insurance

Which Type of Medicare Advantage Plan Is Best for You?

What to do about health care is one of the major decisions that everyone faces when getting close to retirement. A lot of people delay retirement until they reach age 65 because they don’t want to lose their employer-sponsored health plan. Even if they are financially able to retire, they will often continue to work until they are eligible for Medicare. With the uncertainty that is the state of our health care system right now, it’s hard to blame them.

But what do you do once you turn 65 years old and are eligible for Medicare? In the first part of this series on Medicare planning, I discussed the importance of timing your Medicare enrollment (Medicare Enrollment—Not As Easy As It Sounds). The second part of the series (Medicare—Which Path Is Right for You?) was a discussion on the differences between Original Medicare and Medicare Advantage. In this post, I will discuss the types of Medicare Advantage plans that are available.

As a refresher, Medicare Advantage plans are sold and administered by private insurance companies. Original Medicare is administered by the federal government. Medicare Advantage plans must provide, at a minimum, the same coverage as Original Medicare Parts A and B. The plans often include prescription drug coverage and additional coverages like vision and dental, and some come with other benefits, like a gym membership. With Original Medicare, you can visit almost any doctor in the country. With a Medicare Advantage plan, you generally get care from within the provider’s network of medical professionals. Most people choose Original Medicare, but about 30% of enrollees select Medicare Advantage.

For this post, I am going to assume you have decided that a Medicare Advantage plan would be the right path for you. If that’s the case, it’s important that you understand the types of plans you will choose from. The most common Medicare Advantage plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and private fee-for-service (PFFS) plans. Lesser-known plans under the Medicare Advantage umbrella include special needs plans (SNPs) and medical savings account (MSA) plans. We’ll take a closer look at each type and highlight the differences.

Health maintenance organization: With this type of plan, you select a primary doctor from the insurer’s network, and that doctor manages your health care. If you need to see a specialist, you usually will need a referral from your primary doctor, and you are typically not covered for services provided outside of the network, although there are exceptions. The rules of this type of plan may be the most restrictive, but it will generally offer the lowest plan costs.

Preferred provider organization: Under a PPO, you generally can go to any doctor or hospital, but you will pay more if you use a provider outside of the insurer’s network. If you need to see a specialist, you generally won’t need a referral, but if you select a provider outside of network, you will pay more. This type of plan is more flexible, but it usually comes with a higher premium.

Private fee-for-service plan: This plan was once the fastest-growing type of Medicare Advantage plan. It was popular because you didn’t have to choose a primary care doctor and usually didn’t need a referral to see a specialist. You had to be careful with this plan, however, because not all Medicare providers accepted it. The popularity of this type of plan has declined because of some changes in the Medicare laws. It’s important to make sure you understand the details of how the plan works if you opt for it.

Special needs plan: As the name implies, this type of plan is available for Medicare enrollees who have some type of special need. The plan will offer custom benefits designed to meet the specific needs of the plan member. You could be eligible for this type of plan if you have a severe and/or chronic condition like diabetes, end-stage renal disease, chronic heart failure, or dementia. Living in a nursing home is another example of a condition that would be eligible for this type of plan.

Medicare savings account: This type of plan is not as popular as the other types of plans. It combines a high-deductible health plan with a bank account in your name. When you select this type of plan, Medicare will make deposits into your bank account that you can use to pay for medical expenses. This type of plan is really only appropriate for you if you don’t need a lot of care, because the amount deposited into your MSA is often less than the deductible.

As I wrote in the first part of this series on Medicare, getting the coverage that is best for you is not a simple process. You don’t just show up at age 65 and sign up. You need to make sure you understand your options and make the best choices based upon your individual needs. Don’t pick a plan because a friend or family member picked it. Make sure that it’s right for you.

My Long-Term-Care Insurance Premiums Keep Going Up. What Can I Do?

In some ways, long-term-care insurance is like auto insurance. We pay a premium and hope that we never need to file a claim. If we have to file a claim against our auto insurance, it means that our car was damaged or stolen, or that somebody was hurt in an accident. If we have to file a claim against our long-term-care insurance, it means that we’ve lost the ability to take care of ourselves in some way. Our auto insurance will help pay to fix our car or pay someone’s medical bill. Our long-term-care insurance will help pay for someone, or some facility, to help take care of us.

That’s the way insurance works. We pay a premium and the insurance company steps in to pay for losses that we can’t afford. For most of the insurance policies we own (or should own), it’s not unusual for our premiums to increase over time. Of course, we know that if we are in an at-fault accident, our auto insurance premiums will jump dramatically. But if we don’t make any claims, we typically see modest increases, somewhat in line with what we would expect with inflation.

