FIVE POST ENROLLMENT MEDICARE MISTAKES TO AVOID

Of the 60 million Medicare beneficiaries, 22.4 million are expected to enroll in Medicare Advantage Plans in 2020. If you are already on Medicare, you are probably breathing a sigh of relief. But even if your coverage worked well in 2019, the specifics of your plan might be changing, or there may be better options in 2020. 

When reviewing your plan, be sure to look beyond premiums and instead consider your total out-of-pocket spending, no matter how you get your coverage. 

Over the years, we have seen a few Medicare mistakes that we'd like to help you avoid: 

Pitfall # 1  Failure to Pay Your Part B Premium

More and more people are working past age 65. Because of this, some may delay their Social Security income benefits because they are still receiving some type of consistent income. If Medicare is unable to deduct your Part B premiums from your Social Security check, they will instead send you a quarterly invoice. 

It is easy to overlook a bill from Social Security because Medicare beneficiaries get a lot of mail from insurance companies. If Social Security revokes your Part B for non-payment, they will notify your Medigap carrier. Once your carrier is notified, your Medigap plan will be canceled. This will leave you without coverage for outpatient services (including doctor visits, lab-work, surgeries, chemotherapy, dialysis, as well as medical equipment, and other expensive services). What's worse is that you will have to wait until the next General Enrollment Period (GEP) to enroll. 

Each year, The GEP runs from January 1 – March 31. Though you will be able to enroll during this period, your coverage will not start until the following July. A severe illness or injury during this uncovered time could result in thousands of dollars of unpaid medical expenses. 

How to avoid this pitfall:

If you are already enrolled in Medicare Part B, before you begin taking Social Security, call them at 1-800-772-1213. You can ask them to set up a bank draft to avoid missing that crucial payment. 

Pitfall # 2:  You Leave Employment Without Notifying Medicare 

When you reach 65 and decide to leave your employment, your former employer should notify Medicare that you are no longer employed. Once Medicare becomes aware that it is now your primary insurance, it will begin to pay as your primary insurance. If your employer fails to notify Medicare, your claims will be denied because Medicare expects the bills to go to your employer's insurance first.

 How to avoid this pitfall:

A quick call to Medicare at 1-800-MEDICARE after you leave your employer to confirm that Medicare is your primary insurance can prevent denials and hassles.  

 Pitfall # 3  You Pay Your Part B Deductible Too Soon

The Medicare Part B deductible in 2020 is $198 (this will increase annually). Two of the most popular Medigap plans are Plan G and Plan N. In both plans, you will agree to pay the annual Part B deductible.

The proper procedure is for you to go to your doctor's visit, then let your doctor send the bill to Medicare. Medicare will pay your provider all but the deductible. Your doctor can then bill you for the $198 due. 

 Your doctor does not need to collect the deductible from you at the time of service. If you pay your provider, the deductible portion, it will only complicate matters. Here is an example: Let's say you went to the doctor and also went for lab work on the same day. When Medicare receives the bill from your lab facility and your doctor's office, it will apply the deductible to the first one received. So Medicare might pay 100% of your doctor's office bill, leaving you responsible for the full $ 198 lab bill. Your doctor's office, on the other hand, will be paid your $198 plus get paid by Medicare. 

How to avoid this pitfall:

Tell your doctor to bill you, and when Medicare has paid the claim and sent you a notice, you will pay the balance.

Pitfall # 4      You Avoid Preventive Care 

Medicare has numerous preventive care benefits. All of these are fully covered, and Medicare pays 100% of the claim. Preventative benefits include screenings for cardiovascular disease, diabetes, and aneurysms. It also includes cancer screenings such as colonoscopy, mammograms, and tests for lung cancer. In addition, vaccines, an annual wellness visit, bone mass measurements are covered. A full list of preventative benefits is on Medicare's website.

Keep in mind also that while some screenings are covered, related services may not be. We see this all the time on Medicare Advantage plans, where a colonoscopy might be covered, but the anesthesiologists' services during that exam may not be. 

How to avoid this pitfall:

Continue to see your primary care doctor for your preventive care. If you seek out additional preventive/wellness care from another medical provider, confirm what you will owe as a co-pay, before your appointment.

