A New Season: Empty-Nesters

Contributed by: Laurie Renchik, CFP®, MBA

This year the fall season took a different turn than the past eighteen and it wasn’t associated with the weather.  My youngest child was college bound for his freshman year.  How did that happen?  It was a mad rush from high school graduation festivities in June to college move in day in August.  The reality of an empty nest began to set in as my husband and I drove home leaving our son to settle into his new digs.  Our conversation took many expected turns reminiscing about the past and looking forward to the future.  

This new chapter we surmised was as an opportunity to put some additional focus on our life goals including a “catch-up” sprint to shore up retirement savings. More questions than answers surfaced.  Should we downsize, take a big trip, save more, spend more, double up on mortgage payments, or put a finer point on our expectations for the future?  Perhaps you can relate to this milestone in life. 

The following Empty Nest Checklist can help to organize thoughts and prioritize action steps:

1. Revisit the big picture.  Make time to talk about lifestyle changes you’re thinking about, along with their financial impact. Think of it like a test drive for your retirement years. While you are at it, give your financial plan a fresh look. Celebrate successes, clarify goals and identify potential gaps.

2. Consider your finances.  Updating your monthly budget is a good first step.  Putting money you were using to support children toward larger financial goals like paying down your mortgage and boosting retirement savings may be an option with surprising benefits.

3. Review investments.  The status quo may not meet your future needs.  Your financial advisor can help with a review of retirement savings accounts.  Learning how your savings can generate income in retirement helps financial decision making during this new chapter. 

4. Update your goals and need for insurance.  The bottom line is to make sure that existing insurance policies still make sense for your situation.  If your mortgage is paid off and dependents are now independent you may want to reassess your coverage.

Goals change at every stage of life, so regularly reviewing your plans is an important step. Revisiting the basics can build confidence as you plan for tomorrow. Reconciling your next steps as empty nesters is essential to enjoying all that is to come. Don’t forget to celebrate each milestone you’ve achieved along the way and put in place a plan for what comes next.

Laurie Renchik, CFP®, MBA is a Partner and Senior Financial Planner at Center for Financial Planning, Inc.® In addition to working with women who are in the midst of a transition (career change, receiving an inheritance, losing a life partner, divorce or remarriage), Laurie works with clients who are planning for retirement. Laurie is a member of the Leadership Oakland Alumni Association and is a frequent contributor to Money Centered.

Life Insurance and Divorce: A Cautionary Tale, Part One

Contributed by: Jacki Roessler, CDFA^TM

Years ago, I got a call from Lindsay, a divorced client that still sends shivers down my spine. Her divorce had been final for two years when her ex, Justin unexpectedly died from a heart attack. In order to maintain her living expenses, Lindsay had been dependent on Justin’s monthly child support payments for their two young children.  Once the initial trauma subsided, Lindsay pulled out her divorce decree and breathed a sigh of relief; Justin had agreed to maintain a $250,00 life insurance policy to secure his child support payments.

So; why the phone call?

Justin missed a premium payment and the policy lapsed. Lindsay’s child support income was gone and despite their divorce agreement, there wasn’t anything to replace it.

The worst part of this situation was how easily it could have been prevented.

Taking a step back, there are four parties to every life insurance contract; the insurance carrier, the policy owner, the insured (the measuring life) and the beneficiary.

Life insurance is a legally binding agreement that the carrier will make a lump sum payment to a designated beneficiary upon the death of the insured-in exchange for annual premium payments. 

The simplest and easiest solution was to require Justin to transfer ownership of the policy to Lindsay at the time of the divorce.  He would have remained the insured and the person responsible for premium payments.  However, when payments are missed, it’s the owner who’s notified, not the beneficiary. Once a policy lapses, it’s too late to reinstate it. A new policy can be obtained, but only if the insured is still in good health and is willing to cooperate with the application process!  Lindsay could have made the delinquent payment herself and then attempted to enforce the divorce agreement directly with Justin or through the court system. Either way, the policy would have stayed in force.

