves ten million dollars. One-fifth is to go to his wife, one-fifth is to go to his son, one-sixth to his butler, and the rest to charity. Now, what does each get?"

After a very long silence in the classroom, little Morris raises his hand. "Yes, Morris," the teachers says calling on him.

With complete sincerity in his voice, little Morris answers, "A good lawyer."


Guest contributor Marcia A. Franklin, Greenswag & Associates, P.C.

As your child heads off to college or out into the real world, in the event of a medical emergency, will you be able to participate in health care decisions or have access to important medical information?

In order to be able to assist your child under these circumstances, it is important to complete an Illinois Power of Attorney for Health Care that includes a right of access to medical information and records. With this document, at any time your adult child (over 18 years of age) is unable to consent to medical treatment or even give permission to allow you access to his or her medical information and/or records, you will be able to act on his or her behalf with full access to this information.

Without a valid Power of Attorney for Healthcare, doctors and other health care providers may be unable or unwilling to disclose vital information about your adult child and you may not be able to participate in decisions regarding that child's treatment if he or she is unable to make or communicate those decisions.

The Power of Attorney for Healthcare form is relatively simple but includes several elections that the Principal (your child) must make in giving direction to the person named as Agent, including: when it becomes effective, what kind of care should be provided in an end of life situation and whether the Principal wants to include any other specific limits on the Agent's authority.

While the form can be obtained online, it is generally better to sit down with your adult child and an attorney familiar with the process so that your child understands all of the options and elections to be made and the execution of the document is properly handled.

We thank Marcia Franklin who is an attorney practicing in Northfield, Illinois. Her practice concentrates on estate planning and representing closely held businesses and their owners in a variety of commercial areas.

BCBSIL Responds to Declared Disaster Areas in Illinois

Some Illinois counties – Cook, Kane, Lake, and McHenry – have faced severe flooding and have been declared disaster areas. For those who live in these areas, use of phone, mail or other normal channels of communication may be unavailable. On July 17, 2017, the Illinois Department of Insurance (IDOI) issued a notice asking insurance companies to give employers and retail members extra time to pay their monthly premiums. We want to support our employers and retail members affected by this disaster during this stressful time.

A non-payment cancellation notice received by impacted employers or retail members between July 12, 2017, and Sept. 30, 2017, will be withdrawn. Their coverage won't be cancelled, and no new cancellation notices will be sent until after Sept. 30, 2017. However, the terms of coverage still apply. For those in a grace period as of July 12, some claims may not be paid and members should check their plan or call Customer Service for details.

Individual/family members and Medicare Supplement members

Call Customer Service using the number on the back of your card or 800-538-8833(under 65); 800-624-1723 (Med Supp) to

  • Explain benefits
  • Find a doctor, hospital or dialysis center
  • Refill prescription medications
  • Coordinate or transition member care

Or call us, Jerry S. Pearlstein Insurance 847-362-8888.

New Senate Bill Retains Medicaid Cuts, Provides More Money to Stabilize Individual Market

7.17.17 weekly update from Welltheos, a private exchange platform designed for consumers, brokers, and agencies.

Click Here to read New Senate Bill Retains Medicaid Cuts, Provides More Money to Stabilize Individual Market

A revised version of the Better Care Reconciliation Act retains significant cuts to Medicaid. Lawmakers have also decided to keep taxes on the wealthy and insurer CEO compensation, which are projected to bring in $232 billion over a decade. Rick Pollack, President of the American Hospitals Association released a statement saying that in the latest update released, “the unacceptable flaws of BCRA remain unchanged”. The bill adds more than $130 billion in spending, primarily for states to use for high-risk pools or reinsurance programs.* Other developments include the introduction of the Direct Enrollment Proxy Pathway and the Centers for Medicare and Medicaid Services’ decision to discontinue the Federally-Facilitated Small Business Health Options Program (SHOP exchanges).

*BCRA allows individual states to allow insurance companies to offer plans that do not accept people with pre-existing conditions. This would take us back to the days when the Illinois Comprehensive Health Insurance Plan took people the insurance companies had declined based on their medical history. ICHIP was “sundowned” when the Affordable Care Act required insurance companies to take all applicants regardless of medical history.

Insurance companies intending to offer health insurance in Illinois have already filed their plans and prices for 2018 with the Illinois Department of Insurance based on the current ACA.

While we don’t expect Congressional action to affect individual/family health insurance for 2018, we’ll keep you informed.

Jerry Pearlstein   Rebecca Bloomfield