Insurance For Over 65

Serving Georgia, Alabama, and Florida

Greg Nicholaides

By

Ways to Continue Your Education in Retirement

Retirement is the end of one chapter – your work life – and the beginning of another: Your new life. For some seniors, retirement is an opportunity to travel the world. For others, it’s about having the time to pick up old hobbies or try something new. But retirement offers an even bigger benefit: the chance for lifelong learning after retirement. Not sure where to get started? Here are some ways to continue your education after retirement.

BOOK CLUBS

Book clubs are a great way to meet new people and learn new things. Community centers or local coffee shops may have ads for neighborhood book clubs, or you can start your own with just one or two friends. These groups offer opportunities to socialize and the chance to expand your horizons. Plus, you’d be ahead of the curve. According to data from YouGov, 46% of Americans didn’t read a book in 2023. Book clubs offer lifelong learning for seniors, one page at a time.

ADULT LEARNING CENTERS

Adult learning centers are another option for education in retirement. You may have seen advertisements for these centers or passed by them in your neighborhood, and you’ve probably asked yourself, “What are they teaching in there?” The answer is just about anything. You could enroll in senior learning programs that focus on history, science, acting or financial management, to name a few. Plus, learning centers regularly update their course catalogs so you never run out of new options.

ONLINE CLASSES

If you prefer to learn in the comfort of your own home, consider online classes. Platforms such as Coursera, Khan Academy and edX all offer a host of lifelong learning programs for seniors. You can learn about computer programming, economics, U.S. history or personal finance. Some online schools also offer pathways to certification or accreditation if you’re considering a second career (or just want to challenge yourself).

COLLEGE EDUCATION

Want the full education experience? It’s never too late to consider going to college. As noted by NASDAQ, a growing number of U.S. retirees are now returning to college or exploring post-secondary schools for the first time. College offers the dual benefits of huge course selections and built-in social circles to help facilitate lifelong learning for senior citizens.

LEARNING A SECOND LANGUAGE

If you’re considering a trip around the world or have specific countries on your bucket list, why not learn another language? Apps like Duolingo let you start with the basics and build your way up to a working knowledge of languages like French, Spanish, Mandarin or even Norwegian. Many adult learning centers also offer language classes if you prefer in-person learning.

PUBLIC SPEAKING

Terrified of public speaking? You’re not alone – over 75% of people agree it’s a scary prospect. If you’ve decided to push the envelope, however, there are options to boost your confidence. For example, Toastmasters has been helping its members overcome their fear of public speaking since 1924.

COMMUNITY VOLUNTEERING

If you’re interested in learning new things while staying close to home, consider volunteering in your local community. Senior learning opportunities can often be found at local libraries, museums, community centers or charitable organizations such as shelters, food banks and soup kitchens. Volunteering is a great way to meet new people and learn from their experiences, in turn broadening your perspective (and maybe making a few friends along the way).

POTTERY LESSONS

Pottery is growing in popularity for young and old alike. There’s something satisfying about shaping and molding clay and then putting it through the fire (literally) to produce a finished product. Local pottery classes let you work with different materials and use various techniques to create ceramic pieces that last for years or decades. Plus, you get the benefit of a good workout and a class full of like-minded potters.

HOME MAINTENANCE

According to data from the AARP, 77% of older adults want to stay in their homes for as long as possible, rather than moving to a care facility. If home is where your heart is, this is a great opportunity for continuing education in retirement. The more maintenance and repair work you can do around your home, the more you learn and the less you pay for repairs.

Best bet? Start with small projects, such as fixing popped nails or re-caulking seams and windows. YouTube is a great resource for how-to videos, offering everything from in-depth advice to quick overviews that help get you on the right path. The result is a win-win – you get to enjoy your retirement in the comfort of your own home, even as you learn more about keeping it in great shape.

By

Fighting a Denied Medicare Advantage Claim

If a Medicare Advantage plan denies you coverage for medically necessary care, don’t take it lying down.  File an appeal, and your odds are good that the plan will overturn its decision.

