JustCare

Category: Your Coverage Options

  • Health plans must cover preventive care services in full

    Health plans must cover preventive care services in full

    It’s always wise to question your health plan if it denies coverage for your care or covers less than you expected. Improper denials or inadequate coverage appear all too common. The latest evidence comes after a report by the National Woman’s Law Center finding that health plans had been refusing to cover all types of women’s contraceptives in full in violation of the Affordable Care Act. Last week, the Department of Health and Human Services made clear that health plans must cover preventive care services in full.

    Health plans cannot pick and choose among the preventive care contraceptive services they cover. They must cover the full range of FDA-approved contraceptive services. They must also cover well-woman visits at no charge to the patient.

    The National Woman’s Law Center surveyed 100 insurance companies in seven states and found that 15 health plans failed to cover all forms of FDA-approved birth control, including Cigna, Aetna and Anthem Blue Cross Blue Shield. The Kaiser Family Foundation conducted a similar study of 20 insurers in five states and found, among other things, that some insurers do not cover birth control patches, four insurers did not cover the contraceptive implant Implanon, and one insurer did not cover the NuvaRing.

    The Department of Health and Human Services clarified that the health plans must offer for free at least one of the 18 contraceptive drugs available, but they can cover the generic drug in full and charge a copay for the brand name drug. The ruling will take effect in January 2016.

    For answers to a range of questions on the Affordable Care Act, visit the Center for Consumer Information and Insurance Oversight. And, remember, if your health plan denies coverage, fight back.  Here’s how.

  • Do you need Medicare if you live abroad?

    Do you need Medicare if you live abroad?

    Medicare generally only covers care in the United States. And, Medicare premiums can add up quickly. So, if you plan to live abroad, do you need Medicare? The answer is a qualified yes. It depends largely on whether you plan ever to return to the United States and where you are planning to live abroad. You should always contact Social Security to fully understand your options. Here are a few key points:

    You should keep your Medicare coverage:

    • If you plan to live in Puerto Rico, the Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands. Medicare will cover your care in all of these places.
    • If you plan to spend time in the United States at any time after you move abroad. Medicare will likely not cover your care abroad, but whenever you are in the United States you will be sure to be covered. If you stop paying your Part B premium while you are abroad, you will need to wait until the Medicare open enrollment period to regain coverage. And, you will pay a 10 percent premium penalty for every year you did not have coverage.

    If you’re enrolled in a Medicare Advantage plan or a Medicare Part D plan:

    • You should switch out of your Medicare Advantage plan and into traditional Medicare. You are not eligible to be enrolled in a Medicare Advantage plan if you do not live in its service area. You are eligible for traditional Medicare, so long as you pay your Part B premium.
    • You should drop your Medicare Part D plan. You are not eligible to be enrolled in a Part D drug plan if you do not live in its service area.
    • So long as you keep paying your Part B premium, if you move back to the United States you will have a special enrollment period to enroll in these plans if you so choose, without penalty.

    If you’re enrolled in a Medigap or Medicare supplemental insurance plan:

    • You should call the Medigap plan to understand the rules for reenrolling and the premiums you will pay. It could be costly or hard to get a Medigap plan once you drop it.

    For more detailed information about Medicare coverage if you live outside the United States, visit Medicare Interactive.  For information on what to think about before enrolling in Medicare, click here.  And, here are two questions to think about during the Medicare Open Enrollment period.

  • Health caring for mom: Three ways to let your mom know you love her on Mother’s Day

    Health caring for mom: Three ways to let your mom know you love her on Mother’s Day

    Mother’s Day is the time to show your mom some serious love. But how? Most of us love flowers and chocolate. So, consider getting mom a little of both. What we really treasure, though, is the priceless gift of time together and conversation. And there are few things more important to talk about than your mom’s health.  So here are a few priceless gifts for mom on her special day:

