What is a "Letter of Entitlement"?

From time to time I am referred to people turning 65 that have not applied for Medicare until just before their intended effective date. It can take two to three weeks for Medicare to send out the card indicating enrollment in Part A and Part B.

All Medicare health plans require the person be enrolled to Medicare Part A and Part B. In fact, the agent/broker must copy the card information onto the enrollment application verbatim.

So, what if the person has not received their card and they want to get their application filed on time so their Medicare health plan begins on the desired date?

You can get a "Letter of Entitlement" for proof of Medicare benefits online. Log into "My Social Security" at http://www.ssa.gov - create a personal account and print off the letter of entitlement without having to wait for the US Postal Service!

The agent/broker can submit a copy of the letter of entitlement with the insurance application. This prompts the insurance company to pend the application and "ping" (check) the MARx (National Eligibility Database) rather than deny the application.

Thus, if you are close to age 65 and are waiting for your Medicare card to arrive in the mail, you can do an end run on the US Postal Service by using the website above to get your own "Letter of Entitlement."

Identity Theft - What will you do?

You read about it all the time. Somebody gets their whole life turned upside down when a thief steals their identity and goes on a buying spree. But did you know there are other kinds of identity theft besides losing cash from your bank account?

Medical Identity Theft
Someone gets enough information about your health insurance coverage to get medical care they need but the bill goes to you! A plastic surgeon tells of a breast augmentation performed on a woman that used a stolen identity and medical insurance information. The expensive surgery was completed and the woman disappeared. Only weeks later was it discovered that the woman that got the bills was not the woman that had the operation.

Criminal Acts In Your Name
A man gets pulled over by police, handcuffed, Mirandized and hauled off to jail. He was innocent but was arrested because someone unknown to him committed a robbery, used his identity when picked up by police and then skipped bail.

Children Are Vulnerable
Almost every child has a Social Security number, including infants. When an identity thief gleans the child's name, birthdate and SSN it's like taking candy from a baby. The years of felony acts and financial damage may not be discovered until the youngster applies for his/her first job or tries to buy a car on credit.

The financial devastation of identity theft is compounded by the emotional stress that goes with such a loss. It's bad enough that you lost all of your savings or were denied a loan on the house you wanted to buy. It's horrible that you were passed over for the job you really wanted because of a poor credit rating you didn't even know you had.

Restoration Process
Restoring your good name is the toughest part. It takes hundreds of hours and sometimes years and thousands of dollars to put your life back the way it was. Do you have the time and knowledge to handle the myriad tasks AND continue to work, raise a family and maintain your sanity?

It's easy to get an identity theft program that notifies you of a breach against your credit. Most identity theft protection plans promise to help you restore your life. But there is a big difference in how IDT plans approach restoration.

One that is advertised heavily on radio does a good job at alerting you of trouble but when the damage is done (and it often does even though an alert is sent by email or text message) the company sends you a kit with information and instructions for you to follow. It's DIY from that point forward.
Good luck.

The IDT plan I have monitors all three credit agencies 24/7 and sends instant alerts when there is a "hit" to my credit file like you'd expect. My IDT plan monitors my online activity and social media for trouble. My IDT plan monitors police records to see if my name pops up. But they do much more.

The IDT plan I use allows me to sign an affidavit that allows Kroll, the global leader in risk mitigation response, to step in and actually do all the legwork to restore my life. Plus, I have unlimited access to attorneys to counsel me on whatever I need in the way of help following a loss of any kind.

How much would you pay for this kind of protection? This kind of identity theft protection and restoration could cost thousands of dollars. But I pay less than $20 per month. And it covers everyone in my household. Interested?

Medicare to save $100 to $740 million over the next ten years

The following is from a CMS bulletin received May 22, 2014---

 

The Centers for Medicare & Medicaid Services today announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years.

“With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered. This will improve access to services and quality of care,” said CMS Administrator Marilyn Tavenner.

The announcement builds upon lessons learned from the Medicare Prior Authorization of Power Mobility Device Demonstration. Launched in 2012, the demonstration established a prior authorization process for certain power mobility devices. Based on September 2013 claims data, monthly expenditures for certain power mobility devices decreased from $12 million in September 2012 to $4 million in August 2013 across the seven demonstration states (California, Florida, Illinois, Michigan, New York, North Carolina, and Texas) with no reduction in beneficiary access to medically necessary items.