Pitfall # 5   You Neglect to Review Your ANOC 

The annual Medicare election period, also known as the open enrollment period, runs from October 15 – December 7. During this time, you can make changes to your Part D drug plan or your Medicare Advantage plan. 

Because the benefits in the Medicare plans change from year-to-year, this open enrollment period is extremely important. Each September, you will receive an Annual Notice of Change (ANOC) that will list any changes to your plan. You should review this letter thoroughly. 

How to avoid this pitfall:

To say cost-effective, review your ANOC letter annually. Since Part D plans and Medicare Advantage plans lock you in for a calendar year, you should stay abreast of any changes by setting an annual reminder on your calendar each September. Upon receipt of your letter, make an appointment to review your ANOC letter with your insurance agent. If you see a significant premium increase or the change in price for one of your vital prescriptions, you can use the Medicare Plan Finder to easily plugin your medications and shop for the best plan in your zip code.

While Medicare mistakes can happen, you can avoid the most common problems. Remember, even the most prepared person can miss a deadline or have a problem with a claim. It's in your best interest to work with an insurance agent who knows Medicare. 

At Apron Agencies, we offer you a full team of accessible agents who are here to work with you and answer all of your questions. Call to schedule an appointment today at (504) 834-9280. 

SORRY LOUISIANA, YOUR INSURANCE HAS BEEN CANCELLED

The title of this article is a subtle “ripoff” of a Time Magazine cover story written in March 1986; “Sorry America, Your Insurance has been Cancelled”. At this time, the industry went through one of the hardest markets in its history. Of course, the article did not specify Louisiana. However, the insurance market in Louisiana is already difficult and this is compounded by the fact that there is a lack of assistance from the Insurance Commissioner’s office. So what do we mean by this alarmist headline? The drought of commercial markets in Louisiana is at the lowest this professional has seen since 1986, and the commercial auto market is almost non-existent. 

WHAT WILL THE STATE OF THE MARKET BE IN 2020?

It is important that you understand the announcements that come out of the Insurance Commissioner’s office are often not accurate. Before this last election, we heard how so many personal auto companies had decreased rates. While that may be literally true, what was not disclosed was that in the 2 to 3 years before the rate decreases, substantial increases had been filed and approved by the Insurance Commissioners’ office. These large increases were not offset by the small rate decreases that occurred immediately before the election. It should be noted that the large rate increases occurred between elections when there was no publicity around the subject. This may seem unusual, but it is not. Because the Office of Insurance Commissioner is an elected position, and they are allowed by the Ethics Commission to receive donations from parties they regulate, it is pretty much a repetitive cycle. Substantial rate increases occur between elections so that when it is time to appease the voters, the carriers will implement small rate decreases when close to an election cycle. 

In Louisiana, we have two very predominant factors that affect rates. One is the losses associated with accidents that occur in any state. The other is the vast political influence that the Insurance Commissioner has in this state because of the ability to receive political donations from the very companies that he regulates. The first step in fixing the rate issue would be to eliminate through ethics legislation the ability to accept donations from entities that the office regulates. Then, they would be no reason to approve rate increases because of political favors. The other step would be to put together a task force that would place enough pressure on the legislature to amend the laws that make Louisiana a hotbed for plaintiff actions. 

So, where does that leave us for the New Year 2020? 

PERSONAL AUTO

For our personal lines auto customers, most of you from the 2nd half of 2019 has already seen rate increases in your auto. If you have not yet renewed this year, you should expect a rate increase for your next renewal. We have re-rated many of these customers and placed them in alternative markets, or we have suggested alternative markets we do not contract with and referred them to other carriers. For those, we could not get alternative plans for, we proposed changes in coverage if their budgets could not handle a substantial rate increase. Since we mainly write preferred customers, the majority of our policies are written through Safeco, a division of Liberty Mutual, or Metropolitan. Although both had a recent rate increase, their rates had not increased in several years. We do not expect that we will see a significant rate increase in either company in the next year. While you may see some improvements, barring a catastrophe (flood or hurricane), the personal lines market should settle down a bit, and rates should stay stable.