    1. Make sure your mom is safe and healthy.  Talk to her about all of the drugs she’s taking, both over the counter drugs and painkiller prescriptions. If your mom has a chronic condition like asthma or diabetes, find out whether her primary care doctor is doing a good job of coordinating her care. Click here to learn how your mom’s primary care doctor can help her. And, if your mom wants to stop smoking, lose weight or change another unhealthy behavior, here are some tips for motivating her to do so.
    2. Talk to your mom about planning for her future health care needs. Who would she want to take care of her when she cannot take care of herself?  Would she like to remain at home as long as possible? What are the tradeoffs she would like to make? And, make sure your mother has a reliable health care proxy and a living will. (You should have those too!)  Click here for free help with these advance directives.
    3. Double check that your mom is getting the preventive care services she needs.  She should get regular pap tests, pelvic exams and breast exams. If she’s over 60, she should get a shingles vaccine.  Medicare and most insurance cover all these tests in full. Next time she’s headed to the doctor, consider tagging along. Mom, like all of us, could use a health care buddy to ask the questions she might not ask.

    These are important conversations. Most of us know we should talk to our mothers about their health, but we never quite get around to having the actual conversation. Why not use Mother’s Day as a reason to get serious about your mom’s health? Just talking to your mom about these issues can be healthy for her.

  • Three preventive care exams that every woman should get

    Three preventive care exams that every woman should get

    Cancer rates are falling and fewer people are dying of cancer. To help detect cancer early, it’s important for women to get three cancer screenings regularly. And, because older adults are more likely to get cancer than younger adults, older women should continue getting screenings throughout their lives. Medicare and health insurers cover three preventive care exams that every woman should get: Pap smears, pelvic exams and physical breast exams.

    Each of these exams can detect different types of cancer. Early diagnosis is important because it increases the chance that treatments will work. Medicare covers the full cost of these tests performed together every two years for women at low risk for vaginal or cervical cancer. Health insurers also cover these tests in full.  The Affordable Care Act requires insurers to cover an annual well-woman preventive care visit and any additional needed visits in order for adult women to obtain recommended preventive services. 

    • Pap smears are important for detecting cervical and vaginal cancer in their early stages. Pap smears can also reveal other genital problems, fibroids and sexually transmitted diseases. For this test, the medical professional scrapes cells from the cervix and vagina.
    • Pelvic exams help detect fibroids and ovarian cancer. The doctor checks the uterus, ovaries, vagina and rectum for changes in shape or size.
    • Clinical breast exams detect the possibility of breast cancer. For this procedure, the medical professional checks the breasts and underarms for lumps which can be a sign of breast cancer.

    For more information, visit Medicare Interactive.

  • Should you enroll in Medicare if you have employer coverage?

    Should you enroll in Medicare if you have employer coverage?

    Should you enroll in Medicare if you have employer coverage?  The answer is less complicated than some would suggest, but it depends.  If you or your spouse is actively working and you get health insurance from that employer, you might not need to enroll. You need not sign up for Medicare if there are at least 20 people employed at the job.

    Before deciding not to enroll in Medicare, speak with your employer’s insurance company and call Social Security at 800-772-1213 to make sure you do not need to enroll.  Keep in mind that COBRA and retiree coverage are not considered employer coverage. To be more specific:

    If you and your spouse are not actively employed: Medicare becomes your primary insurance when you turn 65, even if you have not signed up.  Any health insurance you have, including retiree insurance from your former employer, pays only after Medicare pays and will not pay if you are not enrolled in Medicare. You should enroll in Medicare during the seven-month initial enrollment period beginning three months before your birthday month. If you do not enroll then, you will not be able to enroll until the general enrollment period, between January and March, and you will pay a 10 percent premium penalty for each year you are not enrolled.

    If you or your spouse is actively employed:  Whether you must sign up for Medicare depends exclusively on whether there are 20 or more employees at your or your spouse’s job.