CMS seeks to leverage this success by extending the demonstration to an additional 12 states. These states include Arizona, Georgia, Indiana, Kentucky, Louisiana, Maryland, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, and Washington. This will bring the total number of states participating in the demonstration to 19.

CMS also proposes to establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies items that are frequently subject to unnecessary utilization. Through a proposed rule, CMS will solicit public comments on this prior authorization process, as well as criteria for establishing a list of durable medical items that are frequently subject to unnecessary utilization that may be subject to the new prior authorization process. The proposed rule is currently on display at https://www.federalregister.gov/public-inspection and will be published in the Federal Register on May 28, 2014. The deadline to submit comments is July 28, 2014.

CMS will launch two payment model demonstrations to test prior authorization for certain non-emergent services under Medicare. These services include hyperbaric oxygen therapy and repetitive scheduled non-emergent ambulance transport. Information from these models will inform future policy decisions on the use of prior authorization.  

Prior authorization does not create additional documentation requirements or delay medical service. It requires the same information that is currently necessary to support Medicare payment, but earlier in the process. CMS believe prior authorization is an effective way to ensure compliance with Medicare rules for some items and services.  

For more information, go to: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Overview.html.

Additioanl Fact Sheets Links:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-05-22-2.html

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-05-22-3.html

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-05-22-4.html

Are IRAs and 401(k)s the best you can do?

If you are using a qualified plan like an IRA or 401(k) it may be the worst thing you can do because you will be taxed out of your gourd when you retire and actually need your money.

There is a better way that is approved by the IRS and beats IRAs and 401(k)s by 25%-40%.

It’s been around for years. Your money grows tax-free, has no taxes at retirement, no taxes when you die and no taxes when passed on to your heirs.

And there is no risk to your principal. If the market tanks like it did in 2008 you lose nothing.

And there is more. This IRS sanctioned retirement plan can be arranged to provide long term care benefits if you become disabled and that money is also tax-free. 

You can find out more about this guaranteed retirement plan by contacting me at 425-338-1000 or richard@ekandek.com

Know a good attorney?

From time to time almost everyone needs legal advice. Bad experience with a car repair, construction job or remodel gone haywire, car accident, legal forms to sign. And the big one, teenagers driving!

Who are you going to call? What is it going to cost?

Legal Shield is the answer. Their motto is "Worry less, live more."

For as little as $20 per month you can

• Call an experienced attorney with any legal question - no charge
• Have up to 15 pages of legal documents reviewed by an attorney - no charge
• A letter or phone call from your attorney to solve a problem - no charge
• Legal documents prepared - a will and power of attorney - no charge
• Up to 60 pre-trial and trial hours of attorney time - no charge
• Representation in court by an attorney for defensible driving tickets - no charge
• Legal representation before the IRS if you are audited - no charge
• Discounts on other legal matters

I've used Legal Shield since 1998 and the service has saved me thousands of dollars. Unlimited phone calls about tax issues, real estate, business questions, estate settlement and probate is a big reason why I use Legal Shield.

Legal Shield also has the best Identity Theft protection you'll find anywhere. Security breaches at Target and other major retailers are in the news and have affected millions of people. Anyone that has used Healthcare.gov or other state health websites should be aware that the sensitive information entered is not secure. Identity Theft protection is a must-have.

Find out how Legal Shield can bring you peace of mind and solve issues you are fretting about. At www.ekandek.com click on ENTER and look at the Legal Shield tab. Watch the videos and learn more.

The Best Retirement Savings Plan?

If you are saving for retirement, chances are you have a "tax qualified" account of some kind - an IRA, 401(k) or perhaps a SIMPLE plan. You get a tax deduction for deposits you make to your retirement plan and it grows "under the radar" of the IRS. You don't pay taxes on the growth as the account accumulates interest over the years.

However, you will be taxed out of your gourd when you withdraw from your qualified retirement plan. 100% of the withdrawals are taxed as ordinary income at whatever the tax rates are at the time. People often say they expect to pay less in taxes when they retire. Huh? When did income tax rates go down in the last 45 years? (they haven't)

Another big thing is that your retirement accounts may be taxed as much as 60% if you leave the money to heirs. Is that what you want?

