Healthy Concepts
John Ulness

John Ulness

John Ulness is co-owner of Ulness Health Insurance & Wellness in Appleton. He helps people in Wisconsin understand their health insurance options to control costs and enroll. He can be reached at 1-800-386-0876 or [email protected]

Wednesday, 30 May 2018 21:21

Many Medicare options

Medicare is a government health insurance program for everyone 65 and older that was signed into law by President Lyndon B. Johnson in 1965. Medicare has evolved over the past 50+ years to offer some really great plan options for Medicare beneficiaries to choose from.

When people call, email or meet with us we try to make Medicare simple and easy to understand. Medicare can be confusing because of the different terms used to define it. There are also many individual considerations in the decision-making process, such as early retirement, income levels, working past age 65, travel, choice of providers and prescription medicines.

Original Medicare, sometimes referred to as Traditional Medicare, has two parts that are essential for everyone to have before they can purchase a Medicare Supplement or Medicare Advantage plan: Part A is for hospital coverage and Part B is for medical coverage. Part A is for when you are admitted to a hospital (in-patient) or need rehab in a skilled nursing facility. Part B is for medical services like doctor visits, ambulance, tests and outpatient services performed in the hospital.

Below are three basic plan options for receiving your Medicare benefits

1. Medicare Part A and B alone is one option, but not recommended because of the potential unlimited out-of-pocket costs. Part A and Part B have no limit on what you pay. If you had a $100,000 bill for cancer treatment, you would pay approximately 20 percent, or $20,000. The bigger the bill, the more you pay. Due to higher cost treatments, you probably do not want a plan with unlimited out-of-pocket expenses, when you can purchase a plan that limits what you may have to pay.

2. Medicare Supplement is a good option to buy from a private insurance company. It pays the deductibles and co-insurance that Medicare Part A and Part B does not cover. These plans start at about $100 per month with great coverage. Monthly premiums increase each year due to age and medical inflation.

3. Medicare Part C (Choice), also known as Medicare Advantage, is another option for Medicare beneficiaries with Part A and Part B. The advantage of these plans is the low-cost premium and extra benefits to stay healthy. You pay a set co-pay or co-insurance amount when you receive hospital and medical services with an annual limit. Part C plans are not age rated, so everyone pays the same monthly premium.

Medicare Part D plans for prescription drug coverage can be purchased from private insurance companies as a stand-alone product or Part D coverage can be included with a Part C plan.

There are many great Medicare plan options for receiving your Medicare benefits, so consider all your choices to find the one that works best for you! 

Tuesday, 01 May 2018 00:49

The birthday gift of health insurance

We all look forward to birthdays, especially when we are younger. You never forget starting school at age five, getting a driver’s license at 16, and voting for the first time after your 18th birthday. Each birthday brings new opportunities to learn, grow and take charge of our lives as we prepare for our future.

Birthdays at ages 26 and 65, or an early retirement age, can have a big impact on our health insurance.

Up to age 26, dependents may stay on their parents’ health insurance plan. You can be married and living on your own, but remain on your parents’ plan. Once your 26th birthdate month comes along, you have a special enrollment period (SEP) to get your own health insurance.

When making that transition, you should get expert help to learn about monthly premiums, provider networks, drug formularies, health savings accounts, direct primary care and out-of-pocket expenses.

Buying health insurance is another example of how we can take charge of our lives for good health, protection against risk and saving money.

The next big birthday for health insurance is becoming eligible for Medicare at age 65.

The 1st of the month of your 65th birthday is the day you can or must transition to Medicare. The decision to enroll into Medicare can be different for everyone.

If you are working and have a qualified employer group health insurance plan, you do not need to enroll into Medicare, but once you stop working you have to take Medicare Part A and B or face a penalty. There are several exceptions to this, so you should work with an expert to make sure you get enrolled at the right time and avoid potential penalties.

Early retirees can really be any age, but are more likely starting at age 59½ when you can draw retirement funds without penalty, or age 62 when you can first apply for Social Security benefits. Whatever your age before 65, your household income may impact your health insurance premium due to tax credits.

Early retirees with incomes below $47,000 for an individual, and $64,000 for a couple, receive advanced premium tax credits that lower the monthly premium. Strategies to stay below these income levels can be successful, but take some advanced planning and consultation with your insurance broker and accountant.

Getting help with insurance gives you peace of mind, and allows you to truly enjoy your 26th, 65th and all the birthdays in between.

Tuesday, 27 March 2018 03:28

Health care consumers want

For years, the troubling trend of consumers spending more and insurance paying less for everyday health care expenses has continued. The health care consumer feels bound to the traditional health care model, with no choice but to stomach the increased costs.

This trend, however, can only go so far before the consumer demands better value and a choice in how their health care is delivered. This choice will inevitably change health care and insurance to lower cost.