    • Your job coverage remains primary only if there are at least 20 full-time employees actively working at the job; in that case, you (and your spouse if your spouse receives coverage through your job) do not need to enroll in Medicare Part B.  You will get Medicare Part A hospital insurance automatically if you are receiving Social Security benefits, since Part A is free. (Call Medicare at 1-800-633-4227 if you need to sign up for Part A benefits.) Your Medicare Part A coverage will serve as secondary insurance, covering costs for hospital services after your employer coverage pays.
    • However, if there are fewer than 20 full-time employees, Medicare must be your primary coverage, and you must enroll in Medicare during the initial enrollment period. Your job coverage will pay only after Medicare pays.

    You have the right to sign up for Medicare any time after you become eligible so long as you have coverage through your or your spouse’s employer and the employer has 20 or more employees.  Once you retire or decide to drop that coverage, you have an eight-month special enrollment period.

    For a simple overview about what to think about when enrolling in Medicare, click here.

    For more information, visit Medicare Interactive.

     

  • Should you get COBRA benefits when you leave your job?

    Should you get COBRA benefits when you leave your job?

    If you are leaving your job, along with your health insurance, you can get insurance through COBRA. But, should you get COBRA? Your state health insurance exchange is now another way to get health insurance if you don’t get it through work. And, it will likely be a far less costly option. But, it may not offer as good benefits.

    What does COBRA do? COBRA allows workers and their spouses and dependents to keep their health insurance coverage from their jobs for 18 to 36 months, so long as the workers pay the full premium.  (Often employers charge an additional 3 percent for administrative costs.) COBRA offers a great protection for people leaving their jobs who don’t want to give up good insurance.  The biggest problem with it for most people, however, is that the full cost of health insurance can be unaffordable.

    COBRA protection is usually available to people who work in companies with 20 or more employees, generally including people who work for state and local governments, but excluding people who work for the federal government. People with costly health care needs benefit most greatly from COBRA since it tends not to be possible to buy individual coverage that is as generous as what insurers offer in the marketplace.  And, when that good coverage is available it tends to be even more costly than the cost through COBRA.

    Even if you have COBRA, you should sign up for Medicare once you become eligible for it.  Medicare becomes your primary insurance.  If you have costly health care needs, COBRA can become your secondary insurer; it may cover services that Medicare does not cover.  (Note: If you do not sign up for Medicare when you become eligible, you will likely end up without any coverage since your COBRA coverage will no longer be primary.)

    For more information, visit Medicare Interactive.  

  • What’s the Medicare premium in 2015?

    What’s the Medicare premium in 2015?

    It wasn’t that long ago that the Medicare premium was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  But back in 2003, Congress decided to impose higher premiums on wealthier people with Medicare. And, today, individuals earning more than $85,000 a year and couples earning more than $170,000, about 6 percent of the Medicare population, pay higher premiums than everyone else with Medicare. So, what’s the Medicare premium in 2015?

    The Medicare premium in 2015 is $105 for almost 48 million people, 25 percent of program costs.  It’s a lot more for the 2.9 million people with incomes over $85,000.  People earning between $85,000 and $107,000 pay $147 a month in premiums or 35 percent of program costs.  And people earning more than $214,000 pay $336 in monthly Part B premiums, 80 percent of program costs.

    People with incomes up to 135 percent of the federal poverty level, ($1,345 in monthly income for an individual and $1813 for a couple) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.  For more information visit Medicare Interactive.

    Click here for the Medicare premium in 2016.

     

  • Four things to think about before moving into a nursing home

    Four things to think about before moving into a nursing home

    Before moving into a nursing home, it’s important to do your homework and understand your rights and options.