That’s the message for consumers in a government report examining service and payment denials in Medicare Advantage plans, which are offered by private insurers and often combine basic Medicare benefits with drug, dental and vision coverage in a single package.  Looking at appeals filed by Advantage enrollees and health care providers between 2014 and 2016, the U.S. Department of Health and Human Services’ Office of Inspector General found that plans overturned 75% of their own denials.

“The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided,” the report says.  More recently, a Kiplinger Foundation analysis found that while just 11.7% of Medicare Advantage denials were appealed in 2023, a whopping 81.7% of those appeals succeeded, suggesting that some beneficiaries may be going without needed services or paying out of pocket for care.

A Growing Problem

For patients, plan denials may have even broader repercussions.  “If a provider is denied payment, they more be more reluctant to provide certain services in the future”, says Leslie Fried, senior director at the National Council on Aging’s Center for Benefits Access.

Inappropriate denials are a growing concern as the number of Medicare Advantage plan beneficiaries soars.  Advantage plans had more than 32.8 million members in 2024, up from about 30 million in 2023.  Because the government gives Advantage plans added flexibility, such as allowing them to offer supplemental benefits not covered by traditional Medicare, the number of people turning to Advantage plans is likely to grow.

But unlike traditional Medicare beneficiaries, Advantage plan enrollees looking to limit their costs must stay within their plan’s network of providers and can be required to have a referral to see a specialist.  “Medicare Advantage plans are committed to providing quality, affordable and appropriate care to patients,” says Cathryn Donaldson, a spokesperson for America’s Health Insurance Plans, a health insurance industry group.  A denial, she says, “can often be a request for additional information for the claim, or a move to an alternative treatment that’s more effective”.

Dealing With a Denial

Advantage plan beneficiaries should read their denial notices, understand their rights to appeal and file appeals promptly, patient advocates say.  But the denial notices that plans send to enrollees aren’t always clear, says Fred Riccardi, president of the Medicare Rights Center.  I 2015, audits by the Centers for Medicare and Medicaid Services found that 45% of Advantage plans sent denial letters with incomplete or incorrect information, according to the Inspector General’s report.

Follow the instructions on the denial notice to make your appeal.  Ask your doctor to write a letter explaining why you need the care and understand the timeline to make your claim.  Advantage enrollees have only 60 days from the date of the denial notice to file an appeal with the plan, compared with 120 days for traditional Medicare beneficiaries.  The plan must then make a decision within 30 days if it’s denying a service that you haven’t yet received, or 60 days if it’s refusing to pay for a service that you have already received.  If your health could be harmed by waiting for the standard appeals process to play out, request an expedited appeal, which requires a decision within 72 hours.

If the plan rejects your initial appeal, your claim will be automatically forwarded to an independent entity for review.  If your appeal is rejected there, you still have up to three more levels of appeal.

Helping Hands

The appeals process can be overwhelming – particularly for patients who are sick or frail.  Find expert assistance through resources such as:

State health insurance assistance programs.  To find your local program, call 877-839-2675 or go to www.shiphelp.org

Medicare Rights Center.  An advocacy group for Medicare beneficiaries.  Go to www.medicarerights.org or call 800-333-4114

Legal aid programs.  Find legal services in your area at https://eldercare.acl.gov or call 800-677-1116

By

Assisted Living vs. Nursing Homes: Making the Best Choice for Senior Care

Making decisions about the care of a parent as they age can be challenging and emotional. It’s not just about choosing a place to live; it’s about finding the right environment where they will thrive. For families trying to choose between assisted living and nursing homes, understanding the differences is crucial for finding the right care.

Assisted living communities offer a balance of independence and support. Designed for seniors who require some daily assistance but still wish to lead an active lifestyle, these communities provide a social environment that combats loneliness in seniors and fosters physical, emotional and cognitive wellness.

