Financial Services & Annuities

Sheldon-Palmes Insurance offers a complete line of financial products and services ranging from annuities to medicare and retirement plans. These products and services are designed to provide solutions to your personal and business financial needs, including:

Individual Insurance

Individual and family health insurance is health coverage specifically tailored to those not covered by employer groups or organizations. A broad selection of individual and family health insurance plans is available. Less expensive plans may provide coverage in case of a major accident or illness, while other plans may provide comprehensive coverage for all your healthcare needs.

Annuities

An annuity can help you accumulate tax-deferred earnings as part of your overall retirement plan. Annuities offer the opportunity for lifetime payments and tax-deferred earnings, and provide a guaranteed death benefit for your beneficiaries. All guarantees are backed by the continued claims-paying ability of the issuing insurance company.

You may want to consider investing in an annuity as part of your long-term financial plan if:

• You're in a higher tax bracket, and want to defer additional income.
• You've reached your deductible limit on all your retirement accounts and wish to save more for retirement.

An annuity is different from most other retirement savings vehicles — it's actually a contract between you and an insurance company. In return for making one or more premium payments, the insurance company agrees to provide you an income stream — usually during retirement. You can elect to receive payment all at once or as a series of payments, even for the rest of your life.

Annuities Quote Request

Medicare Advantage Plans

Medicare Advantage Plans (also known as Medicare Part C) are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include Medicare Part D prescription drug coverage or you can enroll in a separate Medicare Part D prescription drug coverage plan. Medicare Advantage Plans include:

• Medicare Health Maintenance Organization (HMOs)
  
• Preferred Provider Organizations (PPO)
  
• Private Fee-for-Service (PFFS) Plans
  
• Medicare Special Needs Plans (SNP)
  
• Medicare Medical Savings Accounts (MSA)

Medicare Supplements

Eligibility
In general, individuals are eligible for Medicare if they (or their spouse) worked for at least 10 years in Medicare-covered employment and are at least 65 years old and are a citizen or permanent resident of the United States of America.

Individuals who are under 65 years old can also be eligible if they are disabled or have end stage renal disease.  People under 65 and disabled must be receiving disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months before Medicare automatic enrollment occurs.

Many beneficiaries are dual-eligible.  This means they qualify for both Medicare and Medicaid.  In some states those with certain income, Medicaid will pay the beneficiaries Part B premium for them (most beneficiaries have worked long enough and have no Part A premium), and also pay any drugs that are not covered by Part D.

Part A: Hospital Insurance

Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met:

• The hospital stay must be at least three days, three midnights, not counting the discharge date.
  
• The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay.  For instance, hospital stay for broken hip and then nursing home stay for physical therapy would be covered.
  
• If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered.
  
• The care being rendered by the nursing home must be skilled.  Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADLs) such as personal hygiene, cooking, cleaning, etc.
• The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2008, $128.00 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell.
  
• If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period.

Part B: Medical Insurance

• Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis.  Part B is optional and may be deferred if the beneficiary or their spouse is still actively working.  There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.
  
• Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor's office.  Medication administration is covered under Part B only if it is administered by the physician during an office visit.
  
• Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments.  Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered.
  
• As with all Medicare benefits, Part B coverage is subject to medical necessity.  Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria.  On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD).  Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003.

Medigap (Supplemental Insurance) Policies

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage.  Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover.  If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.

Insurance companies can only sell you a “standardized” Medigap policy.  These Medigap policies must all have specific benefits so you can compare them easily.

You may be able to choose up to 12 different standardized Medigap policies (Medigap Plans A through L).  Medigap policies must follow Federal and State laws.  These laws protect you.  A Medigap policy must be clearly identified on the cover as “Medicare Supplement Insurance.”  Each plan, A through L, has a different set of basic and extra benefits.

It’s important to compare Medigap policies because costs can vary.  The benefits in any Medigap Plan A through L are the same for any insurance company.  Each insurance company decides which Medigap policies it wants to sell.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B.  You will have to pay the monthly Medicare Part B premium.  In addition, you will have to pay a premium to the Medigap insurance company.

You and your spouse must each buy separate Medigap policies.  Your Medigap policy won’t cover any health care costs for your spouse.

Group Insurance / Benefits

Many businesses today face challenges in attracting and retaining top employees. As a business owner, you know the importance of employee benefits and their contribution to your business success. We will work with you to develop a program tailored to your individual circumstances.

401(k) Retirement Plans

401(K) plans are tax-deferred retirement savings plans for employees. The employer sets them up and each company has a slightly different 401(k). They are part of a family of retirement plans known as "defined contribution" plans - the amount contributed is defined by the employer or the employee. 

