JustCare

Category: Your Coverage Options

  • Four tips for keeping your health plan costs down

    Four tips for keeping your health plan costs down

    There are a bunch of reasons why you should not think you can choose a health plan “that’s right” for you. If you have Medicare, you can budget for your care with traditional Medicare, though you will need supplemental coverage to protect yourself from financial risk. And, if you are not yet eligible for Medicare, you can do some homework to keep your health plan costs down.
    1. Choice of doctors and hospitals: Each health plan has different networks of doctors and hospitals. Many people choose plans with narrow networks, which tend to have lower premiums. Ask your doctors about which health plan’s network they are in and then call the health plan to confirm. (Sometimes, the same insurance company will offer different plans, with different doctors in their networks.) Also, find out if the hospital you want to use is in the network.
    2. Costs: Before enrolling, understand all of your costs. On top of your monthly premium, some health plans charge a deductible, the amount you must pay before the plan begins covering your care. And, you will likely have a copay, a fixed amount you pay every time you see an in-network doctor, or coinsurance, a percentage of the cost you must pay. If you see out-of-network providers, you’re likely to be stuck with huge doctor and hospital bills.  Most health plans will pay only a tiny portion of those bills, and many won’t pay anything. 
    3. Access: Before receiving services, make sure you understand the health plan’s rules. Even if you use in-network doctors and hospitals, the health plan might require you to get a referral from your primary care doctor or prior authorization from the plan before it will cover your care.  If the plan denies your care, be aware that you have appeal rights.
    4. Coverage: Each health plan has different rules about what it covers and under what conditions.  Different health plans may offer different benefits. If you travel or live in another area during parts of the year, make sure your plan covers your care while you are away and what it will pay.

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  • A crash course in 5 important health insurance terms

    A crash course in 5 important health insurance terms

    As if you didn’t already have enough to think about, you need to understand a sea of insurance concepts to keep your health care costs down. Here are five terms you should definitely know.

    1. Premium—what you have to pay each month for your health insurance.
      • If you have Medicare and are receiving Social Security benefits, the government will take your Part B premium out of your Social Security check—nothing to think about there.  But, if you have Part D drug coverage, you’ll likely have to pay that premium by check directly to the insurance company.  And, if you’re buying your own supplemental insurance, you’ll need to pay that premium as well.
      • If you’re in a Medicare Advantage plan, you’ll probably need to pay an additional premium to the insurance company offering that plan.
      • If you have coverage through the Affordable Care Act (ACA), you’ll have to pay that premium but may be eligible for a government subsidy based on your income.  Use this tool from the Kaiser Family Foundation to calculate the amount of your premium that the government will pay for.
    2. Deductible—what you have to pay out-of-pocket for your care before the insurance starts paying. 
      • If you have traditional Medicare, there is a small deductible for your Part B coverage for medical services and a large hospital deductible as well, both of which you’ll have to pay unless your supplemental coverage picks those up.
      • If you’re in a Medicare Advantage plan, an ACA plan, or an employer HMO or PPO, you’ll need to check on deductibles.  Often, insurers charge a deductible for in-network care and a separate deductible for out-of-network care.  And, if you’re premium is very low, your deductibles could be very high.
    3. Copay—a fixed fee that you pay for a particular service.
      • If you’re in a Medicare Advantage plan or an ACA or employer plan and seeing an in-network doctor, your copay will be a set amount of money that represents your share of the doctor’s charge.
    4. Coinsurance—a fixed percentage that you pay, based on the amount your insurer pays. 
      • If you have traditional Medicare and supplemental insurance, the supplemental insurer will pick up the coinsurance for all the services it covers.
      • If you are in a Medicare Advantage plan or an ACA or employer plan and seeing an  out-of-network doctor, your coinsurance will be a percentage of the doctor’s bill.
    5. Covered services: Insurers only pay for the services they cover.  Before you see a doctor, go to a hospital or use an ambulance, check to make sure that the insurer covers services from those providers and under what conditions.
      • Traditional Medicare covers services from most doctors and hospitals anywhere in America.
      • But, if you are in a Medicare Advantage plan or an ACA HMO or PPO, your coverage for routine care may be limited to your providers in your community. Sometimes, you will need prior approval from the insurer or a referral from your doctor in order for your services to be covered.
    If you like this, you might like these:
    Many Americans do not have a good understanding of how their health insurance works 
    How to keep your out-of-pocket costs down if your income is low and you have Medicare
    How to choose between traditional Medicare and a private Medicare Advantage plan
    What’s your Medicare Part B premium and deductible?
    What’s your Medicare Part A deductible?
  • Free pension help and 401 (k) plan help

    Free pension help and 401 (k) plan help

    Do you need free pension help? The spending bill Congress passed in December 2014 allows multi-employer pension plans that are underfunded to cut pension benefits for retirees; while it hurts retirees, it protects the U.S. pension fund from having to bail out underfunded plans. If you have a question about this or any other pension or 401 (k) issue, the Pension Rights Center has developed a free tool to help you address it.