Here are five examples of how companies and organizations are bringing competition and choice to health care and insurance, preparing for a future in which these marketplaces are centered on what the consumer wants and needs.

  1. On Jan. 30, 2018, CEOs Jamie Dimon of JP Morgan Chase, Jeff Bezos of Amazon and Warren Buffet announced the three companies are forming a separate company to produce “simplified, high-quality and transparent health care at a reasonable cost” for their combined 1.2 million employees. In the press release announcing the initiative, Warren Buffet of Berkshire Hathaway, the world’s third richest person, called rising health care costs a “hungry tapeworm on the American economy.”
  2. On Dec. 3, 2017, CVS Health announced its $69 billion acquisition of Aetna. CVS CEO Larry Menlo, who pulled tobacco products from all CVS stores 2014, is planning dramatic changes to make CVS’s 10,000 community retail pharmacies the convenient places consumers will go to get healthy.
  3. On Dec. 5, 2017, Nestlé, the world’s largest food and beverage company, announced its $2.3 billion acquisition of Atrium Innovations, a global leader in nutritional health products. Nestlé is seeing reduced sales of processed and packaged food and is seeking to increase its focus on nutrition, health and wellness. As a result of the acquisition, consumers can expect greater access to Atrium Innovations’ science-based, nutritional products and brands including AOV, Garden of Life, Douglas Laboratories, Pure Encapsulations, Genestra Brands, Klean Athlete, Minami Nutrition, Orthica, Pharmax, Trophic and Wobenzym.
  4. In January of 2018, Apple announced a new health record software product that gives consumers greater access to their health information. A beta test is in the works with 12 leading hospital systems. The goal is for consumers to have health record control and collaboration with any provider, anytime and anywhere.
  5. Back in 1989, Dr. Jeffrey Bland gathered health leaders to look at what health care would look like in the future. His group determined health care of the future would move away from simply treating symptoms, and look more at cause or body function to prevent and reverse disease. As a result, the Institute of Functional Medicine was founded with these principles in mind. In 2016, the Cleveland Clinic hospital added a Functional Medicine clinic and they currently have a consumer demand of 2,700 patients waiting to get in.

Given a choice, consumers will choose the best care and coverage at the best cost, and, more importantly, drive needed change to health care and insurance. Companies are preparing for a future in which the consumer has more choice. Change is coming.

Health insurance planning in retirement begins for many of us as we approach age 65. This is also true if we want to keep working.

At age 65, we are entitled to Medicare, a government sponsored health insurance program that has been around since July 1, 1966. Medicare Part A Hospital insurance, and Medicare Part B Medical insurance can offer you better benefits at lower cost.

Your decision to enroll into Medicare at 65 is separate from electing your Social Security benefits. For example, you can get Medicare at age 65 and continue to work without electing Social Security benefits.

When To Enroll

You can enroll into Medicare Parts A and B three months before your 65th birthdate month and your coverage would begin the first of the month you turn 65.

What Does It Cost?

If you or your spouse worked and paid into Social Security and Medicare for 40 quarters, or 10 years, the Medicare Part A Hospital insurance cost has always been zero or no cost. The cost or premium for Medicare Part B Medical insurance has increased from $3 per month in 1966 to the current cost of $134/month. Your Part B premium can cost $187.50 to $428 if you are a higher income earner (>$85,000 single or >$170,000 couple) under Income Related Monthly Adjustment Amount. Since 2011, the IRMAA requires higher income earners to pay higher monthly premiums for Medicare Parts B and D.

Part D Drug Coverage

In 2006, Medicare added Part D for prescription drug coverage. Part D plans are supported by the government, but purchased from private insurance companies. Part D premiums start at about $20 per month in 2018. The Part D IRMAA adds $13.30 to $74.80 to your monthly Part D premium.

Part C Plans

Medicare offers you great coverage with many options and protections. With your enrollment into Part A and B, you also have an option to buy a Medicare Part C plan. These private plans, also known as “Choice” or “Advantage” plans, are government contracted to provide you your Part A and B benefits. Many Part C plans also include Part D for drug coverage along with extra benefits to keep you well. These plans begin at no extra cost or premium over your Part B monthly premium.

MSA Plans

Another option is a Part C Medicare Medical Savings Account plan. These plans follow the same concept of HSA plans. Any balance left in your MSA savings rolls over each year.

If your employer group medical plan costs you more than $134/month, you would want to take a look at your Medicare options to see if you can get better coverage at lower cost from your new entitled Medicare benefits at age 65. 

Wednesday, 31 January 2018 20:52

Are you asking your doctor the right questions?

Consumers are central to the changes needed to control health care and insurance cost, yet health care consumers are rarely asked what they want and need.