When you join a 401(K) plan, you tell your employer how much money you want to contribute to your account. This amount is deducted from your salary before taxes are applied, so you pay less income tax. More importantly, the money is deducted even before you have received it, making it the easiest savings plan to contribute to. Your employer may match a portion of your contribution. The money is invested by the plan administrator (on your behalf) in mutual funds, bonds, money market accounts, etc. You decide the mix of investments. They usually have a list of investment vehicles you can choose from as well as some guidelines for the level of risk you are willing to take. Since the plan is an incentive for retirement savings, there is one condition: if you withdraw the money before you are 59½  years old, you will have to pay tax as well as a 10% penalty fine to the IRS.

Buy / Sell Protection

If you have a partner in business, you have a need for insurance so that in the event of death or disability, you can buy out your partner's interest without having to take out a loan or liquidate company assets. This is also important where children and taxes are involved.

Flexible Spending Accounts (FSA)

Employer-sponsored flexible spending accounts (FSAs) are benefit plan arrangements that allow employees to pay for certain health care or dependent care expenses on a pre-tax basis.  There are two FSA options. A Health Care FSA is an alternate way of paying your share of your health care costs. In the same manner, a Dependent/Child Care FSA reimburses you for expenses for dependents and childcare which are necessary to allow you and your spouse to work.

When you create an FSA, you choose to have a specific amount of your annual salary withheld from your paycheck and deposited to your FSA. These withholdings are on a pre-tax basis.    Flexible Spending Accounts (FSA’s)  are benefit options designed to increase your disposable income by reducing the amount of taxes you pay. An FSA enables you to use pretax dollars to pay for qualified health care expenses which are not reimbursed under any health care plan or insurance plan, while a Dependent Care FSA pays for your qualified dependent/child care expenses. However, FSA funds are not interchangeable.

Flexible spending accounts offer significant tax advantages. Employees do not pay federal income, state income, or FICA taxes on the salary they contribute to a FSA plan. Employers, in turn, do not pay matching FICA (7.65%) and FUTA taxes because employees' gross incomes are significantly reduced. A health care FSA, which allows employees to pay co-payments and deductibles with tax-free dollars, can go a long way to helping employees shoulder their share of the burden. FSAs are excellent tools for employees in savings significant tax dollars especially in this day of rising health care costs.

Health Reimbursement Arrangement (HRA)

A Health Reimbursement Arrangement is a tax-advantaged benefit that allows both employees and employers to save on the cost of healthcare.

HRA plans are employer-funded medical reimbursement plans. The employer sets aside a specific amount of pre-tax dollars for employees to pay for health care expenses on an annual basis. Based on the plan design, HRAs can generate significant savings in overall health benefits.

The primary requirements for an HRA are that (1) the plan must be funded solely by the employer and cannot be funded by salary reduction, and (2) the plan may only provide benefits for substantiated medical expenses.

HRAs may be designed in many fashions to suit the specific needs of the employer and employees. It is one of the most flexible types of employee benefit plans making it very attractive to most employers.

Health Savings Accounts (HSA)

A Health Savings Account (HSA) helps you save money on health care. By making you a part of the medical services decision process, HSAs are designed to help you manage medical expenses and reduce the continuing raising of health care expenses. Equally as important, the money you save remains part of your retirement account, even if you leave your present employer. You can also save the money in your account and grow your account through investment earnings. Funds in the account can grow tax-free through investment earnings, just like an IRA In short, if you don’t use all the money in your HSA for medical expenses, it can accumulate as tax-free savings for your retirement. One final benefit, HSAs can pay for many more procedures than were ever allowed before by government sponsored programs. Health Savings Accounts help you save money on unavoidable expenses and build investment savings for your retirement.

Account funds are used to cover medical expenses before the plan deductible has been met. Unspent account balances accumulate and accrue interest from year-to-year. Unlike amounts in Flexible Spending Accounts that are forfeited if not used by the end of the year, unused funds remain available for use in later years. Once the health plan’s annual deductible has been met, coverage resembles conventional insurance, typically in the form of a preferred provider organization (PPO) with little-to-no cost sharing for in-network services, and limits on total out-of-pocket costs. 

Key Person Coverage

Your key employees are your most valuable business asset. Their skill, knowledge and experience are your real profit makers. Without them, the success and growth of your business could be in jeopardy. Key employee insurance is designed to protect your business from the adversities associated with the loss of a key employee, manager or executive. The death or disability of a key employee could result in a substantial financial loss due to hiring and training a replacement, lost sales, and/or slowed production.

Part D Prescription Plans

Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD).  These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies.  Unlike Original Medicare (Part A and B), Part D coverage is not standardized.  Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all.  The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates.   Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.
 
It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid will pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.