My clients use an IRS sanctioned plan that has been around for generations. There are no limits on how much you can save per year. Deposits are not tax deductible but withdrawals are tax-free. Your money grows as the economy improves. You never see a downturn or loss in your retirement plan if the economy tanks. There is also a self-completing feature: if you become disabled and your work income stops, the plan continues to make annual deposits for you. If you happen to die before or during retirement, the entire account goes to your heirs income tax free.

Contact me for more information and a tailor-made plan for your retirement.

Health Insurance Premium Tax Credits for All?

WASHINGTON — The Obama administration said Friday (february 28th) that it would allow some people to receive federal subsidies for health insurance purchased in the private market outside of health insurance exchanges. The sudden shift was the latest in a series of policy changes, extensions and clarifications by federal officials trying to help beneficiaries and minimize political damage to Democrats in this election year.

Federal officials said they had agreed to provide such assistance retroactively because technical problems had prevented consumers from using online exchanges to obtain insurance and financial aid in some states.

Gov. John Kitzhaber of Oregon, a Democrat, had specifically asked the federal government to allow financial assistance, in the form of tax credits, for people buying insurance outside the state’s troubled exchange. Other states running their own exchanges, including Hawaii, Maryland, Massachusetts and Minnesota, have also experienced technical difficulties, creating political problems for their governors.

The Obama administration’s decision came as a surprise because the Affordable Care Act is clear: Federal subsidies are available only to people who enroll in a “qualified health plan” through an exchange.

But some of the online state exchanges have not been working well enough to determine if people are eligible for coverage, one of the basic functions of an exchange. The exchanges are competitive marketplaces where consumers are supposed to be able to shop for insurance, enroll and get financial assistance to help pay premiums.

“We recognize that some states have experienced difficulties in processing automated eligibility determinations and enrollments,” said Aaron K. Albright, a spokesman for the federal Centers for Medicare and Medicaid Services. “We released guidance providing options to marketplaces to ensure eligible consumers have access to financial assistance.”

The new policy applies to people who — because of “technical issues” — were stymied in trying to buy insurance through an online exchange and signed up for a health plan outside the marketplace. They will now be allowed to sign up for coverage in the exchange and get federal subsidies “on a retroactive basis,” going back to the date on which they first enrolled in a health plan outside the exchange.

Representative Joe Pitts, Republican of Pennsylvania and the chairman of the Energy and Commerce subcommittee on health, expressed disbelief at the latest policy change.

“The administration is blatantly ignoring the law, paying subsidies to plans outside of exchanges,” Mr. Pitts said. “The unilateral delays and changes have been rampant.”

Until now, people who bought insurance outside an exchange were not eligible for subsidies.

Under the new policy, insurers may have to give refunds or credits to reimburse consumers for some of the money they spent on insurance premiums and co-payments before getting subsidies.

The subsidies can greatly reduce the cost of coverage. The Congressional Budget Office estimates that four-fifths of people buying insurance through exchanges will qualify for subsidies, with the government spending an average of $4,700 for each “subsidized enrollee” this year.

Sara Rosenbaum, a professor of health law and policy at George Washington University, said that by offering subsidies for insurance purchased outside an exchange, the Obama administration was avoiding a huge potential legal liability.

“People could have gone to court to obtain benefits denied without due process of law, because of a breakdown in government eligibility systems, and a judge would probably have ordered retroactive relief,” Ms. Rosenbaum said. “The federal government is voluntarily providing equitable relief that a court would have given.”

Mr. Kitzhaber thanked the administration, saying its action would “ensure that Oregonians who enrolled in health plans outside of our insurance exchange would still be able to claim tax credits that are a key benefit of the Affordable Care Act.”

Dr. Joshua M. Sharfstein, Maryland’s health secretary and chairman of its insurance exchange, said he was studying the new federal policy to see if it could be used in Maryland. Many “logistical details” would need to be worked out, he said.

The health law fix this week comes after the administration delayed the requirement for larger employers to offer coverage to employees; extended the deadline for people to sign up for coverage starting on Jan. 1; delayed the opening of online marketplaces for small businesses; and asked insurers to extend individual health care policies that had been canceled for not complying with the new federal law.

Source: New York Times, February 28, 2014