In my experience, attorneys can be very uncomfortable insisting on policy ownership transfers.

By the time agreement’s reached on the parenting schedule, alimony and who gets to the keep the house, no one wants to see the case fall apart over who owns the life insurance policy.  As it was in Lindsay’s case, this was a disastrous mistake on her attorney’s part.

As an additional reason to change ownership on the policy, keep in mind that only the owner can change the life insurance beneficiary. Suppose Justin had remarried and decided to switch the beneficiary to his new wife. Sure, he would have been in default of the divorce decree, but there wouldn’t be any consequences to that once he’s dead.

Another unexplored option in this case was to request that the insurance carrier send duplicate statements to Lindsay, the beneficiary. Since the divorce decree itself isn’t legally binding on third parties (like the insurance carrier), there isn’t any real way to force this on the carrier, but some will comply. 

A last option would have been a requirement that Justin pay annual premium payments instead of monthly. Although most people prefer to make monthly or quarterly payments on insurance contracts, this would have provided Lindsay with less to follow up on. Rather than being forced to confirm monthly payments, she’d only have to confirm once per year.

Luckily, Lindsay’s kids were eligible to receive Social Security survivor benefits, which helped replace some of the child support income and she was eligible for widows’ benefits while their children remained minors. Despite that, she was still forced to sell her house.

The moral to this tale? Sometimes the issue that seems nit-picky or trivial is the one that can unravel someone’s finances after a divorce.  If you’re dependent on an income stream to pay your bills, make sure you understand how it can be protected and then insist on it before you sign your judgment of divorce.

Are there any other tax issues or potential financial pitfalls related to life insurance and divorce?  Glad you asked and yes, there are! Stay tuned for my next blog!

Jacki Roessler, CDFA^TM is a Divorce Financial Planner at Center for Financial Planning, Inc.®

Guide to the 2017 Benefits Open Enrollment

Contributed by: Nick Defenthaler, CFP®

As summer winds down and we quickly approach the holiday season, many employees will soon be updating their benefit options at work during open enrollment (click here to check out our webinar from last year on this topic).  It’s extremely easy to procrastinate and set that employer benefit booklet off to the side and put it off until you receive the e-mail from HR reminding you it’s due in a few days.  You scramble to complete the forms and more than likely, not spend as much time as you should on electing the benefits that will impact you for the next 365 days.  We’ve all been there, but it’s important to carve out a few hours several weeks before your benefit elections are due to ensure you put in enough time to thoroughly review your options.

If offered by your employer, below are some benefits that you should have on your radar:

• 401k Contributions

  • Are you maximizing your account? ($18,000 or $24,000 if you’re over 50 in 2017)

  • Traditional vs. Roth – click here to learn more about which option could make sense for you  

• Health Insurance

  • HMO vs. PPO - Click here to learn more about how these plans differ from a cost and functionality standpoint  

• Flex Spending Accounts (FSA)

  • “Use it or lose it” – click here to learn more 

  • Medical FSA maximum annual contribution 2017 is $2,550

  • Dependent care FSA maximum annual contribution for 2017 is $5,000

• Health Savings Accounts (HSA)

  • Can only be used if covered under a high-deductible health care plan

  • Click here to learn more about the basics of utilizing a HSA 

    • $3,400 maximum annual contribution in 2017 if single ($4,400 if over 50)

    • $6,750 maximum annual contribution in 2017 for a family ($7,750 if over 50)

• Life and Disability Insurance

  • Most employers will offer a standard level of coverage that does not carry a cost to you as the employee (example – 1X earnings)

  • If you’re in your 20s, 30s and 40s, in most cases, the base level of coverage is not sufficient, therefore, it’s important to consult with your advisor on the on appropriate amount of coverage given your own unique situation  

As with anything related to financial planning, every situation is different.  The benefits you choose for you and your family more than likely will not make the most sense for your lunch buddy co-worker.  We encourage all clients to loop us in when reviewing their benefit options during open enrollment – don’t hesitate to pass along any questions you might have to ensure you’re making the proper elections that align with your own personal financial goals.

