Finally a Seriously Decent Dental Plan for Individuals, Sole Props & Small Biz

   USA+ Ameritas DENTAL CARE Insurance 

UPDATE 2015 - AMERITAS DENTAL CARE PLAN NO LONGER AVAILABLE IN NY STATE. I CAN HELP MY CLIENTS WITH THIS PLAN IN PA, NJ, CONN & GA.

               Call or email and I can tell you all about it. Robin Alexander-917.406.8714                                                       Robin@RobinAlexander.com

Sold under the name USA+ Ameritas Group (United Service Association). You receive the benefits and costs of large group coverage as an individual. (Think AAA or Union Plans)

Check out this video for a quick overview:  http://player.vimeo.com/video/82391754

How does this plan stack up against the popular AARP Dental Plan? See for yourself

PLAN BENEFIT DESCRIPTION	AARP - PPO Plan B Monthly Premium  Individual:  $47.76 2 people    $93.97 3 + $133.53	AARP - PPO Plan A Monthly Premium  Individual:  $67.51 2 people:  $133.44 3 +$202.90	AMERITAS DENTALCARE 1st Year Monthly Premium  Individual:  $69.00 2 people    $99.00 3 + $139.00	AMERITAS DENTALCARE 2nd , 3rd, 4th Year, etc Monthly Premium  Indiv:  $69.00 2 people    $99.00 3 + $139.00
Deductible per calendar year per person	$100	$50, waived on Diagnostic and Preventive	$70	$70
Maximum per calendar year per person	$1,000	$1,500	$2,500	2nd Yr: $2,900* 3rd Yr: $3,300* 4th Yr: $3,900*
	You Pay	You Pay	You Pay	You Pay
Office visit	20%	0%	20%	0%
Exams	20%, 3 per Calendar Year	0%, 3 per Cal Year	20%	0%
X-rays	20%	0%	40%	0%
Cleanings	20%, 3 per Calendar Year	0%, 3 per Cal Year	20%	0%
Fillings	50%	50%	75%	25%
Root canals   (Endontic Services)	50%	50%	90%	60%
Gum treatment (Periodontic Services)	50%	50%	90%	60%
Extractions       (Oral Surgery)	50%	50%	75%	25%
Denture repair	50%	20%	75%	25%
Crowns	50%	50%	90%	60%
Orthodontics	Not a covered benefit	Not a covered benefit	Not a covered benefit	Not a covered benefit

*AMERITAS DENTALCARE has a “Reward” program for members who take care of their teeth and use a portion of their annual maximum benefits. With this increasing maximum feature, each member/dependent earns additional money towards their next  year annual max all the way up to year 4. Here’s how it works:                                                                                                                               1) Visit your Dentist during the year.

2) Submit claim for payment prior to April 1st                                                                                                 3) Total benefits paid for current year visits musrent year visits must be less than  $750

* If you meet all 3 requirements you will have an additional $400 available in Annual Maximum for the next year.                                                                                            

** In future years, if you have benefits paid of less than $750, additional amounts of $400 will be added to  the carryover amount.                                                    

***Your annual maximum caps out at $3700 in four years just for visiting the dentist at least once a year and having no more than $750 of work done.       

THIS PLAN HAS AN "ALL DENTIST NETWORK" ANY DENTIST WILL OFFER REDUCED FEES. GO TO AN AMERITAS DENTIST (65,000 DENTISTS IN THE NETWORK) AND SAVE SIGNIFICANTLY MORE 

              Call or email and I can tell you all about it. Robin Alexander-917.406.8714                                                       Robin@RobinAlexander.com  

My Advocate helps you find healthcare programs and savings which you deserve. Sign up today for free.

https://www.myadvocatehelps.com/

My Advocate

formerly Social Service Coordinators, is a set of three different programs designed to assist members with health care costs and other potential financial and social challenges: Low Income Subsidy (LIS), Medicare Savings Program, and Golden Touch.