Asking the right questions and listening leads to better answers.

Many years ago, there was a consumer survey that asked, “What do you want from your doctor most?” The top four responses were as follows:

  1. Wait fewer than 15 minutes in the waiting area for a scheduled appointment
  2. Doctor help with exercise
  3. Doctor help with food
  4. Doctor help with stress

This is an eye opener for health care providers as they look to provide greater value to patients to achieve better health outcomes. It is also an eye opener for consumers who never thought about directly asking their doctor or health professional for help with everyday lifestyle needs.

While most clinics have gotten very good at scheduling patient appointments, doctor help with fitness, nutrition and stress-relief is limited.

It takes effort from the consumer and doctor, but take a look at what is possible. In 2016 Geisinger Health, an integrated insurance and health care provider in Pennsylvania launched “Fresh Food Farmacy.” It’s a program where doctors prescribe a food program before or in conjunction with prescription medication. In a very short time this program has helped 250 patients, with many getting off medicines and some saving up to 80 percent on medical costs.

To learn more, go to

Use this type of program to ask questions of your doctor and other health professionals on what you can do on your own for better fitness, nutrition and stress-relief.

When you ask the right questions, you will learn about what’s best for you and how to take action.

Could a “Fresh Food Farmacy” approach benefit me?

Friday, 29 December 2017 15:55

Is bigger better?

Two major deals in the health care and insurance industry were announced in December 2017. CVS Health is buying Aetna, a $63 billion insurance company for $69 billion, and Wisconsin’s largest hospital system, Aurora Health Care, is merging with the largest system in Illinois, Advocate Health Care, to form the 10th largest hospital system in the United States. 

The CVS Health Aetna deal will take months to be approved and finalized, but it represents a major shift away from the hospital-doctor-centered delivery system like Aurora and Advocate to a more consumer-centered approach. 

CVS pharmacies will be expanded to include doctor, wellness and insurance services. CVS Health also owns the CVS/Caremark PBM and Silver Script Medicare Part D drug plans.

We will have to wait and see how these mega mergers affect future health care and insurance costs. Amazon, Apple and Google are also working on new technologies and services to address health and cost. 

Ultimately, employer group plans and individual consumers will drive innovation given better opportunities to improve health and lower cost. 

In the meantime, it is important for us to take charge of our health.

Many of the health care professionals in this magazine offer you great health care value as we learn to shop for health care. We encourage you to ask how they can help you in your path to healthy living. And as always, use a licensed health insurance advisor when selecting your health plan. 

In 2018, at the age of 63, the individual monthly health insurance premiums can start at $1,000 per person as shown to the right.

The $12,000 annual premium cost is a big burden, but when you add the potential $7,350 maximum out-of-pocket cost when you need expensive medical care, the total annual cost burden is $19,350.

The current law offers no tax credit or cost-share reduction if you make over $49,000 per year. If you make less than $49,000, you can receive substantial tax credits to lower your monthly premium. Cost-share reductions start below $30,000.

If there is any silver lining in these high costs, it is that more of us as consumers are beginning to realize that it is up to us to reform health care and insurance.

We cannot wait for the government to solve our problem of higher costs. 2018 will be the year that moves us to change as we seek out health care and insurance that offers us better health at lower costs. 


Tuesday, 31 October 2017 16:45

Five basics to know about health insurance

When you buy health insurance, you want to look at five basic items to find the best plan that meets your wants and needs.

1. Premium

You can pay a monthly premium from $0 up to about $1,200 per month. Tax credits based on your household income and other government programs such as Medicare and Medicaid can lower your monthly premium cost. If you have an employer group plan, your employer will pay a large portion of your premium with the balance taken off your paycheck. You always want to know your premium cost options to compare your plan benefits.

2. Out-of-Pocket-Cost

Deductibles, co-insurance and co-pays make up your maximum out-of-pocket (MOOP) costs, or sometimes called your out-of-pocket limit. This is the most you would pay in any given plan year or calendar year. You can see MOOP costs up to $7,150 for one and $14,300 for a family of two or more. As these costs increase, you want to be more aware of your health and ask more questions about medical care benefits and cost.

3. Provider Network

HMO, PPO, POS, EPO and PFFS are all different types of insurance plan options to access providers. Preferred Provider Organizations allow you to see any doctor while the Health Maintenance Organizations require you to see specific providers.

You want to know your cost and access to providers both at home and away to avoid billing surprises.

4. Rx Formulary

A list of covered drugs, at different tier levels, encourages you to use lower cost medicines. If your medicine is not on the formulary, it is not covered.