Nick Defenthaler, CFP® is a CERTIFIED FINANCIAL PLANNER™ at Center for Financial Planning, Inc.® Nick works closely with Center clients and is also the Director of The Center’s Financial Planning Department. He is also a frequent contributor to the firm’s blogs and educational webinars.

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This information has been obtained from sources considered to be reliable, but we do not guarantee that it is accurate or complete.

Medicare Open Enrollment

Contributed by: Kali Hassinger, CFP®

As the weather changes and fall begins, there seems to be a general shift from the summer mindset to a more focused fall mentality.  Maybe it’s because, even well into adulthood, we’re accustomed to that “back-to-school” switch.  If you are currently enrolled in Medicare (not quite school, but significant nonetheless!), fall will continue to mark an important time of year because the Medicare open enrollment period begins on October 15th and lasts until December 7th.  This is the time when Medicare participants can update their health plans and prescription drug coverage for the following year. 

If you participate in a Medicare health and/or prescription plan, it’s important to be sure that your coverage will continue to meet your needs in the year to come.  Plans will send out notification materials if coverage is changing, but, even if it isn’t, it may be worth comparing your current coverage to other options.  If you are thinking of updating your coverage, there are several items that you should consider. 

Other coverage options:

If you are currently covered by or eligible for coverage through another provider, such as your former employer, you’ll want to understand how this plan works with Medicare.  Most retiree plans are designed to coincide with Medicare for those 65 and older, but you’ll want to be sure that the premiums and plan benefits are more advantageous than the open market Medicare options.

Cost:

This may seem like a given, but there are several cost factors to take into consideration.  Premiums, deductibles, and other costs can add up throughout the year, so it’s important to have a grasp of the plan’s monthly AND annual expenses.

Accessibility: 

Are the doctors and pharmacies who participate in this plan convenient for you?  If you have a current doctor or pharmacy that you want to continue using, be sure that they are in network.

Quality of Coverage:

Perhaps another seemingly obvious but important consideration, quality of coverage means how well does the plan actually cover the services you need.   Some plans require referrals and limit (or won’t provide) coverage if you go out of network.  If you have ongoing prescriptions, make sure the drugs are covered and that you understand any rules that may affect your prescription in the future.  

It’s important to understand and compare your Medicare options, but it’s easy to be overwhelmed by the process.  Raymond James partners with a group called Health Plan One to help clients strike the right balance between appropriate coverage and healthcare costs.  Our office has the opportunity to host a webinar with HPOne on October 23rd at 1:00 PM, and you can register for the webinar by clicking here.

Kali Hassinger, CFP® is an Associate Financial Planner at Center for Financial Planning, Inc.®

Planning for Health Insurance and Medical Expenses in Retirement

Contributed by: Matt Trujillo, CFP®

At any age, health care is a priority. However, when you retire, you will probably focus more on health care than ever before. Staying healthy is your goal, and this can mean more visits to the doctor for preventive tests and routine checkups. There's also a chance that your health will decline as you grow older, increasing your need for costly prescription drugs or medical treatments. That's why having the right health insurance for you is extremely important.

If you are 65 or older when you retire, your worries may lessen when it comes to paying for health care--you are most likely eligible for certain health benefits from Medicare, a federal health insurance program available upon your 65th birthday. But if you retire before age 65, you'll need some way to pay for your health care until Medicare kicks in. Generous employers may offer extensive health insurance coverage to their retiring employees, but this is the exception rather than the rule. If your employer doesn't extend health benefits to you, you may need to buy a private health insurance policy (which may be costly), extend your employer-sponsored coverage through COBRA, or purchase an individual health insurance policy through either a state-based or the federal health insurance Exchange Marketplace.

But remember, Medicare won't pay for long-term care if you ever need it. You'll need to pay for that out of pocket, rely on benefits from long-term care insurance (LTCI), or if your assets and/or income are low enough, you may qualify for Medicaid.