• Low Income Subsidy (LIS) is available for Part D premium, Part D deductible, Part D  copayments.
• The Medicare Savings Program (MSP) is similar to state Medicaid and covers Part B premium ($104.90/month in 2014), Part B deductible ($147 in 2014) and Parts A and B cost sharing.
• Golden Touch is a collection of financial assistance and other community-based programs. Golden Touch Advocates have access to over 7,000 different national and local programs to offer individuals.

As a Licensed, certified Medicare Product Specialist, I can help members and consumers understand if My Advocate is a good fit for their needs. Many Americans are eligible for, but not enrolled into, social service programs that can improve quality of life and lower cost of care. Members and consumers might not know that they are eligible for My Advocate, which may offer valuable assistance in their health care needs. This is where I come in – as your agent I can help you learn more and understand if the My Advocate Program is a good fit.

 

Talk to you soon!

 

Robin Alexander
Licensed Medicare Agent
9701 Shore Road | Suite 1C | Brooklyn, NY 11209
p. 917.406.8714 | f. 718.374.5358
email: robin@robinalexander.com
http://robinalexandermedicare.blogspot.com/

The greatest compliment you can give me is a referral.
Please feel free to pass along my contact information!

 

 

 

 

Health Care Nightmares

APRIL 10, 2014

NYT OP-ED

Paul Krugman

 

 

When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.

Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.

But while Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.

Let’s start with the good news about reform, which keeps coming in. First, there was the amazing come-from-behind surge in enrollments. Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage. Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress.

But wait: What about all the people who lost their policies thanks to Obamacare? The answer is that this looks more than ever like a relatively small issue hyped by right-wing propaganda. RAND finds that fewer than a million people who previously had individual insurance became uninsured — and many of those transitions, one guesses, had nothing to do with Obamacare. It’s worth noting that, so far, not one of the supposed horror stories touted in Koch-backed anti-reform advertisements has stood up to scrutiny, suggesting that real horror stories are rare.

It will be months before we have a full picture, but it’s clear that the number of uninsured Americans has already dropped significantly — not least in Mr. McConnell’s home state. It appears that around 40 percent of Kentucky’s uninsured population has already gained coverage, and we can expect a lot more people to sign up next year.

Republicans clearly have no idea how to respond to these developments. They can’t offer any real alternative to Obamacare, because you can’t achieve the good stuff in the Affordable Care Act, like coverage for people with pre-existing medical conditions, without also including the stuff they hate, the requirement that everyone buy insurance and the subsidies that make that requirement possible. Their political strategy has been to talk vaguely about replacing reform while waiting for its inevitable collapse. And what if reform doesn’t collapse? They have no idea what to do.

At the state level, however, Republican governors and legislators are still in a position to block the act’s expansion of Medicaid, denying health care to millions of vulnerable Americans. And they have seized that opportunity with gusto: Most Republican-controlled states, totaling half the nation, have rejected Medicaid expansion. And it shows. The number of uninsured Americans is dropping much faster in states accepting Medicaid expansion than in states rejecting it.

What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.

And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.

But nobody expects to see a lot of prominent Republicans declaring that rejecting Medicaid expansion is wrong, that caring for Americans in need is more important than scoring political points against the Obama administration. As I said, there’s an extraordinary ugliness of spirit abroad in today’s America, which health reform has brought out into the open.

And that revelation, not reform itself — which is going pretty well — is the real Obamacare nightmare.

 

 

A version of this op-ed appears in print on April 11, 2014, on page A27 of the New York edition with the headline: Health Care Nightmares

Still Smoking? Read this - there's help out there with Medicare.

According to a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC) earlier this year, the rate of new lung cancer cases in the United States decreased from 2005 to 2009. Specifically, the study found that new rates of lung cancer went down 2.6 percent each year among men, and 1.1 percent each year among women. The study also found that the fastest drop in new lung cancer rates occurred among adults ages 35-44 years old. The study used data from the used 2005-2009 data from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. According to the report’s press release, smoking continues to be the leading cause of preventable death and disease in the United States. The press release quotes CDC Director, Dr. Tom Frieden, who said that “while it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many.” He goes on to say, “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.” In general, Medicare covers two counseling attempts each year to help you quit smoking. Each attempt includes four sessions, meaning Medicare covers a total of eight counseling sessions every 12 months to help you quit smoking. Click here to read more about Medicare coverage of counseling sessions to help you quit smoking. Click here to read the entire press release on the CDC report.

