JustCare

Tag: Enrollment

  • 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.

  • 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 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.