SIMPLER HORIZONS

INSURANCE SOLUTIONS

Medicare Solutions Made Simple

About Us

Simpler Horizons is dedicated to providing quality service to every community we serve. We believe in the idea that if we can provide value to the people we work with, our success is guaranteed.  We have helped thousands of Medicare recipients find the right plan for their individual needs. We partner with hundreds of doctors, hospitals, health plans, and brokers to ensure that every single one of our members has access to the quality, benefits, and care they deserve.

Our Services

Medicare Supplement Insurance Plans

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Simpler Horizons Insurance Solutions

Since 2012 Simpler Horizons Insurance Solutions has been servicing the needs of thousands of Medicare beneficiaries every year! We represent multiple Medicare Advantage & Medicare Supplement companies. Therefore, we are able to educate you on the full range of options available to you in your area. We give you the power to compare and the freedom to choose the plan that works for you. Best of all, at Simpler Horizons Insurance Solutions, we never charge for our services.

Ensure that you are receiving all the benefits you are entitled to by calling us today to schedule a no-cost, no-obligation benefit review.

Quick Contact

Simpler Horizons Insurance Solutions Proudly Serving Most States

Phone: 1 (866) 900 – 1957

Email: admin@simplerhorizons.com

License: CA: 0H86802

Meet the Team

Elka Soussana

DIRECTOR OF OPERATIONS

Dubbed herself as the ‘Wonder Woman’ of Medicare, Elka has used her experience as a mother of 4, successful business owner, as well as experienced manager to bring an open mind and patient attitude to every member interaction.  Whether you’re just getting to understand Medicare as an incoming member, or even as a potential broker or physician affiliate, you’ll be treated like family and may even be lucky enough to get one of her famous homemade desserts.  When you leave a meeting with Elka, you’ll be better educated and have a stronger understanding of the product and future outlook.

Seth Paul

PRESIDENT

With nearly 15 years of experience in the Medicare field, Seth offers a unique blend of business development knowledge, leadership skills, and industry expertise. Born and raised in Orange County, Seth has 2 amazing daughters, and although he loves watching them grow up, his second focus is helping people with Medicare.  Seth has helped both his parents navigate the Medicare maze, and in the process realized how important it is to work with someone that can really help. Seth’s devotion doesn’t stop with members; he is equally dedicated to leading by example and duplicating himself with his elite brokers.  He is devoted to assisting every broker with the necessary tools to gain a competitive edge in the Medicare market space.

Medicare Solutions

MEDICARE SOLUTIONS MADE SIMPLER

Medicare Supplement Insurance Plans

If you are in the original Medicare Plan, you may want to buy Medicare Supplement Insurance Plans health care insurance, also called Medigap. These plans help you pay for uncovered health care. If you currently have a Medicare Advantage plan such as a Medicare HMO you will not need to purchase a supplemental insurance policy. All Medicare Supplement Insurance Plans are sold by private companies and offer a variety of plan choices to fit your needs and budget. There are twelve standard Medicare Supplement Insurance Plans plans named A through L suited to fit your needs. Please use the chart on the right labeled “Comparison of Medicare Supplement Insurance Plans” for an easier understanding of plans A through L. Please note that some supplemental health care companies offer a “high deductible option” on plan F.

Medicare Select is an additional supplemental plan designed to cost less – however it requires you to go to selected doctors and hospitals for your care and it is not available in all states – for more information on Medicare Select, please give us a call at 866-900-1957.

Medicare Supplement Insurance Plans fills in the gaps with various healthcare benefits with variable prices. Keep in mind that all Medicare Supplement Insurance Plans plans must cover basic benefits.

Several states may have different standards of Medicare Supplement Insurance Plans healthcare, such as Massachusetts, Minnesota, and Wisconsin. Check with your state insurance department for guidelines for people with Medicare.

All Medicare plans with the same letter designation cover the same benefits – no matter what carrier is offering it. For example, all plan F policies cover up to part B excess charges. The premium may vary from carrier to carrier.