Medicare Drug Restriction? Don't take "No" for an answer.

			Volume 13 Issue 6 • March 24, 2014
What is a coverage restriction?	Dear Marci, I went to the pharmacy to pick up a new medication, but my pharmacist told me that there is a coverage restriction on the drug I need. What is a coverage restriction?  - Chuck (Staten Island, NY) Dear Chuck, A coverage restriction is a restriction that Medicare prescription drug plans, also known as Medicare Part D plans, place on certain covered drugs to limit use of that drug. In other words, while a drug may be covered by your Part D plan, your plan may not pay for a drug you need if it has a coverage restriction.There are three types of coverage restrictions: Prior authorization is a type of coverage restriction that requires you to get prior approval from your Part D plan, before your plan will pay for a prescription drug you need.  Quantity limit is a type of coverage restriction that limits you to a specific amount of a medication over a certain period of time. For example, let’s say your Part D plan only covers 30 pills of Drug X in one month. If you need 40 pills of Drug X in one month, your prescription may be denied. As such, you will most likely need to request that your Part D plan make an exception to its quantity limit.   Step therapy is a type of coverage restriction that requires you to try other, usually cheaper drugs that treat your medical condition, before your Part D plan will cover the drug that your doctor originally prescribed. If you aren’t able to get your drug at the pharmacy because of a coverage restriction, your pharmacist should give you a notice called, Medicare Prescription Drug Coverage and Your Rights. This is a notice that explains the process of contacting your Part D plan to request coverage of the drug you need. Keep in mind that this is simply an educational notice that provides you with very general information on the first steps of the appeal process. This is important to know, since you generally need to receive a written, formal denial notice from your Part D plan in order to begin the appeal process. The Medicare Prescription Drug Coverage and Your Rights notice is not a formal denial from your Part D plan. However, you should still read it for your own understanding. If your pharmacist told you that your Medicare Part D plan will not cover the drug you need, you should contact your Part D plan directly. It’s helpful to do this to find out why your Part D plan is not covering the drug you need. If the denial is due to an administrative error, it should be resolved when you call your plan. Remember to write down the date and time in which you call, the name of the Part D plan agent you speak to, and the outcome of your call. If your Part D plan is denying your drug because of a coverage restriction, contact your doctor to see if another unrestricted drug covered by your Part D plan will work for you. If your doctor cannot prescribe a different drug, ask your doctor to help you file a formal request to your Part D plan so that you can try to override the coverage restriction. This is called filing an exception request. It may also be referred to as filing a coverage determination. Filing an exception request with your Part D plan is the step you take before you can file an appeal. While plans generally provide decisions on exception requests within 72 hours, you and your doctor can request that your plan make a quicker (expedited) decision to your exception request in 24 hours if your health would be harmed by waiting the standard 72 hours for a plan decision. Keep in mind that you can file an exception request with your Medicare Part D plan, whether you get Medicare Part D through a stand-alone Part D plan that works with Original Medicare or through a Medicare Advantage Prescription Drug Plan, also known as a Medicare private health plan that provides you with Medicare prescription drug coverage. Click here to use a Medicare Interactive Roadmap that can help walk you through the necessary steps of appealing a Part D drug denial. Click here for information on the Medicare Part D appeal process. -Marci
	According to a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC) earlier this year, the rate of new lung cancer cases in the United States decreased from 2005 to 2009. Specifically, the study found that new rates of lung cancer went down 2.6 percent each year among men, and 1.1 percent each year among women. The study also found that the fastest drop in new lung cancer rates occurred among adults ages 35-44 years old. The study used data from the used 2005-2009 data from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. According to the report’s press release, smoking continues to be the leading cause of preventable death and disease in the United States. The press release quotes CDC Director, Dr. Tom Frieden, who said that “while it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many.” He goes on to say, “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.” In general, Medicare covers two counseling attempts each year to help you quit smoking. Each attempt includes four sessions, meaning Medicare covers a total of eight counseling sessions every 12 months to help you quit smoking. Click here to read more about Medicare coverage of counseling sessions to help you quit smoking. Click here to read the entire press release on the CDC report.
	Medicare Interactive, a online resource developed and maintained by the Medicare Rights Center, can help you find easy-to-understand answers to your Medicare questions. Check out Medicare Interactive’s newly redesigned appeals section. The appeals section reviews how to appeal any Medicare health or drug denial. Remember, you have the right to appeal if you disagree with Medicare or your plan’s coverage decision on a health care service or item you need.
For reprint rights, please contact Mitchell Clark. Privacy Policy: Medicare Rights will never share your e-mails address with a third party. Contents are © 2014 by Medicare Rights Center, 520 Eighth Avenue, North Wing, 3rd Floor, New York, NY Join us on:		The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives. Donate to support free resources like Dear Marci.
Dear Marci is a biweekly e-newsletter designed to keep you -- people with Medicare, social workers, health care providers and other professionals -- in the loop about health care benefits, rights and options for older Americans and people with disabilities.