As mentioned, most Americans automatically become entitled to Medicare when they turn 65. In fact, if you're already receiving Social Security benefits, you won't even have to apply--you'll be automatically enrolled in Medicare. However, you will have to decide whether you need only Part A coverage (which is premium-free for most retirees) or if you want to also purchase Part B coverage. Part A, commonly referred to as the hospital insurance portion of Medicare, can help pay for your home health care, hospice care, and inpatient hospital care. Part B helps cover other medical care such as physician care, laboratory tests, and physical therapy. If you want to pay fewer out-of-pocket health-care costs, you may also choose to enroll in a managed care plan, or private fee-for-service plan under Medicare Part C (Medicare Advantage). If you don't already have adequate prescription drug coverage, you should also consider joining a Medicare prescription drug plan offered in your area by a private company or insurer that has been approved by Medicare.

Medigap Policies:

Unfortunately, Medicare won't cover all of your health-care expenses. For some types of care, you'll have to satisfy a deductible and make co-payments. That's why many retirees purchase a Medigap policy.

Unless you can afford to pay for the things that Medicare doesn't cover, including the annual co-payments and deductibles that apply to certain types of care, you may want to buy some type of Medigap policy when you sign up for Medicare Part B. There are 10 standard Medigap policies available. Each of these policies offers certain basic core benefits, and all but the most basic policy (Plan A) offer various combinations of additional benefits designed to cover what Medicare does not. Although not all Medigap plans are available in every state, you should be able to find a plan that best meets your needs and your budget.

When you first enroll in Medicare Part B at age 65 or older, you have a six-month Medigap open enrollment period. During that time, you have a right to buy the Medigap policy of your choice from a private insurance company, regardless of any health problems you may have. The company cannot refuse you a policy or charge you more than other open enrollment applicants.

Long-term care insurance and Medicaid:

The possibility of a prolonged stay in a nursing home weighs heavily on the minds of many older Americans and their families. That's hardly surprising, especially considering the high cost of long-term care.

Many people in their 50s and 60s look into purchasing Long Term Care Insurance (LTCI). A good LTCI policy can cover the cost of care in a nursing home, an assisted-living facility, or even your own home. If you're interested, don't wait too long to buy it--you'll need to be in good health. In addition, the older you are, the higher the premium you'll pay.

You may also be able to rely on Medicaid to pay for long-term care if your assets and/or income are low enough to allow you to qualify. But check first with a financial professional or an attorney experienced in Medicaid planning. The rules surrounding this issue are numerous, complicated and can affect you, your spouse, and your beneficiaries and/or heirs.

The issue of how to properly plan for health insurance in retirement is complex and multi-faceted. As with many aspects of good financial health I recommend working with a qualified professional to address your evolving health care needs, and to ensure that you and your family have the proper coverage for your circumstances.

Matthew Trujillo, CFP®, is a Certified Financial Planner™ at Center for Financial Planning, Inc.® Matt currently assists Center planners and clients, and is a contributor to Money Centered.

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This information has been obtained from sources considered to be reliable, but we do not guarantee that it is accurate or complete. Long Term Care insurance policies have exclusions and/or limitations. The cost and availability of Long Term Care insurance depend on factors such as age, health, and the type and amount of insurance purchased. As with most financial decisions, there are expenses associated with the purchase of Long Term Care insurance. Guarantees are based on the claims paying ability of the insurance company.

Webinar in Review: A Beginners Guide for Those Just Starting Out

Contributed by: Emily Lucido

With a little bit of wit and a whole lot of information, Kali Hassinger, CFP® and Josh Bitel, Client Service Associate, recently presented a webinar that provided young folks with a broad guide for how to start their financial lives off on the right foot. As we found out during the presentation, making smart choices early can make life easier in the long run.