But it doesn’t work that way with long-term-care insurance premiums. Over the years, if you’ve owned a long-term-care policy, you’ve seen premium increases every few years, often as much as 40 to 60 percent each time. In fact, last year, the federal government announced that the long-term-care insurance premiums for federal employees and retirees would increase an average of 83 percent. In other words, the cost of protecting yourself against a future claim that may or may not occur would almost double!

The Double Whammy for Insurance Companies

Before we discuss how you might control your premium increases, let’s go over why we’ve seen such large increases. I’m not one to feel sorry for insurance companies, but when it comes to long-term care, the insurance companies face a double whammy. First, we are all living longer, which means that we may need our policies to pay for a longer period. And health insurance costs are also increasing. So the insurance company has to pay higher claims for longer periods of time—not a successful business model. It’s been so bad for so long that many companies in the long-term-care business have stopped selling policies.

How to Control Your Insurance Costs

So the insurance company can raise your premium or it can stop selling policies. But what choices do you have? While you do have a few options, none of them is great. We’ll discuss those now.

First, you can dig a little deeper into your pocket and pay the premium increase. If you like the coverages in your existing policy and you can afford the increase, this may be a good choice for you. This is also your best choice if you do not want to self-insure the risk of needing long-term care at some point.

On the other end of the spectrum, you could just not pay the premium and let your policy lapse. This is a tough call. If you let your policy lapse, you will effectively be self-insuring against the risk. Maybe you can afford to do so. Maybe not. Would you qualify for Medicaid? It’s important to know because Medicare provides only limited coverage for nursing home or custodial care.

You could shop around for a policy with another company. Unfortunately, as I mentioned earlier, there just aren’t many companies selling long-term-care policies any longer. So this might not be a good option.

The option that we see most often is to reduce the benefits in your policy. A long-term care policy includes many features and options. They are the coverages provided by your policy and include:

  • The benefit period: This is the length of time the policy will pay benefits and is typically three to seven years, although some early policies provide for an unlimited benefit period.

  • The amount of coverage: This is typically quoted as a daily or monthly amount (e.g., $150/day or $4,500/month).

  • The inflation protection: This is designed to make sure that the amount of coverage in your policy keeps up with inflation. There are two types of inflation protection: simple and compound. The compound feature results in higher coverage and, therefore, higher premiums.

  • The elimination period: This is basically your deductible. It is the number of days that you must pay for care before the policy kicks in and starts paying.

These are not all the features and options of a policy, but they are the major ones. They’re also the ones that you can typically adjust to reduce the premium. For example, if you have an unlimited benefit period, you could reduce it to a three- or five-year coverage period, which would result in less risk to the insurance company and a lower premium to you. Another adjustment that we see often, and one that my wife and I have used for our policy, is to change from compound to simple inflation protection.

Please keep in mind that these are just examples of ways that you can manage the premium increases that have become all too frequent for many. Before making any changes to your policy, you should consider your situation carefully. Determining the best way for you to protect you and your family from the costs of long-term care can be complicated. We recommend meeting with a professional who can help you clarify and understand your options.

A Teaching Moment for Teachers

Our teachers are a very special group. They work long hours for low pay, helping to shape the minds of our young. They are a very important part of our society. So why do the local governments that they serve allow them to be taken advantage of when it comes to their retirement planning?

I am lucky enough to have several clients who are either retired teachers or are planning to be one. In my work with them, I get to know their financial situation pretty well. While teachers don’t make a lot of money, they are one of the few groups who still receive a pension. If they qualify, and most do, the pension provides a monthly income for the rest of their life. But since the benefit amount is based on their income, they won’t be getting rich from the pension. When you add in any Social Security benefits, most teachers will be able to maintain a “modest” lifestyle.

But what if the teacher wants a little more? What if they can save a little from each paycheck to improve that future retirement lifestyle? In the private sector, many of us have access to a company retirement plan; most often, it’s a 401(k). We can have money withheld from our paycheck and have it invested automatically for our future. Our contributions are deducted pre-tax, and grow tax-deferred over the years. Teachers have access to a similar plan, but for them it is known as a 403(b).

In the private sector, the employer selects an investment firm to handle the administration and investing of the plan’s assets. For our teachers, the School Board selects a handful of “approved” providers from which the teachers can place their retirement funds. The problem comes from this list of “approved” providers.

It has been shown, and it just makes sense, that the costs of an investment portfolio are a huge factor in its long-term performance. At Rall Capital Management, we know that we can’t control the financial markets, so we don’t try. Instead, we work to control what we can control, one of the most important being the costs involved in managing the account.