    PensionHelp America guides you through a series of questions, including your zip code, the type of pension you have, and your current job status, to connect you with free counseling and legal services in your state or community.

    In addition, the U.S. Administration on Aging supports pension-counseling projects in 30 states.  You can visit the Pension Rights Center for a list of those projects.

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    JustCare’s Get Help page offers a list of free services available online, nationally and locally. 
  • Beware of discriminatory pricing by health plans

    Beware of discriminatory pricing by health plans

    Under the health care law, insurers must cover everyone who wants to enroll in their health plans, but they can and might use discriminatory pricing or narrow networks to keep you from enrolling or try to push you out if you need a lot of health care services.  They stand to make a lot more money from people who are healthy than from people who are sick and need a lot of services.

    There are two key ways insurers might get you to switch to a different plan:

    1. They might not have doctors in their network who are skilled to treat your health condition.  There are “network adequacy” rules that require health plans to have in-network doctors to treat you. But, you might disagree with them about the skills of their doctors. Or the in-network doctors might not be taking new patients, might have long waits for their services or be located far away.
    2. They might charge high copays to people with costly needs.  Humana, Coventry, Preferred Health and CIGNA did just that in Florida for patients with AIDS.  CIGNA has settled a complaint filed by advocates there and is reducing its HIV drug costs, which the advocates said were discriminatory. 

    If you experience these kinds of practices from you health plan, please let us know, and we will do our best to get you help.

  • Four things to think about regarding Medicaid estate recovery

    Four things to think about regarding Medicaid estate recovery

    If you have Medicaid, you will likely have low health care costs.  However, in some instances, after you pass, your state may attempt to get back some of those costs through Medicaid estate recovery.  That could affect what your heirs inherit.  You should understand what your state might do.

    1. Rules: Children may not be able to inherit the home of a parent for whom Medicaid has covered medical costs. Federal law requires that states recover Medicaid costs from the estates of some Medicaid patients and allows states to recover these costs from the estates of other Medicaid patients.
    2. Process: Each state has different laws on whether it will impose a lien on a Medicaid patient’s property.
    3. Timing: States cannot recover any Medicaid costs from the sale of the home of a Medicaid patient living in a nursing home until the patient and his or her surviving spouse living in that home have passed away or the property, which the state has claimed a stake in, is sold.
    4. Waivers: States must have procedures for not taking money from a Medicaid patient’s estate when it would cause undue hardship.
    For more information on Medicaid estate recovery, go to the National Health Law Program here.
  • It’s time to enroll in a health plan if you are under 65

    It’s time to enroll in a health plan if you are under 65

    Open enrollment in state health exchanges begins on November 15 and lasts through February 15.  You can enroll in a health plan or switch health plans even if you have costly health care needs.  Health plans cannot cancel your coverage if you need costly health care. Here are four things to keep in mind:
    1. Help with premiums: If your income is no more than four times the federal poverty level (between $11,670 and $46,680 for an individual or $23,850 and $95,400 for a family of four), you are eligible for help with the premiums.
    2.  Automatic reenrollment: If you have health insurance through an exchange and do nothing, you will be reenrolled in the same health plan.  But, if you’re smart, you’ll visit healthcare.gov to see whether there are any new plans in your area and what your current health plan is offering in terms of costs and benefits as compared to other health plans in your area.  Read these tips for choosing a health plan.
    3. Expanded Medicaid eligibility: If your income is at or below 138 percent of the federal poverty level ($16,105 for an individual and $32,913 for a family of four) in many states you are likely eligible for Medicaid
    4. Penalty if you go without health insurance: If you did not have insurance in 2014 or if you don’t have insurance in 2015, you will pay a penalty when you file your federal taxes.  In 2014, the penalty is $95 or 1% of your income, whichever is higher.  In 2015, the penalty is $395 or 2% of your income, whichever is higher.

    If you enroll after the 15th of the month, your coverage will not begin until a month and a half later.  If you enroll between the 1st and 15th of the month, your coverage will begin on the 1st of the following month. For more information, check out the Kaiser Family Foundation’s Consumer Guide.