Studies show that good friends are good for your health. Community living has been proven to reduce a variety of ailments, from cognitive decline and heart disease to anxiety and depression. One of the benefits of senior living communities is that they offer daily events and activities for seniors. The programs offered by a community can indicate whether or not it would be a good fit.

Assisted living communities respect residents’ independence while offering support for activities of daily living (ADLs), such as getting dressed, bathing and medication assistance. Care isn’t one-size-fits-all, though. Finding a community that offers a personalized approach ensures that individual care needs are met, and changes in health and well-being are noticed.

While assisted living communities don’t typically offer skilled nursing services, you may find a community that offers regular care assessments and on-site healthcare services – giving residents and their families peace of mind.

Amenities such as a fitness center, swimming pool and nutritious dining experiences all enhance the well-being of older adults. Entrusting daily tasks such as cooking, cleaning and household maintenance to a professional staff frees assisted living residents to enjoy life and spend more time doing things they want to do.

Nursing homes cater to individuals who require extensive 24-hour medical care for acute or chronic illnesses. These facilities are equipped with professional healthcare personnel, making them suitable for complex health conditions that cannot be self-managed or addressed in an assisted living community.

Long-term care facilities can provide for a wide variety of needs. Understanding your family’s long-term care options will help you make a confident choice. Skilled nursing care and professional healthcare practitioners providing round-the-clock care are the key components of nursing homes. These facilities offer a higher level of medical attention, which includes rehabilitation, intensive therapies and specialized care plans.

Nursing homes offer a medically oriented environment rather than the social setting you’ll find in assisted living communities. While less emphasis is placed on social events, many nursing home facilities do offer some activities.

At its core, the decision between assisted living and a nursing home comes down to the level of care required. It’s about aligning care needs with the right environment – one that not only ensures safety but also promotes a sense of belonging and happiness.

For those who benefit from daily support but don’t require round-the-clock skilled nursing care, assisted living can be the perfect solution. Thanks to the supportive environment, a short-term assisted living stay can also provide a safe place to recover following an illness or injury – before your parent returns home. Conversely, when constant medical care is the priority, a nursing home may offer the necessary resources and expertise.

If you’re not sure your parents are ready for either care option, keep in mind that the social, supportive environment found in assisted living can help maintain good health, allowing your parent to age in place. Many assisted living communities also offer independent living – with the option to add care services as needs arise.

Not sure where to start? Creating a long-term care plan will help your family prepare for changing care needs and identify available resources.

By

Reverse Life Insurance vs. Life Settlement Explained

Life insurance plays a significant role in financial planning for seniors who are managing retirement income and long-term care costs. However, many are also starting to wonder if they can turn their life insurance policy into something useful today, rather than just a future benefit for their heirs.

The options on the market can be confusing. The term “reverse life insurance” frequently appears in online searches and conversations. However, the truth is that there is no such product. There is, however, a life insurance payout alternative – a life settlement.

There is no official product called reverse life insurance. You will not find it listed in a policy brochure or offered by insurance companies. But people use the phrase when trying to figure out how to convert a life insurance policy into cash.

Many people searching for reverse life insurance are:

  • Looking for ways to get money for retirement
  • Paying premiums on a policy they no longer need
  • Curious about selling their policy for a lump sum payout

They may have heard from a friend or read online that it’s possible to “cash out” of a life insurance policy, and that’s where the confusion starts. Some assume that reverse life insurance is a formal option, similar to a reverse mortgage, which allows homeowners to convert part of their home equity into cash.

What most people are thinking of is a life settlement. This is a real and regulated financial transaction that allows you to sell part or all of your life insurance policy for a cash payout that you do not have to repay.  A life settlement is a transaction where you sell your life insurance policy to a third party for a lump sum. The payout for a life settlement is typically greater than the policy’s cash surrender value but less than the full death benefit.  Once the policy is sold, the buyer takes over future premiums and receives the death benefit when you pass away.