Although Millennials have an average debt of 50% in just student loans, they are doing better than most people might think. About 80% have a budget and 72% are saving for retirement. (Source: http://bit.ly/2bBC3vG). If you are a Millennial and are reading and thinking, “I’m not saving for retirement and I don’t have a budget,” that’s okay! Even by taking small steps now, you can make a huge difference rather than waiting. There are a lot of different factors to think about when tackling financials in the “real world.” The first step is to get organized.

Spending vs. Saving

You can spend smarter by following these tips below:

• Stay Organized - which can include setting up account notifications & alerts

  • These notifications can be set up for when you complete a transaction, or if your balance falls below a specific amount (you can set the minimum balance amount yourself)

  • The notifications can also be good for detecting fraud

• Applications & Technology

  • There are a ton of free apps out there that can help with any situation, just google your need and you can find something suitable for you

• Figuring out your Credit Score

  • Credit Karma gives you free access to your credit score and is highly secure

  • What determines your credit score?
    ~ Check out our blog that breaks down your credit score composition!

  • When building credit and using credit cards, you want to make sure to use only around or below 30% of your available credit

  • Watch for annual fees on credit cards; see if opening the card is worth the annual fee you will end up paying

  • Set up auto pay on all your bills with your credit card to benefit with cash back and rewards

  • To avoid ATM fees, go to the store and buy something small (like a pack of gum) and then get cash back on that purchase

• Student Loans

  • Student loans are something you want to start paying down right away – and if you can make more than just the minimum payment, try to do that

  • Make sure your payments are being allocated toward your highest interest loan

  • A good resource to show you every student loan you have, whether federal or private is, Annualcreditreport.com

Saving is so important, and to start sooner can make such a big difference in the long run. These tip s help with how to smartly save money:

• Cash Savings

  • In case of emergency it’s good to have six months of living expenses in a savings account

• Investing Early

  • The graph below demonstrations how investing your savings early can really benefit you in the long run

  • In the example below Chloe started investing from age 25 and almost reaches $2 million dollars by the age of 65, while we see Noah saves from age 25 (the same amount of money) and just let it sit in cash and only obtained about $653,000 by the age of 65.

• Retirement Savings

  • Although retirement might seem far away, it is important to be forward thinking and plan ahead

  • Employer plans are a great opportunity to save money if your company offers one - always remember to contribute at least the match if you can

• If your employer doesn’t offer a retirement plan you can still invest through a Roth IRA or Traditional IRA. Depending on your situation a Roth or an IRA could work for you.

• Taxes – some quick tips

  • The more money you make, the more you pay in taxes!

  • You can write off student loan interest of up to $2,500 per year

  • TurboTax® is a great online resource for doing your taxes with a 100% accurate calculation guarantee

• Insurance

  • Insurance is something that is so important – but something that can be overlooked when we are young

  • Staying on your parents health coverage until age of 26 is great – but don’t just assume it’s the best option because you aren’t paying anything

  • Remember to get renters insurance when living in an apartment – you never know when you might need it!

The last thing to remember is the 28/36 Rule. Your housing expenses should not exceed 28% of your gross monthly income while your total debt payments should not exceed 36%. Remember, the earlier you start saving the better – and any place you start at is good.

Take 30 minutes to view the webinar below and get the full details of Kali and Josh’s discussion. If you have any questions, please reach out to us -- we’re here to help!

Emily Lucido is a Client Service Associate at Center for Financial Planning, Inc.®

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The information contained in this blog does not purport to be a complete description of the securities, markets, or developments referred to in this material. The information has been obtained from sources considered to be reliable, but we do not guarantee that the foregoing material is accurate or complete. Any opinions are those of Emily Lucido and not necessarily those of Raymond James. There is no guarantee that these statements, opinions or forecasts provided herein will prove to be correct. You should discuss any tax or legal matters with the appropriate professional. Prior to making an investment decision, please consult with your financial advisor about your individual situation. Links are being provided for information purposes only. Raymond James is not affiliated with and does not endorse, authorize or sponsor any of the listed websites or their respective sponsors. Raymond James is not responsible for the content of any website or the collection or use of information regarding any website's users and/or members.