We strongly suggest running a free quote on our website so that you may compare plans before deciding which is best suited for you. Every Medicare Supplement Insurance Plans policy offers different benefits. For example, some plans may include deductibles and coinsurance while other plans cover some home health care and prescription drugs.

A deductible is an amount you pay for health care before Medicare begins to pay while coinsurance covers the amount you pay for your care after you pay the deductible.

 

Medicare Supplement Insurance Plans does not cover:

•Long-term care to help you bathe, dress, eat or use the bathroom
•Vision or Dental Care
•Hearing Aids
•All Prescription Drugs
•Private-Duty Nursing
•Medicare Supplement Insurance Plans Basic Benefits

 

The Basic Benefits

Medicare Supplement Insurance Plans A is the most basic plan. Each Medicare Supplement Insurance Plans policy must offer its most basic benefits.

 

Medicare Part A

Once you have paid your hospital deductible – original Medicare pays all of your hospital care costs for up to 60 days in a benefit period. If you decide to stay on the plan for more than 60 days – you are required to pay a 2012 rate per day for days 61 through 90. For days 91 through 150, the cost will be $512 throughout 2012.

All 10 supplemental plans cover your costs for days 61 through 150. In addition, once you use 150 days of Medicare hospital benefits, all Medicare Supplement Insurance Plans plans cover 365 more hospital days in your lifetime.

Benefit periods begin the day you go to the hospital and ends when you have been out of the hospital for 60 consecutive days. If you were to go to the hospital again after the 60th day, you would have started a new benefit period.

 

Medicare Part B

Once you pay your yearly Part B deductible, Medicare generally pays 80% of doctor and other medical services. It pays 50% of mental health services.

Every Medicare Supplement Insurance Plans plan covers your share of these services such as 20% of Medicare-approved doctor services and 50% for mental health services. Medicare approves the payment amount of reasonable health care services.

Medicare does not cover the first 3 pints of blood you need each year. Every Medicare Supplement Insurance Plans plans cover these 3 pints of blood you require each year – Medicare will then pay for any additional blood.

 

Medicare Supplement Insurance Plans additional Benefits

Medicare Supplement Insurance Plans Plan A (as well as Plan B through J) covers only the basic benefits – for some, this is all they need, for others, they may want to have additional supplemental coverage with Plans B through J.

At a higher monthly cost, you can purchase a Medicare Policy with the following additional benefits:

•Medicare Part A Hospital Deductible
•Skilled Nursing Home Costs
•Medicare Part B Deductible
•Medicare Part B Excess Charges
•Foreign Travel Emergency
•At Home Recovery
•Preventive Care

Medicare Advantage

Medicare Advantage is quickly becoming popular because of the extra benefits that are offered such as extra days in the hospital, cheap out-of-pocket costs for doctor visits and low-cost prescriptions.

These plans are offered throughout the United States through private insurers. Part A and Part B of Medicare is required to join the plan and Medicare’s Part B premium must be paid by the Medicare recipient in order to enroll. Private insurers offer policies that have varying co-payments and premiums that may start as low as $0.00 per month.

A Medicare Private Fee for Service or (PFFS) Advantage Plan is exploding with members because it allows the Medicare recipient to visit any doctor in any hospital in the United States. The Medicare PFFS Advantage Plan is the current superior value versus the traditional Medicare Supplement Plans for most people.

The Health Maintenance Organization or HMO Advantage Plan continues to be a favorite for those who desire minimal out-of-pocket expenses and extremely low monthly premiums.

 

Medicare Advantage in a nutshell:

•Medicare Advantage plans are available with little or $0.00 monthly premiums.
•Medicare Advantage plan holders are still on Medicare and retain the rights and protections of Medicare.
•A Medicare Advantage member will continue to receive regular Medicare-covered services. In addition, a Medicare Advantage plan holder will also have access to additional services that neither Medicare supplements nor the original Medicare providers.
•Most prescription drugs are included in Medicare Advantage, while supplemental Medicare policyholders must pay extra for Part D.
•Medicare Advantage plans are now being offered to 98% of the counties in the USA.
•Supplemental Medicare policyholders must pay their monthly premium whether sick or not. Medicare Advantage plans have the policyholders make a small co-payment for doctor visits and a somewhat larger co-payment for hospital visits.
•The Medicare recipient should know that Medicare Advantage guarantees that even in a time of poor health there is a maximum out of pocket expense. A Medicare Supplement policy guarantees the Medicare recipient to spend $1,600 to $2,000 a year even if you never go to the doctor.
•A primary physician (PCP) referral to see a specialist is no longer required. A PFFS or PPO Medicare Advantage plan permits the policyholder to go to any doctor or hospital with no referrals!
•End Stage Renal Disease (kidney failure) can even qualify for the advantages of a Medicare Advantage plan. In some counties, we even have companies specifically people with an end-stage renal disease.

Important: You may only be able to buy Medicare Advantage plans that have prescription drug benefits within 6 months from the first date of Medicare Part B. After 6 months, your choice of plans may be limited.

 

What You Need to Enroll for Medicare Advantage

You will need your Primary Care Physician’s name and ID number to enroll. To find this information, you will need to call your primary care physician.

You will also need information found on your Medicare card (example shown below):
Medicare Claim Number
Hospital (Part A) Effective Date
Medical (Part B) Effective Date

 

Medicare Part D

Medicare Part D is a prescription drug coverage policy. It covers both generic and name-brand drugs. Its purpose is to help people who already have high prescription drug costs as well as help with rising prescription drug costs. There are a variety of plans available offering various costs and coverage.

Everyone eligible for Medicare Part A is automatically eligible for Medicare Part D. However you must enroll in Part D three months in advance or three months after you become eligible – otherwise you will have to wait for open enrollment. Open enrollment usually takes place in the last few months of the year.

If you decide to enroll in this coverage you will be responsible for paying monthly premiums as well as a yearly deductible. If you are considered low-income, you might be eligible for lower or no-cost plans, including Medicaid.

It is important to have prescription drug coverage even if you don’t take a lot of prescription drugs because as people get older they tend to have an increased necessity for prescription drugs. It is better to be covered should the need for prescription drugs shall arise. Keep in mind prescription drugs are rising and you should have a plan to offset this cost.

When can you join a Medicare Part D Plan?

Enrollment starts between October 15th and December 7th – anyone can join, switch or drop a Medicare Part D plan. The change will take effect on January 1st so long as the carrier receives your request by December 7th.

When you are first eligible for Medicare – you can join Part D within the seven month period that begins three months before the month you turn 65 which includes the month you actually turn 65 and ends 3 months after the month you turn 65.

If receiving Medicare due to a disability, you can join during the seven month period that begins three months before the 25th month of disability which includes your 25th month of disability and ends 3 months after your 25th month of disability. You will be able to join 3 months before and after the month you turn 65.

 

Special Enrollment Periods

Generally, you must stay enrolled for the calendar year. However, in some situations, you may be able to join, switch, or drop Medicare Part D plans in various instances:

•If you move out of your plan’s service area.
•If you lose creditable prescription drug coverage.
•If you live in an institution such as a nursing home.

Broker Solutions

Be part of an Elite Insurance team at Simpler Horizons.

Simpler Horizons and it’s leaders have been instrumental in providing thousands of brokers with business planning, growth opportunities, and creating a network of professional contacts that consistently resulted in solid referral sources.

Simpler Horizons goes above and beyond in supporting your business, for example:

  • Customizing a business plan for your personal production based on your schedule
  • Marketing campaigns designed exclusively for our team
  • Team chat group
  • Weekly business development meetings
  • Doctor introductions in your area
  • Automated marketing to your book of business at no cost.

Contact us today to see how you can become a Simpler Horizons Elite Broker.

Contact Us

By submitting this information you acknowledge a licensed insurance agent may contact you by phone or email to discuss Medicare Advantage Plans, Prescription Drug Plans or Medicare Supplement Insurance.

SIMPLER HORIZONS

Health Insurance Agents

By calling the number above you will be directed to a licensed insurance agent. Medicare has neither reviewed nor endorsed this information.  

Last Updated 7-17-2019.

In some states, all Medicare Supplement plans are offered to qualified individuals under the age of 65.