To qualify for a life settlement, you typically need to:

  • Be over age 65
  • Have a whole life, universal life or other permanent policy with a death benefit of at least $100,000
  • Have held the policy for at least two years (which varies by state)
  • Have changes in your health status since you purchased the policy

Let’s take Judy, a 76-year-old with a $250,000 universal life insurance policy. Her children are grown, she is retired, and the premiums are starting to strain her fixed income.  She decides to sell her policy for a $60,000 lump sum payment and rids herself of any future premiums.

This is a much better option than letting the policy lapse or taking the $15,000 surrender value from the insurance company. That’s the power of a life settlement. It turns something you no longer need into cash you can use today.

REVERSE LIFE INSURANCE VS. LIFE SETTLEMENTS: WHAT’S THE DIFFERENCE?

Reverse life insurance and life settlements are often used in the same breath, but they are not the same thing. Think of “reverse life insurance” as a casual term. It’s not a product. It’s more like a search phrase, or a placeholder people use when they are unsure what the real option is. On the other hand, a life settlement is a legitimate, regulated transaction. It involves paperwork, legal review and protections for the seller and buyer.

OTHER TERMS CONFUSED WITH REVERSE LIFE INSURANCE

When people search for ways to get cash from their life insurance, “reverse life insurance” is not the only phrase that causes confusion. There are a few other options that sound similar, but each one works differently:

  • Viatical settlement: This is similar to a life settlement but for terminally ill individuals. The payout is often higher, and it is based on the life expectancy of the insured.
  • Cash surrender: If you cancel your policy, your insurance company may pay you a surrender value. This amount is usually much lower than what you would get from a life settlement.
  • Accelerated death benefit: Some life insurance policies let you access part of the death benefit early if you are diagnosed with a serious illness. This is not a sale, but more like a loan against your coverage.

Each of the options above works in different situations. However, a life settlement usually delivers the highest value when you simply no longer want or need a life insurance policy.

By

Medicare Fraud Alert

Medicare related fraud is on the rise.

According to the Department of Health and Human Services, over $100 billion was lost to “improper payments” across the Medicare and Medicaid programs in 2023.  It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes. The FBI is the primary agency for investigating health care fraud for both federal and private insurance programs.

Medicare beneficiaries are often targets of scams designed to acquire personal information that can be used to impersonate you and steal your money. Besides medical identity theft there are several other forms of Medicare fraud. Some examples are:

  • Ambulance Fraud – Medicare will cover an ambulance ride to the hospital to diagnose or treat symptoms of an illness in an emergency. However, Medicare will not cover the cost of an ambulance if the reason for using the ambulance is not medically necessary, meaning the ride is not to treat or identify an illness. It will also not be covered by Medicare if other forms of transportation can move you safely or if it is for a ride to your doctor’s office, a community mental health center, or other health care appointments.
  • COVID-19 Fraud – As the COVID-19 Public Health Emergency comes to an end, fraudsters are still attempting to bill Medicare for sham tests or treatments and are targeting individuals to illegally obtain money or Medicare numbers.
  • Durable Medical Equipment Fraud – Durable medical equipment (DME) and orthotics companies offer a valuable service by providing wheelchairs, surgical supplies, catheters, and respiratory nebulizers as well as nutrition and tube feeding supplies and other health care equipment. DME and/or orthotics are considered medical equipment prescribed by your doctor that can withstand repeated use, serve a medical purpose, and can be used in the home. However, many fraudulent companies across the country are charging Medicare beneficiaries for this equipment without showing the medical necessity and sometimes without even sending the equipment to the beneficiaries.
  • Genetic Testing Fraud – Scammers are offering Medicare beneficiaries cheek swabs for genetic testing to obtain their Medicare information for fraudulent billing purposes or possibly medical identity theft. Genetic testing fraud occurs when Medicare is billed for a test or screening that was not medically necessary and/or was not ordered by a beneficiary’s treating physician. Here are several ways genetic testing is advertised:
  • Cancer screening/test             
  • DNA screening/test
  • Hereditary cancer screening/test
  • Dementia screening/test
  • Pharmacogenetics (medication metabolization)
  • Parkinson’s screening/test
  • Hospice Fraud – Hospice is an important benefit for the Medicare population. Hospice fraud threatens this benefit for all beneficiaries. Scammers are getting beneficiaries to agree to hospice care even though they do not qualify for the benefit. Hospice fraud occurs when Medicare Part A is falsely billed for any level of hospice care or service.
  • Nursing Home Fraud – Medicare doesn’t generally pay for long-term nursing home care. However, Medicare Part A covers medically necessary, short-term care in a skilled nursing facility (SNF) within a nursing home under certain conditions. SNFs play a crucial role in providing therapy and rehabilitation after you or a loved one has suffered a debilitating illness or stroke. After a qualifying stay in the hospital, Medicare beneficiaries frequently need some time in a SNF to regain their strength. However, some unscrupulous facilities (even some associated with national chains) have engaged in fraudulent billing.
  • Outpatient Mental Healthcare Fraud – Medicare Part B covers outpatient mental health services in places such as a doctor’s office or other health care provider’s office, a hospital outpatient office, or a community mental health center. Medicare only covers visits when provided by a health care provider who accepts the Medicare-approved amount as full payment for any covered service provided.  Some examples of this type of fraud are:
  • You were picked up by bus or van along with other beneficiaries and taken out for a meal and Medicare is billed for a mental health evaluation.
  • You spend all day watching TV or playing games at a facility and Medicare is billed for group therapy.
  • You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for mental health services:
  • With time spent listed as more than what you received
  • That you did not receive
  • That were not provided in a health care office or by a licensed professional such as a psychiatrist, psychologist, social worker, nurse specialist, or nurse practitioner
  • Pharmacy and Prescription Drug Fraud – Medicare drug coverage (Part D) helps cover the cost of prescription drugs; some prescriptions are also covered under Part B. Pharmacy and prescription drug fraud schemes can happen in both. A common scheme is if someone’s Medicare plan was billed for medication that was not received, or if they were given a different drug than the medical provider ordered.
  • Telehealth Fraud – Medicare covers telehealth services (also known as teledoc services or telemedicine). This could include medical appointments, therapy, consultations, and other medical or health services. These services are provided through an interactive, live, two-way communication system with audio and video. Criminals are using telehealth services to steal from beneficiaries and the Medicare program.
  • Medicare Marketing Violations and Misleading Marketing – Health insurance companies try to reach people in various ways, like television commercials, radio ads, events, mailings, phone calls, and texts. The Centers for Medicare & Medicaid Services (CMS) has rules for marketing Medicare Advantage plans and Part D plans, though. These rules protect Medicare beneficiaries from aggressive or misleading marketing.  For example, without your permission marketers are forbidden to call or text you.

It’s important to know the signs of a Medicare scam so you can protect yourself.  To get your personal information, like your Medicare number, scammers may call, text and email saying things like:

  • “You need to activate or renew your Medicare card”.
  • “We’d like to send you a free genetic testing kit”.
  • “Medicare has authorized us to send you a free (knee, back or elbow brace)”.
  • “You qualify for a refund on your Medicare costs”.

Remember, never give your Medicare card or number to anyone except your doctor or people you know should have it.  And keep in mind that caller IDs and email addresses can be faked, so if you’re not sure who’s calling, call Medicare at 1-800-633-4227, and remember, Medicare will never contact you unless you have contacted them first.

Reduce your risk by:

  • Only share your Medicare and Social Security numbers with people you trust.
  • Carry your Medicare card only when you need it.
  • Keep a record of all your medical visits and procedures.
  • Carefully review Medicare statements for mistakes and charges you don’t recognize.
  • Trust your instincts and report any suspected fraud.
  • Ask for help – If you have questions about how to protect yourself, need to report fraud, or want help determining whether you’ve been a victim, Senior Medicare Patrol (SMP) can help.  SMP provides free, unbiased, one-on-one assistance to Medicare beneficiaries, their families, and caregivers.  SMP has offices in all 50 states. You can find your local SMP at https://smpresource.org/