PERSONAL HOMEOWNERS

This market has seen a rate increase in 2019 from relatively mild to over 10%. We have had carriers that took flat rate increases across their book of business and other carriers who raised rates based on the activities of each customer and the territories in which the risks reside.  

At Apron Agencies, we have a rule of thumb that should there be a rate increase that is more than 4 to 5 percent; we automatically put the risk back out to the market to see if we can obtain a better rate for our clients. Our principles direct us not to sacrifice a policy that has great coverage for a policy with lesser coverage UNLESS detailed explanations are given to our clients to ensure they know what coverage they are sacrificing for the lower premium. In some circumstances where economics is a big issue, a client may choose the lesser coverage because of cost. If this is the case, we make sure the client knows what he is sacrificing for price. But, that is alright if that is what the client can only afford. Better to have some coverage than none at all. 

We have been fortunate at Apron Agencies to pick up some new markets that have supplied us with coverage that we were able to substitute for carriers that left the market. We continue every day to scour the markets to find new carriers that will write in Louisiana.

 Rate increases in personal homeowners were subject to quite a few hurricanes in the past few years. While none of these were direct hits on Louisiana, there were some regional storms, (Texas and Florida) that were large loss catastrophes. 

 If you had a claim, large or small on your homeowner’s policy, expect a rate increase. It does not matter if you were at fault or not. Insurance is based on one premise; money in and money out. There are no emotions taken into account when a claims adjuster is settling a claim on a property. It is all figured by the square or linear foot based on construction costs charts for your area of the country. 

 At Apron, we do encourage our clients to speak directly with their adjusters. However, if you have difficulties with the adjuster for whatever reason, we urge you to contact us. We can often intervene with your adjuster, or through our representatives at the carrier, to mitigate any issues you may have. Does this always work? No. Sometimes, you happen upon an adjuster that sees a situation his way and no other way. At that point, you may have to seek other remedies. But we will try our best to assist you.

 We expect the homeowners' market to stay on the “hard” side for the next couple of years regardless of storms. If any extreme storms happen in the next few years, this will increase rates.  

COMMERCIAL AUTO

For our customers that are in business, small or large, we are afraid the news is not good. The Commercial Auto market has been decimated in the past two years and the past year in particular. There have been no new markets coming into the state in the last two years, and the ones that are here are extremely expensive and very rigorous concerning underwriting restrictions. We have one market that will write non-emergency medical transportation, and they want a completely clean record (no accidents or moving violations in the past three years), and the cost is $30K per vehicle. That is an impossible cost. 

I can quote other examples like this, but the main point is that this price issue is now beginning to affect commerce in this state. No one can afford these rates and still make a profit in their business. In other industries, we would call this price gouging. However, by using sophisticated mathematical analysis and all types of expense ratios, these carriers can show on paper where they are losing money in this line of business. In truth, much of the industry is. However, some of the industry is using these facts to increase rates while they can, before someone becomes wise to their subterfuge. 

Insurance is one of the industries that depend on holding premiums from insureds for years before paying out cash in claims. Depending on the type of insurance, we categorize claims in two categories: short tail and long tail. Most auto claims are considered short tail, as an accident occurs, and money is paid out to repair the property and/or pay medical bills. Sometimes, long tail claims occur if there is litigation that occurs as a result of an auto accident. However, most long-tail claims are considered something like Worker’s Compensation. This occurs when someone is hurt on the job and will take a significant amount of time for the claim to reach its ultimate end. 

While claims are waiting to be settled, the insurance carrier is holding this money in “reserve”. While in reserve, this money is being invested and making interest on money that will eventually be used to pay the claims. Because interest on investments has been so low in the past several years, carriers are making less money in the investment business than ever before. Investment income has always been used to make up losses on less profitable lines of business. Since investment income is so low, carrier losses in lines like commercial auto are now lines that carriers no longer want to write. Before this time, commercial auto may not have been a large money-maker for the carriers, but they sold it because it was what we would call a “complementary line”. In other words, for a carrier to write your business owners' insurance, they might write commercial auto because your business has a few trucks that are used in your business. Thus, the company would write the coverage on the trucks, but the real money maker was on the property coverage and general liability. But, you had to have the auto coverage to run your business. Thus, the carrier would write the commercial auto as a “compliment” to the rest of your coverage. You also must remember that the state of auto coverage was not as litigious as it now is, so that auto was not the loser carriers now characterize it. 

