Value Based Care Healthcare Model

By Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366

There are more and more Health Clinics opening in SWFL, many are Values Based Care (I can’t mention names). They should:

1. Identify patient population and needs…
2. Design appropriate care solutions…
3. Build integrated knowledge teams…
4. Quantify health outcomes and costs metrics…
5. Develop partnerships with technology and
healthcare providers…
6. Educate providers and patients…
7. Measure and improve…

How they work is the company is paid a lump sum to manage your care. The doctor will be your primary care provider and will collaborate with their internal team to help manage your care. The goal is to be seen every 3 months, sometime more often depending on your medical condition. They will coordinate your care and services within their network. They work with specific insurance companies, and it varies by company. They often offer a lot of attractive benefits. If there are certain provider’s you want to see make sure you can do so. Some do NOT accept Original Medicare and require you to have a Medicare Advantage Plan. Be careful if you change you may NOT be able to get your Medicare Supplement back, plus you are now older and your premium could increase.

Travel Insurance – Most of our USA Health plans do not include coverage when leaving the United States, including Cruises. We recommend always getting a comprehensive Medical Travel Insurance Policy. They are less than you think and can make a world of a difference.

HEALTH INSURANCE is more important than ever! There is no way to determine when something will happen or when you could be diagnosed with a serious medical condition. So, saying I am healthy, so I do not need health insurance makes no sense. Insurance is moving the financial risk from you to the insurance company. There are always options for about every budget. Work with a professional that is contracted with many carriers and offers multiple options. Many plans are available year-round, the government plans such as the Marketplace and Medicare have specific times that you can enroll unless you have a Special Enrollment Period due to, as an example loss of coverage, marriage, moving out of the plans service area, etc.

Medicare Advantage – Part C & Part D Prescription Plans
Most of the plans in your area have made many changes and things you might not notice, especially important, are your doctors still in network, what tier are your medications and maybe the tier changed, copays, coinsurance. What extras are the plans offering? Maybe you need extra dental, vision, hearing aids. Many plans include some wonderful extra benefits, but it is also particularly important to know how to use the benefits and if they work for you.

CMS has made many rules for 2023 Medicare season. If you want to enroll or review your plan over the phone or on a Webex, you need to agree to be recorded and Medicare requires us to keep the recording for 10 years. In person appointments do not have that requirement, but you need to sign a scope of appointment that just authorizes us to talk to you about what you checked, such as Medicare Advantage or a Drug Plan it does not allow us to do anything but talk to you about these topics. Many plans have decreased the cost of Insulin which will be a huge savings for so many in 2023. Talk about maximum of $2,000 drug cost in a year, is not valid in 2023 but hopefully in 2025. Many changes are happening year after year. Find an agent that will be there for you, year after year.

When you turn 65 you are eligible for Medicare, once you have worked 40 quarters roughly 10 years there is no cost for Medicare Part “A”. Part A covers Hospitals, Skilled Nursing, Home Health & Hospice.

Medicare Part B you can choose to take at 65 or you can hold off if you are still working and have credible coverage. If you do not have group health insurance that is considered qualified, and then you want it you would have a late enrollment penalty for each month you did not have Part B & Part D and that penalty will last for the rest of your life. Part B covers doctors, imaging, blood work, ambulance, durable medical equipment, etc. Part D is a Medicare Drug Plan and covers medications. During your initial enrollment period it is especially important to understand your options! Medicare Supplements/Medigap Plans are NOT guaranteed issue you may need to medically qualify. You can purchase a Medigap Plan during your 1st 6-month on Medicare Part B without medical underwriting. There are a lot of things you need to know. Again, work with an agent you can trust! Especially important: when you move you need to know your options. Can you keep the same plan? Do you need to make a change and what does that look like?

We offer Free New to Medicare Seminars, Personal Appointments & Virtual appointments. Please e-mail info@logicalinsurance.com to register or call 239-362-0855 for dates. Medicare’s website is www.Medicare.gov.

Logical Insurance Solutions is a SWFL Insurance Broker that works with most of the carriers, we are happy to help you through the maze. This is what we do daily, it is second nature to us. We offer virtual seminars, one on one WebEx, phone and in person appointments.

To learn more about your options call to schedule an appointment contact: Logical Insurance Solutions for all your insurance needs, we I am licensed in 30 states.

Logical Insurance Solutions

www.Logicalinsurance.com
info@Logicalinsurance.com

239-362-0855