5. Wellness

More health insurance plans are offering benefits to improve your health. Some of the plan offerings can be free fitness club memberships, health coaches, doctor visits online and by phone, over-the-counter products and devices to track your health improvement. Wellness plan designs can include HSA and MSA plans that offer a savings account for your health care expenses. Your incentive is to eat healthy and be active to reduce your need for expensive medical care. Any money left in your account at the end of the year rolls over to increase your HSA or MSA savings account while your deductible stays the same.

You can get expert help on all this with a licensed health insurance advisor during your annual open enrollment period.

Marketplace OEP is November 1 to December 15.

Medicare OEP is October 15 to December 7.

Employer group plans set their own annual open enrollment period. 

The annual open enrollment period (OEP) is when you can enroll or change your health insurance plan.

Employer group plans have their own OEP dates, but if you have Medicare or buy health insurance on or off the Marketplace, you have a set OEP each year that follows a calendar year.

The 2018 Marketplace OEP is November 1 – December 15.

The Marketplace OEP is shorter this year, and we are expecting a very busy OEP due to the fewer days and more insurance carriers ending their Marketplace place plans. Anthem Blue Cross and Blue Shield and Molina Healthcare are ending their Marketplace plans on 12/31/2017.

If you have an Anthem BCBS or Molina plan, you will need to pick a different company and plan during the 2018 OEP. If your current plan is continuing in 2018, you will be able to review any changes to determine if you want to stay or change. If you have no health insurance, this is your opportunity to enroll.

After you enroll and pay your first month premium, your new plan begins January 1.

2018 plan offerings and prices will be released Wednesday, November 1.

For your convenience, on November 1, you can visit our website at to see 2018 Marketplace plans, prices and tax credits for 2018. Just click on health insurance for Wisconsin and put in your information to view and compare plans, tax credits and prices.

The Medicare 2018 OEP is October 15 – December 7.

It is your opportunity to change or add plans for January 1.

As a current Medicare member of a Part D prescription drug plan or a Medicare Part C (Choice) Advantage plan, you will receive your notice of any changes for 2018. Your annual notice of change (ANOC) letter from your current plan is mailed to you by October 1. It gives you any changes on your current plan by line item for 2018. If you are OK with any changes, your current plan will automatically renew.

Please feel free to call our office to get 2018 plan information on Medicare plans beginning October 1. You can also go to to see schedules for educational and informational meeting opportunities to learn more about 2018 plans. Other insurance agents and companies will be holding meetings that you can attend as well.

You want expert help during the 2018 OEP to avoid any surprises in the New Year. 

Thursday, 31 August 2017 03:08

Who pays?

It happened at 3 a.m. and something that you never expected. But two trips to the hospital emergency room over three days and a $34,000 bill later, the question is what was more painful: the kidney stone or the bill? 

Who would have thought that going to the emergency room could cost that much?

The $34,000 bill was reduced to $19,000 by insurance discounts, but your $5,000 deductible with a $7,150 maximum out-of-pocket (MOOP) limit can put the hurt on anyone.

What should you do when pain hits? 

On the second visit when the ER urologist suggested a procedure of inserting a stent to help remove the stone, your initial reaction is to do it, but what about cost? If you knew the cost was over $30,000, would that change your decision to proceed? Years ago, when you paid less and insurance paid more, this decision would be easy, but not anymore. You want to know your cost, health care benefit and risk. Until you reach your $7,150 limit, you will pay much of the bill. 

Using this example, see what you pay and what insurance pays as follows:

Individual pays

Insurance pays



(Billed charges)

(Insurance discount)



(Approved amount)







(20% co-insurance)

(80% co-insurance)




(Balance due)



(Total you paid) 38%

(Total insurance paid) 62%

Now that you’ve reached your maximum out-of-pocket for the calendar year, your health insurance plan will pay 100 percent of approved medical charges for the rest of the year. Hopefully the kidney stone did not occur in December, because in January your deductible and MOOP start all over again. When pain hits, you want to ask questions about your options to best address the root cause of it at the best cost.

In regard to cost, you want to know your insurance out-of-pocket costs in the form of deductibles, co-insurance and co-pays. It is these costs that make up your annual MOOP limit. In the hospital, your MOOP limit can be reached very quickly. Tell your doctor or other health professional right up front that you have a higher deductible and need to know the approximate procedure’s cost, expected benefit and risk for doing a certain procedure, and on the flip side what is the cost, benefit and risk for not doing it or doing a different approach. 

Also, always ask what you can do to manage your condition better at lower cost. This is something that frustrates doctors because many people will not actually follow recommended options to manage or reverse a health condition. The kidney stone episode is a learning experience on cost, benefit and risk. 

Understanding more about your health care and insurance is more important as these costs are shifted to us, the consumer. It requires a greater awareness about all this and lots of questions to stay in control of your decisions. Once you have greater control, you can do more to help yourself improve health, lower cost and save money. 

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