None of the investment factors now play into the profits of the insurance carriers as they once did. In order to make up for the loss of investment income, insurance carriers are now raising rates to compensate their shareholders for the loss.

  COMMERCIAL PROPERTY AND GENERAL LIABILITY

Commercial Property is a line of insurance that will see large increases in the next two years. You will hear the term capacity used in the insurance market. Capacity means the amount of dollar volume that insurers are willing to place at risk in a particular line of business. In the past year, Lloyds has shut down eight (8) syndicates, all of which had vast sums in the commercial property market. The syndicates are no longer willing to place their Members' money at risk in this market. Some of this is because of catastrophic losses in the past few years, and others claim that it is just not a profitable market and has to have rate increases to become profitable. Some industry analysts are stating that the market is just starting to firm up and will remain that way for the next five years. Regardless of which analysts in whom you place your faith, the outcome is still going to be a “hardening” market. 

On top of the primary carriers, we must also deal with the re-insurers.

 Many of the re-insurers are tired of not making underwriting and investment profits on their money. They are shutting down exactly like the eight (8) syndicates referenced above, or they are raising the rates. When my business was operating in the re-insurer markets, there was always one principle we swore by; re-insurers always made deals that made money for them. Sometimes those deals were so complex it took us neophyte’s weeks along with other consultants to assist us in trying to figure out whether or not we could meet their demands or whether we just needed to fold our tents. Re-insurers always make certain they have what is called a “margin”. That margin is pretty much a percentage guarantee of what they intend to make on a given program. If they do not believe they cannot make a guaranteed minimum percentage, they will not enter into the treaty. However, there is always an upside where they can make more money if results are good. The re-insured entity seldom shares in that upside unless it is so lucrative it would be considered unconscionable not to share the profits with the primary carrier. Re-insurers are tough to deal with, and most Insurance Commissioners have little idea of what is going on in the insurance market in general and no idea of the reinsurance market at all. Thus, rates are increased with their not having a clue of the real reasons.

General Liability markets are experiencing rate increases because of a litigious society that is being fueled by social media. That result is now being termed “social inflation”. What exactly is this? Let’s take a look at an issue most everyone has heard of by now; the #MeToo movement.

The #MeToo movement began in 2017-18 with women coming forward, stating they were sexually assaulted and abused by men in the Hollywood Studio setting. It then spread quickly into the corporate arena, in both large and small offices. A firms’ General Liability Insurance would be the line of insurance that would cover this type of claim. Also, Workers’ Compensation insurance could be involved. For the sake of simplicity, we will use the term Liability Insurance for this discussion.

The alleged victim makes a claim against the alleged predator and hires an attorney to file suit. Whether or not the claim is true or false makes no difference at this juncture. The defendant must then hire an attorney to defend himself. This normally takes place in the venue of calling your insurance carrier, and the carrier sets up a claim and then hires counsel to defend the insured and the carrier. 

What are the financial outcomes of these cases? Whether the alleged predator is found guilty or not, the economic toll can be quite costly. This is particularly true of high profile insureds. Many insurance carriers have specific questions on applications asking if the applicant is a “high profile person,”; i.e., an athlete, an entertainer, a politician, etc. Underwriters know from experience that persons seeking financial settlements are not going to file suit against someone that has no money. Therefore, when underwriters look at applications for General Liability risks, they have to take into consideration the finances of the insureds, as well as their employment, their reputations, etc.