Financial Scams Target Social Security and Medicare

Contributed by: Sandra Adams, CFP®, CeFT™

According to the Federal Trade Commission, of the 65 and older population, over 33% are victims of financial frauds and scams on an annual basis. It is not surprising, then, that the latest scams to come out are related to Social Security and Medicare – two of the most widely used social support programs by the 65 and older population. Here is what you need to know about the newest scams:

Social Security:

There are two Social Security scams on the current watch list:

• The first one is where you will receive an official-looking e-mail from the Social Security Administration with an invitation to create a Social Security account so that you can receive your benefits. You land on a webpage where the scammers hope you will fill out your confidential information. DO NOT FALL FOR THIS. Never click on links in any of these e-mails. If you want to sign up for a Social Security Account, go directly to https://ssa.gov/myaccount/ (see our blog with detailed instructions about how to set up your Social Security account here).

• The second one is where the scammers actually create an account for someone and redirect their payments to a bank account controlled by them, not by the victim. To prevent this from happening, create your own MySSA account with a strong username and password. This is similar to filing your tax return early before the scammers file a fake return and steal your refund. In addition, a recommended and increased security measure is that when you create your MySSA account, go to the settings and choose the option that any changes to the bank account into which your check is electronically deposited can only be done in person at a Social Security brank office and not done using your online account.

Medicare:

This scam is related to Congress’ passage of the Medicare Access and CHIP Reauthorization ACT (MACRA) in 2015 which is requiring the Centers for Medicare and Medicaid Services to remove Social Security numbers from all Medicare cards. Thus, they will begin reissuing Medicare cards in 2018. The current scam has scammers calling Medicare beneficiaries claiming to be Medicare and saying that they must confirm their current Medicare numbers before sending them a new card. Others call saying there is a charge for the new card and are collecting beneficiaries’ personal information. Please note that there is no charge for your new card and Medicare will never call you for your information. They already have it. 

As an additional note, there are still tax scams continuing to occur. We wrote a blog about tax season scams earlier this year -- please take a moment to review this information to protect yourself and your loved ones.

Always Remember:

• A government agency will not contact you by phone or e-mail to request personal information or to demand money/payment from you.

• You will always be contacted by mail or registered letter by government agencies and if money is owed, you will be given an opportunity to dispute charges.

If you suspect fraud related to these examples or any other type of financial scams or fraud, please contact the U.S. Senate Special Committee on Aging Fraud Hotline at 1-855-303-9470 or contact your financial planner for assistance.

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Sandra Adams, CFP® , CeFT™ is a Partner and Financial Planner at Center for Financial Planning, Inc.® Sandy specializes in Elder Care Financial Planning and is a frequent speaker on related topics. In addition to her frequent contributions to Money Centered, she is regularly quoted in national media publications such as The Wall Street Journal, Research Magazine and Journal of Financial Planning.

Ford Buyout: Knowing your Options

Contributed by: Nick Defenthaler, CFP®

Over the past month, Ford has extended buyout offers to nearly 15,000 of its salaried employees. The offer, in most cases, contains two main components – a severance package or an enhancement of your retirement benefit from Ford.  Below is a high-level breakdown of some of the key points of the offer:

Special Incentive Program (SIP) and Select Retirement Program (SRP)

• Up to 18 months’ severance

• Retirement benefit enhancement

  • Credit for three additional years of age and three years of service for calculating benefits under the General Retirement Plan (GRP), Benefit Equalization Plan (BEP), and Supplemental Executive Retirement Plan (SERP)

  • This can translate into a nearly 15% increase over your normal benefit

• Must retire no later than September 30, 2017

  • This means up to 27 months of income received in 2017 which more than likely means higher tax brackets for those accepting the offer

• Access to reemployment assistance from Ford for six months

• Health insurance – type of coverage will depend on if you were hired before or after 6/1/2001