    If you like this post, you might also like these:
    Four tips for keeping your costs down in a private health plan or Medicare Advantage plan
    A crash course in five important health insurance terms

  • Two ways to make sure Medicare covers ambulance services

    Two ways to make sure Medicare covers ambulance services

    Medicare covers ambulance services when they are medically necessary. Here’s how to ensure Medicare will pay:

    1. Be prepared. Identify an ambulance company to use. Confirm with your local ambulance service that it is Medicare-certified. If you are enrolled in a Medicare Advantage plan, find out which ambulance is in the health plan’s network.
    2. Only use an ambulance if you have an immediate health risk or are bed-bound and require constant monitoring.  And, make sure that the ambulance will take you to the hospital you want to use if there is more than one hospital in your area.  Under the law, the ambulance generally must take you to the nearest hospital.

    If you want Medicare to pay for ambulance services, do not use an ambulette. Medicare will not cover it. For more information, visit Medicare Interactive.

  • Three tips to plan for long-term care

    Three tips to plan for long-term care

    1. Protection: Because most of us will need long-term services and supports, it’s important to plan ahead for long-term care.  If your income is low, Medicaid will pick up the cost of a nursing home stay.  Depending upon the state you live in, you also might be able to spend down your income to qualify for Medicaid. If not, Medicare will at most only pick up the cost of a short-term stay in a skilled nursing facility depending on whether you meet the eligibility criteria.  Most people rely on family members and friends to provide long-term care at no or low-cost.
    2. Cost: If you cannot count on Medicaid or assistance from family and friends, you should plan ahead and set aside funds to pay for long-term care.  For more information on costs, this  AARP report shows that long-term care is unaffordable for many middle-income families. In 2013, an average nursing home stay cost $84,000 a year and the average cost of care in an assisted living facility was $42,000.
    3. Long-term care insurance: Before buying long-term care insurance, keep in mind that the premiums are likely to rise dramatically over time. And, the coverage you buy today may be inadequate when you need it since health care costs likely will rise more than the 5 percent inflation protection in some policies. If you’re thinking of buying insurance, find out what will trigger your getting benefits—e.g. inability to bathe or to dress—as well as when those benefits will begin, how much you will receive in benefits daily, how long you will receive benefits, and the maximum amount you will receive in benefits.

    For information on the costs and risks of buying a long-term care policy, read this article from Consumer Reports.

    Learn the full range of issues you need to consider before buying a long-term care policy from California Health Advocates, the consumer experts on long-term care here. You can also get answers to frequently asked questions.
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    Long-term care at a glance
  • Two questions you should answer during the Medicare Open Enrollment Period

    Two questions you should answer during the Medicare Open Enrollment Period

    For anyone on Medicare and many caregivers, Medicare’s Open Enrollment Period is a time to reconsider coverage options. The open enrollment period runs between October 15th and December 7th this year. Here are two questions you should answer during the Medicare Open Enrollment Period:
    1. Is your Medicare doctor and hospital coverage meeting your needs?
    • If you’re in traditional Medicare and have supplemental coverage, you might be paying a little more than if you are in a private Medicare Advantage plan, but you have the widest choice of hospitals and doctors. And, you have good protection against health and financial risk.
    • If you’re in a private Medicare plan, you might save some money upfront, but you have a limited group of doctors and hospitals you can use. If you end up needing a lot of health care, it’s hard to know whether the doctors or hospitals in the health plan’s network will meet your needs. If you use out-of-network doctors and hospitals, you will likely spend a lot out of pocket for that care, more than your costs in traditional Medicare with a Medicare supplemental plan. Also, if you will be traveling out of area and you need care, it’s not likely your care will be covered, except in emergencies or urgent care situations.

    2. Is your Medicare (Part D) drug coverage meeting your needs? If you have Part D drug coverage, you should consider your options and not assume that the plan you have is still the one that you want or will cover the same drugs with the same cost sharing next year. The Part D plans often change the drugs they cover and the terms under which they cover drugs from one year to the next, as well as midyear sometimes. What makes sense this year may not make much sense at all next year. In 2015, the average monthly premium nationally is $32.

    To compare Medicare plan benefits and cost, visit the Open Enrollment Center page on the Medicare website.
  • Three things to know about cardiac care

    Three things to know about cardiac care

    More than 2 million people in America experience a heart attack or heart failure each year. Often they need cardiac care, specifically rehab services.  Here’s what you should know:
    1. Coverage: Medicare will cover most of the cost of your cardiac rehab care if you meet the qualifying criteria, which differs depending upon whether you receive the care as an outpatient or as an inpatient, after a hospitalization. The amount of care you receive will depend upon your condition.
    2. Access: Your doctor is responsible for prescribing the services you need and should be able to help you decide where to receive them. If you qualify for cardiac care in a Medicare-certified facility, make sure that the facility has a good cardiac rehab program.
    3. Cost: If you have traditional Medicare and supplemental insurance that fills gaps in coverage, your cardiac care costs should be covered once you’ve met the deductible.  If you are in a Medicare HMO or other private plan, you are likely to have a copay.  You should ask about it.