---

 

This email was sent to robin@robinalexander.com. You are receiving this email because you are registered with Medicare Rights Center to receive this mailing. To opt-out or change your subscription preferences please do not reply to this email since it will only delay your request. Instead, please click the link below to process your subscription and opt-out requests. Update your newsletter subscriptions Thanks, Medicare Rights Center 520 Eighth Avenue, North Wing, 3rd Floor New York, NY 10018 USA

White House budget proposal targets Social Security benefits

White House budget proposal targets Social Security benefits

Have Medicare? Keep it. The MarketPlace Exchange Plans are for those who don't. Confused? Just give me a call.

MedicareRights.org   Dear Marci, I have a Medicare Advantage plan, but I’ve heard that I can buy a health insurance plan with better coverage in the Marketplace. Should I drop my Medicare Advantage plan and buy a health insurance plan in the Marketplace? – Luiz (Norwalk, CA)   Dear Luiz, No. If you have Medicare, you should not buy health insurance plans through the Health Insurance Marketplace.This is true, whether you get your Medicare benefits through Original Medicare, the traditional Medicare program directly administered by the federal government, or through a Medicare Advantage plan, which is Medicare coverage offered through a private insurance company. Health Insurance Marketplaces, also known as Health Insurance Exchanges, were created under the Affordable Care Act (sometimes called “Obamacare”) as a way for people who are uninsured or underinsured to compare and purchase health insurance plans. Keep in mind that Marketplaces may have different names, depending on which state you live in. For example, the California Marketplace is called Covered California, while the New York Marketplace is called the New York State of Health. Again, the important thing to know is that people who have Medicare should not drop their Medicare coverage and sign up for a Marketplace plan. If you have Medicare, your Medicare benefits will not change as a result of the Market- places. In addition, insurance agents and brokers are not allowed to sell you Marketplace health insurance plans if they know you have Medicare. Another thing to keep in mind is that the Marketplace is not a way for you to get Medicare coverage. You cannot get Medicare coverage, such as Original Medicare or Medicare Advantage plans, in the Marketplace. Medigap plans, also known as supplemental insurance plans that helps pay Original Medicare costs, will not be sold through the Marketplace. Similarly,  Medicare prescription drug plans, also known as Medicare Part D plans, will not be sold through the Marketplace. Lastly, keep in mind that there are some consequences that may occur if you drop your Medicare coverage and somehow mistakenly sign up for a health insurance plan in the Marketplace. If you drop your Medicare coverage, you  will most likely have to pay a premium penalty if you enroll in Medicare again in the future. In addition, you will likely have to wait until a specific enrollment period to sign up for Medicare and may therefore, experience gaps  in health coverage. Remember, it’s best to speak to a Social Security Administration agent anytime you decide to drop your Medicare coverage. You can contact Social Security by calling 800-772-1213 or by going to your local Social Security office. Be sure to record the time and date of your conversation, who you spoke to and the outcome of your conversation. For information about your Medicare benefits, contact 800-MEDICARE or go online and visit www.medicare.gov. Click here for more information on Medicare and the Marketplaces. -Marci   http://www.medicarerights.org/resources/newsletters/dear-marci/