Most of the plan providers that teachers have to choose from are insurance companies. That usually means that the retirement contributions are being invested in an annuity contract, often with layers of different types of expenses. Most of the other providers on the “approved” list are investment firms that put together a menu of funds for teachers to choose from. All too often, the funds on the menu have very high expense ratios, creating an unnecessary headwind for account performance.

The expenses in the plans that are available to our teachers are among the highest. In fact, the New York Times did a 5-part report highlighting the abuses across the country. The first part of the series is entitled, “Think Your Retirement Plan is Bad? Talk To a Teacher.” I think the title says a lot. The article says a lot more. And it showed me that the problem is not just local to Brevard County’s teachers. It’s like this across the country. Why?

I’m not trying to be conspiratorial (or maybe I am) but I would dare to say that there’s some combination of politics and money at the core of the “approval” process. This system has been in place for years and any change is now subject to inertia. There’s not enough of a rank and file movement to improve the choices because most teachers don’t know. It’s been widely reported that most people don’t know how much they are paying to have their accounts managed. Teachers are no different.

It’s so much of a problem that I will typically advise my teacher clients to stop participating. What?? Advise a client to stop contributing to their retirement plan? No; we just advise them to redirect those contributions. Instead of investing in high cost annuities or other funds, I often recommend that they fund a Roth IRA instead. Roth IRA contributions are made with after-tax money and you lose the ability to have it taken directly from their paycheck, but that’s a small price to pay for the money you’ll save.

Inside the Roth, you can invest in low-cost funds that are often 1/10th the cost of many of the 403b accounts I’ve seen from my teacher clients. A 1-2% difference in costs over a number of years will make a huge difference in the value of your retirement account years from now.

One big difference between the 403(b) plan and the Roth IRA plan is the amount you can contribute. Like the private sector 401(k), participants in a 403(b) can contribute up to $18,000/year; $24,000 if you are over 50. You can only contribute $5,500 a year into a Roth IRA, or $6,500 if you are over 50. If you do have the ability to contribute more than the Roth maximum, one option would be to direct the excess to the 403(b) plan.

To become successful financially, you must do a lot of little things right. Not paying exorbitant investment expenses is one of those things.

So, if you are a teacher, here’s your homework: evaluate whether it makes more sense to fund your 403(b) account, or whether it would be better to fund a Roth IRA. If you are not a teacher, but you know one, please forward this article to him/her. They should know this!

A New Year's Resolution We Should All Try to Keep

The beginning of a new year always brings us the opportunity to make positive changes in our lives. Over the years, we’ve all set resolutions to lose weight, quit smoking, save more money, spend less, spend more time with our loved ones, etc. But there’s one resolution that I’ve never seen anyone talk about; one that we should really all consider.

I’m talking about creating or reviewing our estate documents. Yes, estate planning. Ok, so now that I’ve probably lost half of the people reading this, I’ll speak to the other half. Nobody likes to think about, let alone do, estate planning. We don’t want to think about our death, even though I’m pretty sure it’s eventually going to happen to all of us. But planning for how things are handled at our death is only one part of estate planning. The other part is planning for the possibility of becoming incapacitated. But no one likes to think about the possibility of a terrible illness or accident either.

As much as we don’t want to go through the estate planning process, it’s important that we do so. After all, estate planning is simply capturing the way we want things to be handled in the event of our death or incapacity. And who is better equipped to make those decisions besides us? And, if we take care of it, then we spare our loved ones from having to make hard decisions during a very difficult and emotional time.

For most people, an estate plan consists of a few simple documents. First, there’s a will. The main purposes of the will are to name the person you want to handle your estate and to document how you want your assets distributed when you pass away. But, if you are a young parent, there’s another very important reason to have a will. It will let the courts know who you want to serve as your child’s guardian if something were to happen to you.

Then there’s a document known as Health Care Directives. It can serve as a living will, which will detail the level of medical treatment you desire in the event that you are not able to communicate. It will also allow you to name a person who you want to make health care decisions for you if you can’t.

Next, there’s a Durable Power of Attorney. This document allows you to appoint the person who you would like to make financial decisions for you if you are unable to.

Finally, you should also consider your digital estate plan. This is something relatively new, but it reflects the age in which we live. If something happens to you, how do your loved ones handle your digital assets like your online photos and Facebook account? And how do they access your computer and passwords to all of your online accounts? Having a plan in place to answer those questions can make it much easier on our loved ones.

It is often said, that if you don’t have a formal estate plan in place, then your state has one for you. It’s true, the state has regulations in place on how things are handled when someone does not have estate documents. But wouldn’t you rather make the decisions than some government agency?

