Insurance Audit Information

FOR A BETTER INSURANCE EXPERIENCE…

Do yourself a favor and KNOW your insurance coverage. Not being fully informed can cost you hundreds if not thousands of dollars.

TO REDUCE INSURANCE PROBLEMS and MISUNDERSTANDINGS:

1. Have a copy of your insurance’s formulary.

What is a Formulary?

A formulary is a list of all the medication your insurance will help you pay for. This list does change over time, so make sure to have the most up to date edition. On a formulary, the amount you’re expected to pay is your co-pay.

Most insurance formularies are in levels or tiers.

EX: Tier 1 Generic Medication

Tier 2 Preffered Medication (Brand)

Tier 3 Non Preffered Brand Medication

Price generally escalates with increasing Tier position.

Also note that Tier 2 and 3 are both brand name medication. That is, there may be more than one brand name medication for the same condition. Your insurance may have a prefference.

So…

Ask your insurance to mail you a copy of your current formulary. You can also ask your insurance carrier where you can find a copy of your formulary online. If you have more than one insurance carrier, make sure you have access to each individual one.

ALWAYS go with a copy of your formulary to your Dr.’s office, or leave it with them. It will save you a potential headache and surprise at the pharmacy.

WHAT IF A MEDICATION IS NOT ON THE FORMULARY?

Don’t give up yet!! You can ask your Dr. directly, or your Pharmacy to conduct a Prior Authorization for you.

What is a Prior Authorization?

Usually in reference to non-formulary medication, but can also refer to non-formulary directions – For example your insurance carrier may only cover 30 pills of a medication within a 30 day period, but your Dr. prescribes it for twice a day (60 pills within 30 days).

If your doctor prescribes a drug that requires prior authorization for coverage, ask your doctor to call the number on your Prescription Insurance card to begin the authorization process. Your doctor’s office must complete a prior authorization form or call your Insurance at the number on your card to provide the necessary information.

And lastly, some insurance plans have preffered pharmacies. So make sure that your regular pharmacy is a participating pharmacy. This is usually not a big deal especially in regards to most retail pharmacies, but to be safe, call your insurance company to make sure. Getting medication filled at a non-participating pharmacy will cost you more!

For more Pharmacy Related Questions, please visit cvscustomers.com

The important information that you should know before you start reading this page: Medicare does not cover the whole cost of healthcare desired by mature adults. It takes care of few things like ingoing hospital costs and the related expenses that come with it. This is the reason to think about a supplementary plan that may help you in the time of emergency. Medicare supplement insurances are planned to help you this way.

Now, as a citizen of California, you may know the survey report that says: it was 157% increase of mature adults (defined as 60 years or older people) in 1950-1990 in California.  In 2010, it would come in a 1:5 ratio e.g. one mature adult in each 5 Californians. It is the expectation that the percentage would be increased about 232% by 2040. It means 12.5 million people would be mature adult on 2040 in California. What would be the scenario of Medical supplement insurance by that time in California? Everybody would have run for the best Medicare supplement plan which would seem like a challenge. To get rid of this challenge, try to manage Medigap California now!

It’s time to know few things that would help to set your mind and decide to choose the best Medicare supplement insurance for you. It may cause a disappointment that California government does not play a direct role to solve out the problem yet. There is no governmental practice to help on Medicare supplement plans. However, you would find ample of Medicare supplement insurance companies who have hold a good package. Do not hurry but take your time to compare between all the Medicare supplement insurance companies to find out the best one for you.

The first thing you can do is to contact with the agents of the companies to learn about their schemes. It would be easier if you can understand the attitude of the agent properly to understand the market position of the company from whom you are going to by your Medigap California. If the agent takes time to reply you about their schemes or cannot clear up everything properly do not go for the company. Avoid those who ask you to find out the details from their web pages. Try not to be involved with those who have a complicated procedure. Choose the agent who has a clear vision on the matter with a simple procedure and provide you the quote of the Medicare supplement plans of the company quickly with his/her telephone no and email address.

If you are done with this much it would be easier to do the rest. Go through all the Medicare supplement plans of the company. If you cannot decide alone you may take help of the adviser of the social welfare group of your locality. They may help you to compare Medicare supplement plans of the company to choose the best Medicare supplement plan for you. You do not have to be bother for your future anymore; Medigap California is there to take care of the rest.

In social functions, I always get asked about the new Medicare nursing home qualifications. Seniors become very anxious about having to spend-down their assets with no cap on the amount that they can keep. This unlimited drain on their funds is of major concern to the healthy spouse, and because the sick spouse can’t do anything about getting sick, they become more and more depressed. These folks are of the World War II generation and the market crash of 1929 mentality. If you don’t have the cash you don’t buy it. Most of them got a credit card only because they had to pay their prescriptions over the mail.

Their health and well-being depends on knowing that they can tap into their resources to get what they need or when their grandkids come to visit they want to reward their visit with a few bucks. My mother is of this vintage, and I know that when my kids drop in for a visit, it makes her day. She wants to give them something in return, not because it’s an enticement to come back, but she doesn’t get out enough visits and she values their time, especially in this day of instant gratification with Ipods, Internet, cell phones, video, etc. and because they valued their grandmother more.

So, how can I hide my assets from Medicare is relevant to their lives. My answer is that if they did not do something as far back as five years ago, chances are that trying to do something now, could very well be considered a fraudulent conveyance in order to defraud a potential creditor. For example, if they were to put their son or daughter on the deed of the house without adequate consideration, it would be considered a” fraudulent conveyance” because they did it for less than the fair market value, they received nothing back in return. Or, if they did recognize that they gave away the house to their children it was a taxable gift and taxes are due on the transferor (the person giving the gift has to pay the tax, the person receiving the gift is always after taxes). But like many people they don’t think it through in terms of filing of a gift tax return or fraudulent conveyance. They just do it for their convenience.

The new Medicaid spend down provisions are very restrictive. The intention is that if you (the elderly) have assets, before you qualify for nursing home assistance, they want you to become a welfare recipient. And that’s what seniors are afraid to become. Their generation never asked for assistance if they had a strong back, they worked for their dignity. They don’t want to become “welfare recipients” it a very humiliating concept to them.

Most common mistakes committed by seniors when trying to hide their assets:

1.Naming their children as (Parent’s name “and” Child ’s name) (Parent name “or” Child’s name) on their savings, checking, investment accounts, or near cash accounts. THIS IS NOT A GOOD IDEA. Too much risk, what if child gets sued, or divorced, or worse dies. You open a new can of worms.

2.Give the house to the children. You name one or more of the children. Again not a good idea. What if the children get sued, divorced, or prematurely dies. There’s too much risk.

3.Cash under the mattress, in between the walls, in the basement, etc. Well it works, but unless you tell someone the hiding place, then what? Or, leave the cash to lose interest or depreciate with inflation?

In God we Trust.

Trusts are the most common and useful legal devices. An “Irrevocable Trust” works best for hiding your assets. Your assets are RE-POSITIONED from you to an irrevocable trust. You “legally” no longer own the assets. This involves the actual transfer of assets to an independent trustee who will independently manage and actually own the assets for the benefit of all beneficiaries. This type of control over assets is not new, it goes back to medieval times when landlords went off to the crusades and left their lands in trust of monks for when they returned. There are specific laws and it’s generally accepted by the judicial system as a legal, acceptable method of protecting one’s assets for legal protection and tax minimization.