    1. Care: You have the right to receive whatever care you need to reach the highest reasonable level of functioning or so that your condition does not deteriorate.  Medicaid patients have exactly the same rights to these services as everyone else in the nursing home so long as the nursing home accepts Medicaid patients. And all patients and their families have the right to help develop the care plan so that it is tailored to the resident’s needs
    2. Choice: The nursing home must accommodate the resident’s preferences, whether they be to wake up late in the morning, to participate in an activity, to change schedules or to have family visit any time of the day or night.
    3. Costs: Only the resident is required to be financially responsible for his or her care.  The nursing home cannot force a family member to take responsibility.  Medicare should pick up the costs for residents needing daily skilled nursing or therapy care who have been hospitalized for three days in the 30 days prior to admission, so long as the nursing home is Medicare-certified.  If the nursing home says Medicare won’t pay, you still should insist that it submit the bill to Medicare.
    4. Help: Every state has a long-term care ombudsman program to help ensure the nursing home provides you with the benefits and protections to which you are entitled free of charge. There are also websites where you can find nursing home ratings, but read them with caution.
    For more information from the National Senior Citizens Law Center, click here.
  • What will your Social Security benefits be when you retire?

    What will your Social Security benefits be when you retire?

    What will your Social Security benefit be when you retire? Knowing how much you will receive from Social Security can help with your retirement planning. Two-thirds of Americans rely on Social Security for most of their income in retirement, and one third rely on it for virtually all (90 percent or more) of their retirement income.

    The Social Security Administration cannot tell you exactly what you will get.  But, it has a calculator that will provide you an estimate. What you receive depends on the average of your top 35 earnings years, as well as on the age at which you choose to claim Social Security.

    You can sign up to get benefits before the full retirement age (age 66 today, i.e. for those born between 1943 and 1954, and rising to age 67 for those born in 1960 or later). But your benefit will be reduced by around 6 percent for each year you retire prior to your full retirement age — up to a 25 percent reduction if you retire at age 62, the earliest possible age you can claim benefits. If you wait until after your full retirement age to claim benefits, your benefit is increased by 8 percent per year — up to a 24 percent increase if you wait till age 70.

    Your benefits will be protected against inflation by cost-of-living increases. And, of course, if Congress changes the Social Security Act, that could affect your benefits as well.  In January 2015, the average estimated monthly benefit for a retired worker was just over $1300 and just over $2100 for a retired couple.

    To qualify for benefits, you need at least 40 credits of earnings, i.e. 10 years of either working four quarters or paying enough into Social Security during the year to satisfy the four-quarters requirement. To understand how credits are calculated, click here. Or, you might qualify based on the earnings record of a current or divorced spouse (if the marriage lasted 10 years or longer).

    Click here to use the Social Security Administration’s Retirement Estimator; SSA also provides calculators to estimate survivors or disability benefits. And the AARP has a calculator to help you decide when to sign up for benefits.

    If you like this post, you might like this:

    U.S. offers stingy Social Security retirement benefits

  • Three tips to avoid a health insurance scam

    Three tips to avoid a health insurance scam

    Health insurance scams abound. Marketing agents working for a health insurer may call you, appear at your door, or email you to get you to sign up for a health plan. That’s how they make money. So, beware. And keep these three tips in mind:

    1. Protect your personal information. Do not give anyone your Medicare number or Social Security number, credit card number or bank account details. Before speaking with anyone about your health plan choices, make sure the person is really representing a health insurance company. Some people pretend to be selling a health plan just to get your personal information. If you have Medicare, call Medicare, 1-800-333-4114, or call the health plan directly to confirm the agent trying to sell you health insurance is not scamming you.
    2. Don’t take the word of the person trying to sell you a health plan about the doctors you will be able to use. Before you sign up, call your doctors to make sure they are in the plan’s network and that they will continue to treat you. Or, if you’re willing to switch doctors, call to confirm that the doctors listed in the plan’s network are taking new patients and that you can use them. If you have Medicare, keep in mind that only traditional Medicare covers your care from most doctors and hospitals anywhere in the United States.
    3. Know your rights. Agents selling health plans to people with Medicare cannot call you, email you or appear at your door unless you give them permission to. They also cannot ask you for financial information or your Medicare number. Before you let them try to sell you a health plan, call your state health insurance program for free advice on your options. And, if you receive a letter that looks official–it looks like it comes from Medicare or a government agency–call your State Health Insurance Plan to confirm it’s legitimate before doing anything else.

    For more information on how to protect yourself against Medicare fraud, visit MedicareInteractive.org.