So, if you don’t have an estate plan in place, you could make it a resolution to get it done as soon as possible. There are a number of ways to get it done. We always recommend seeing an attorney who specializes in estate planning; then you know that it’s done properly. And, it’s not very expensive.

If you do have an estate plan in place, make a resolution to review your plan to see if it’s still appropriate. Lives change and laws change, so it’s important to make sure your plan is still up to date.

Putting an estate plan in place is not fun, and involves thinking about some unpleasant possibilities. But, but once you have it done, I can guarantee you’ll feel good about having checked it off your to-do list. And then you can get back to working on those other resolutions.

It's Summertime! A Perfect Time for a (Credit) Freeze!

Originally posted July 28, 2014.

The words "identity theft" in red binary code on computer monitor.

The words "identity theft" in red binary code on computer monitor.

One of the first steps in building a financial plan is to make sure that the assets you own are properly protected.  When we talk about protecting your assets, most people think of making sure their auto, homeowners and liability insurance policies are in place and sufficient.  If you are working, it's also important to make sure you are protecting your biggest asset, which for most people is the ability to get up and get out the door to earn a living.  We protect that asset using disability and life insurance.

But this article is going to focus on an asset you have worked hard to build and protect, and which is under constant attack.  We are talking about your identity.  Identity theft occurs when a thief pretends to be someone else by using their personal information to gain access to their credit, or other resources and benefits.

Identity theft is a term that was originally coined in 1964 and has been a growing problem for years. Advances in technology have turned this into a huge issue over the last several years.  Last year a new identity theft victim was hit every two seconds in America!  The number of victims climbed to 13.1 million in 2013 - an increase of more than 500,000 from the year before.

While it is obviously not possible to literally steal an identity, there are several ways that criminals make it pay:

  • Criminal identity theft occurs when someone is arrested for a crime and poses as another person to law enforcement.

  • Financial identity theft happens when the criminal uses your identity to obtain credit and buy goods or services

  • Identity cloning is when a person uses another person's information and assumes that identity in their daily life.

  • Medical identity theft occurs when the criminal uses someone else's identity to obtain medical care or drugs.

  • Child identity theft, which is generally the hardest to detect, is when the criminal uses a minor's Social Security number for some personal gain. The thieves can often establish lines of credit, get a driver's license or even buy a house using the child's identity. Sadly, this version of the crime is often carried out by a family member or friend of the family. Also, this type of identity theft can go on for years because the damage can go undetected until the child grows up and tries to access or establish credit.

As a financial advisor, I’m going to focus on the financial identity theft problem.  The potential for being a victim will only grow as we continue to move more of our financial lives online, where the thieves will continue to focus more and more attention.  So, what can we do to protect ourselves?  

Closeup of ice crystals with very shallow DOF

Closeup of ice crystals with very shallow DOF

Freeze It

While there are some companies that say they offer "identity theft protection", they tend to be expensive and of questionable value.  The single best thing you can do is to freeze your credit.  A credit freeze will prevent anyone from opening new credit in your name.  It's also very simple to do and it's inexpensive...in fact, it's free in some states.  It used to be that you had to be a victim of identity theft to get the bureaus to freeze your credit.  But a few years ago, the three major credit bureaus gave everyone access for a small fee...usually $10 per agency.  Each state has their own rules, but in Florida, the fee to freeze is $10 per credit bureau… and it’s FREE if you are over 65!

If you freeze your credit, there is no impact on the existing lines of credit that you have.  You can go on using whatever credit lines and credit cards you have just as you were before the freeze.  You can also “thaw” your credit freeze if you need to access your credit files for a creditor, like a new car or home loan, or a new credit card.  There is typically a $10 charge to thaw your account.

Computer hacker stealing data from a laptop concept for network security, identity theft and computer crime

Computer hacker stealing data from a laptop concept for network security, identity theft and computer crime

Protect your financial identity by going online to the three credit bureaus, Equifax, Experian, and TransUnion.  Follow the directions at each of the links to freeze your credit with that bureau. After submitting your request, you will be given a Personal Identification Number (PIN) that you need to lock away and make sure you know where to find it.  This PIN is what you will need to thaw your credit when you need to. The next time that you need to apply for a new line of credit, ask your lender which credit bureau they'll be using, and you can unfreeze just that one.

So, for a total of $30 you can lock down your financial identity so that no one can possibly access credit in your name…even if they have all of your personal information.  A thief can have your social security number, date of birth, and even your driver’s license number, but if you have put a credit freeze on your finances, it won’t do them any good.

For more ways to protect yourself in the digital age, see our newest blog post!

By Bob Rall, CFP®

What is Your Most Valuable Asset?

Your most valuable asset might not be what you think it is; in this video, we reveal what it really is for most people, and list some of the ways you can protect it.