• Life insurance – eligible to maintain if you were hired on or after 1/1/2004, are age 55 or older with at least ten years of service, or are age 65 with at least five years of service upon termination

• Vacation

  • Regular – accrued through your last day on pay roll, unused accrued vacation is paid out if the last day on pay roll is prior to year-end

  • Purchased – unused days are forfeited

Buyouts from Ford or any of the “Big Three” are nothing new. As always, however, a thoughtful analysis should be completed when ultimately making a decision on whether to stay employed with Ford or to retire early. Many of the offers extended will be virtually the same, but everyone’s situation is different. If you’ve received an offer from Ford and would like our take on how that offer could impact your own long-term financial game plan, don’t hesitate to reach out to us for guidance. 

P.S. I did a webinar on this topic where I dug deep into the nuances of the offer and discussed some planning opportunities you might consider if you decide to retire early. Check out the replay below!

Nick Defenthaler, CFP® is a CERTIFIED FINANCIAL PLANNER™ at Center for Financial Planning, Inc.® Nick works closely with Center clients and is also the Director of The Center’s Financial Planning Department. He is also a frequent contributor to the firm’s blogs and educational webinars.

A Closer Look at Medicare Part D (Prescription Drug Coverage)

Contributed by: James Smiertka

Today, we will take a more in-depth look at an important aspect of Medicare coverage: Part D, which covers prescription medications. Each Medicare Prescription Drug Plan has a unique list of covered drugs which is called a formulary.

Here are some important notes regarding Medicare Part D coverage:

• Drugs may be placed into different cost “tiers” within the specific formulary

• More common, generic, drugs will often be in a lower tier that will cost you less

• You can choose your Part D plan based on your current list of medications to help you obtain the most appropriate plan for you

• Commercially available vaccines that are medically necessary to prevent illness must be covered by a Medicare drug plan (if not already covered under Medicare Part B)

• Formularies are unlikely to cover every existing drug and will often have drugs placed outside of tiers that require special approval to be covered

• You should receive an “Evidence of Coverage” (EOC) each September from your plan which explains what your Medicare drug plan covers, how much you pay, etc.

  • You should review this notice each year to determine if your current plan will continue to meet your needs for the next calendar year or if you may need to consider another plan

  • If you do not receive this important document, contact your plan

    • Your plan’s contact information should be available via “Personalized Search” on the Medicare website.

    • You can also search by your plan name.

Common Coverage Rules:

• Prior Authorization: Your prescriber may be required to show that the drug is medically necessary for the plan to authorize coverage

• Quantity Limits: Different medications may have limits on quantity fillable at one time (ex: 10 days, 14 days, 30 days, 60 days, etc.)

• Step Therapy: You must attempt treatment with one or more similar, lower cost drugs before the plan will cover the prescribed drug

If you or your prescriber believe one these coverage rules should be waived, you can contact your plan for an exception. Your plan’s contact information should be available via “Personalized Search” on the Medicare website.

• You can ask your prescriber or other health care provider if your plan has special coverage rules and if there are alternatives to an uncovered drug

  • It is not uncommon to be required to attempt treatment with other similar drugs (often less expensive, lower tier) on your formulary first

• You can obtain a written explanation from your plan which should include the following:

  • Whether a specific drug is covered

  • Whether you have met any requirements to be covered

  • How much you will be required to pay

  • If an exception to a plan rule may be made if requested

• You can request an exception if:

  • You or your prescriber believes you need a specific drug that is absent from your plan’s formulary

  • You or your prescriber believes a coverage rule should be waived

  • You believe you should pay less for a more expensive, higher tier drug since your prescriber believes you cannot take any of the less expensive, lower tier options for your condition

• If you disagree with your plan’s denial of coverage there are five additional levels in the appeals process

Additional Considerations:

• Your Medicare Part D plan is allowed to make changes to its formulary during the year

  • These changes must be made within existing Medicare guidelines

  • If a change is made to your formulary:

    • You must be provided written notice at least 60 days prior to the effective date of the formulary change

    • OR your plan will be required to provide the current drug for 60 days under the previous plan rules

• Many Medicare Advantage Plans (Part C) cover prescription medication coverage, and you cannot have concurrent coverage of prescriptions through both a Medicare Advantage Plan and a Medicare prescription drug plan. You’ll be unenrolled from your Advantage Plan and returned to Original Medicare if you have an Advantage plan with prescription coverage in addition to a Part D Prescription Drug Plan.