So, in the first example, we will assume the defendant is held liable. In addition to all of the legal fees, expert witnesses, research, and investigative expenses and all other expenses that go into a case of this type, the insurance carrier is at the mercy of a jury as to how much money they will award the plaintiff. In addition to actual monetary damages, the jury can award what are called punitive damages. These are damages that are assessed on the defendant to “punish” his or her behavior. Punitive damages have no cap and can be any amount that a jury feels justified in awarding. In cases where the defendant has been sued multiple times for the same outrageous behavior, the award could enter the hundreds of millions of dollars. Even if a defendant is held not liable, the insurance carrier still has a financial loss in covering all of the expenses involved in a lawsuit like this, and the defendant may have substantial expenses trying to reestablish his or her reputation. 

All of these expenses have significantly increased because of social media, thus now termed as “social inflation”. Social media has become a nightmare in the handling of high profile claims because what was once handled by a PR firm or held in confidence is now splashed all over social platforms with little value given to the significance of any truth. Each juror that sits in judgment cannot help but hear and read these comments, and this bias is taken with them into the Court Room. No amount of jury instructions given by the Judge will change the effects of hearing or reading these statements one way or the other and will affect the outcome of any deliberations. Remember, in civil trials, it only takes a preponderance of evidence for a jury to hold someone liable. This principle was exhibited in the O.J. Simpson trial. He was found innocent in the criminal trial and held liable in the civil trial. 

Because of all of the aforementioned discussion, there will be significant increases in General Liability rates as well as a decrease in the amount of coverage that will be provided. I have already been notified by some carriers that they will not afford coverage for Personal Umbrellas unless the underlying auto has coverage of $1,000,000 combined single limit. At present, companies have been accepting coverage of $250/$500. This will no longer be acceptable in the future with some carriers. If you are with any of these carriers, we will have to make changes to move your business to other insurance companies. 

MISCELLANEOUS COVERAGES

For most of our clients, the four categories above have covered all of your concerns. But, for some of our clients, we have other coverage like Cyber Liability, Vacant Property, Directors and Officers Liability, Surety Bonds, Etc. Most of these policies have seen some increases. On the other hand, Cyber policies have softened and are experiencing decreased rates. Each of these markets has to be analyzed on an individual basis and will be discussed with each client as they come up for renewal. Suffice it to say, that very little in this economy is getting cheaper and everyone should prepare for their business and personal expenses to rise in the next two years. 

Professional Liability insurance has been on the decline for the past four years, but I doubt that that will continue in 2020. If you have been one of our fortunate commercial clients, you have saved a great deal of money with us in the past 3 to 4 years, remember that when we renew your policies this year. What comes down will eventually go up, and that maybe the story line this coming year. 

 We will certainly try to notify you of any upcoming trends in the market place as we see them coming. However, please know that while we work very hard to stay well informed of current changes, no one is a fortune teller at Apron Agencies. As the veteran of this group (that means old broad), I try to read as much about the markets as time permits. I do enjoy staying abreast, but the reading material is enormous, and sometimes I need to take out time for a really good football or basketball game. We will do the best we can to forewarn you of significant changes.  I hope this newsletter finds all of our customers well and about to embark on a new decade with us!!

At Apron Agencies, we offer you a full team of accessible agents who are here to work with you and answer all of your questions. Call to schedule an appointment today at (504) 834-9280.

DID YOU KNOW THERE ARE TWO KINDS OF WIND DAMAGE DEDUCTIBLES FOR YOUR HOME?

It’s the start of a new year.  A great time to review and evaluate your homeowners and other insurance policies. 

Did you know?  There are two kinds of wind damage deductibles for your home:

1)        Hurricane deductibles which apply to damage solely from hurricanes.

2)       Windstorm or wind/hail deductibles, which apply to any kind of wind damage.

 Percentage deductibles typically vary from 1 percent of a home's insured value to 5 percent. In some coastal areas with high wind risk, hurricane deductibles may be higher. The amount that the homeowner will pay depends on the home's insured value and the "trigger" selected by the insurance company, which determines under what circumstances the deductible applies.

In some states, policyholders may have the option of paying a higher premium in return for a traditional dollar deductible, depending on how close to the shore they live. In some high-risk coastal areas, insurers may not give policyholders this option, making the percentage deductible mandatory.