• Even if a desired medication is covered, it is important to note that some plans may require fulfillment via mail order services in lieu of local retail pharmacy pickup

• This may be very inconvenient for some (ex: people that travel often) and may be avoidable when comparing plans

If you have any questions, please contact your financial advisor at The Center. We are more than happy to help you or refer you to one of our expert resources.

James Smiertka is a Client Service Associate at Center for Financial Planning, Inc.®

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Sources: www.medicare.gov
The information has been obtained from sources considered to be reliable, but we do not guarantee that the foregoing material is accurate or complete.

American Health Care Act Pulled: Details and What to Expect Next

Contributed by: James Smiertka

Last week, the American Health Care Act (AHCA) was pulled from the House floor when it was clear that there would not be enough votes to pass it. President Trump conceded that they were about 10 to 15 votes short with no support from Democrats and even some moderate Republicans. The opposition came amid worries that the bill would take away medical insurance from millions of Americans. Some of the House’s most conservative members (members of the Freedom Caucus) were instrumental to the bill’s failure as they viewed parts as too similar to Obamacare, among other concerns.

Main Takeaways

• The AHCA would have rescinded a range of taxes created by Obamacare, ended the penalty on people who refuse to obtain health insurance, and ended Obamacare’s income-based subsidies while creating less-generous age-based tax credits.

• The AHCA would have ended Obamacare’s expansion of Medicaid, cut future Medicaid funding, and let states impose work requirements on some Medicaid recipients.

  • States would have been allowed to deny Medicaid coverage for able-bodied adults without children who did not work, study, train or seek work.

• The nonpartisan Congressional Budget Office (CBO) estimated the AHCA would:

  • Lower premiums by 10%.

  • Reduced the federal deficit by $337 billion.

  • Capped Medicaid spending for the first time (saving taxpayers $880 billion).

  • Increased choices for consumers.

  • Lowered taxes by $883 million (targeted toward middle-income Americans and small business owners).

• The CBO also estimated that the AHCA would have immediately stripped health insurance from millions of Americans.

  • The CBO stated that 14 million people would be uninsured by next year, rising to 21 million in 2020 and 24 million in 2026.

• The conservative House Freedom Caucus wanted to more aggressively lower insurance costs and to dismantle federal regulation of insurance products along with eliminating federal standards for minimum benefits that must be provided by health insurance products.

• The American Psychological Association (APA) voiced major concern that the AHCA would have reduced mental health and substance use coverage for millions of Medicaid enrollees and contributed to the loss of coverage for millions more.

What’s Next?

Based on Representative Paul Ryan’s comments immediately after the AHCA bill was pulled, there was no indication that another attempt at healthcare reform was imminent. Within a few days, there was news that House Republican leaders and the White House had restarted negotiations for healthcare legislation, but no timeline has been given. It seems likely that the Trump administration will look to focus on other priorities in the near future as well. Healthcare reform is still a top priority for the Trump administration, but it’s worth noting that a total repeal of the Affordable Care Act (ACA) may be difficult to pass through the Senate, so the failure of this bill also has the potential to be a catalyst for Congress to combine efforts to make changes to the existing ACA. The current administration believes that this will be a tough year for the ACA, and some Democrats are open to change so it’s likely not a question of if it will be revisited, but a question of when and how. If you have any questions about how changes created by the new administration may affect your financial situation and plan, reach out to us!

James Smiertka is a Client Service Associate at Center for Financial Planning, Inc.®

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