There are three deductibles for homeowners policies related to wind damage: hurricane, named storm and windstorm and hail.  Named storm deductibles are activated when the National Hurricane Center reports that a storm reached tropical storm strength when winds reach 39 miles per hour (mph).  Hurricane deductibles are activated when the National Hurricane Center reports that a tropical storm reached hurricane strength, at 74 mph.  Windstorm and hail deductibles are used when homes sustain damage from winds from any source: hurricanes and tropical storms, tornadoes, or other storms.

Insurers generally cannot increase the named storm or hurricane deductible on homeowners insurance policies that have been in effect for more than three years. Insurers cannot impose more than one named storm or hurricane deductible per hurricane season.

State regulations mandate that homeowners may be eligible for premium discounts if they build or retrofit their home to comply with the state’s construction code or install mitigation or retrofitting improvements that are known to reduce loss from a windstorm or hurricane.

Make 2020 the best year yet by being prepared for the unexpected.  We can help you by completing an insurance check-up on your home. Call us today at 504-834-9280.

 

YOUR HOME MATTERS - PROTECT AGAINST FLOODING

Did You Know?

One of the most common homeowner's insurance claims is completely preventable? It’s not fires or theft; it’s water damage. This is not damage due to flooding, heavy rainstorms or snow on the roof – rather, it’s due to simple maintenance tasks that are often ignored or go unnoticed.

5 TIPS TO PREVENT WATER DAMAGE

1.        Check hoses for kinks and cracks when you do laundry, and replace your washing machine hose every five years with a high-pressure hose. At a cost of less than $10, it’s an inexpensive way to ward off costly problems.

2.       Check for signs of leakage by inspecting the floor near your water heater and other appliances. Hire a licensed technician to periodically inspect appliances, and replace a water heater that is more than 10 years old.

3.       Check Inspect the refrigerator, dishwasher and outdoor faucets for leaks and crimps.

4.       Place a tub under your kitchen sink to catch leaks before they start.

5.        If you move your refrigerator to clean the floor, do not overextend the icemaker line. Call a licensed technician if you see signs of moisture or brittleness.

We’re here to help with all your home matters. Contact us today at (504) 416-0237, and let us know how we can assist you.

Prevention Pays

How does water damage occur? It’s simple: homeowners fail to check the connection between the water line and their washing machine or other similar appliances. Eventually, the connection fails, and water leaks into the home until someone discovers the mess.

Do a quick check of all your water lines from time to time, especially in low-traffic areas of the home. If you notice anything suspicious, contact a licensed professional to come take a look immediately.

Call us for your free household insurance check up and let us get you the best coverage at the best price!

 

"Like momma in the kitchen, we've got you covered." Apron Agencies, LLC

This flyer is for informational purposes only and is not intended as professional advice. © 2008 – 2010, 2013, 2016 Zywave, Inc. All rights reserved.

WHAT IS THE MEDICARE ENROLLMENT PERIOD?

Medicare’s Open Enrollment is happening now running from October 15 through December 7.

If you’re age 65 or older and are eligible for Medicare, don’t miss this opportunity to choose your coverage or make any corrections to your previous Medicare elections.  Now is also the time to upgrade your coverage for 2020 and potentially save money.

If you’re Medicare-eligible, your mailbox will likely be filled in the upcoming weeks with suggestions for policies to supplement your Medicare coverage.  You may not think you need a medical insurance policy to supplement Medicare, think again.  Medicare has substantial deductibles and copayments.  It also doesn’t cover services commonly covered by many medical insurance plans.

As a result, a Medicare Supplement Plan which pays for Original Medicare’s deductibles and copayments or a Medicare Advantage Plan, which delivers integrated health care in a managed care environment are available.  Both types of coverage have their pros and cons.  Do extensive research to see which type of policy might work best for you.

Are you spending a significant amount of money on prescription drugs or think you will be?  If so, it’s a good idea to compare your current or potential Medicare Part D Prescription Drug Plan to other policies.

During Open Enrollment, you can switch your Medicare Advantage Plan or Part D Prescription Drug Plan.  If you want to switch to a new Medicare Supplement Plan, in most states, you might need to satisfy medical underwriting.

Get prepared by letting us do an insurance check-up on your Medicare coverage. Call us today at 504-834-9280.