JustCare

Tag: SHIP

  • Medicare Open Enrollment: Consider changing health plans

    Medicare Open Enrollment: Consider changing health plans

    Medicare Open Enrollment begins on October 15 and runs through December 7. During this time, it’s wise to take a hard look at your Medicare options for next year. Your health coverage may be changing and, you should consider changing Medicare health plans.

    If you’re enrolled in a Medicare Advantage plan or a Part D drug program, look at how your current plan is changing and your 2018 options. You may want to switch plans. Health plan costs and benefits often change significantly from one year to the next. Although it’s hard to know whether a health plan will meet your future health care needs, you may be able to save money by switching.

    You should know that after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you can do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    Before you make your choice, keep these facts in mind.

    • Traditional Medicare:
      • Traditional Medicare, the government health insurance option, is the Medicare health plan choice for seven out of ten people with Medicare.
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare charges a deductible—the amount you pay before coverage begins–and coinsurance for most of your care.
      • Supplemental insurance—Medicaid, retiree coverage from a job or a Medicare supplemental insurance plan you can buy–generally fills most or all coverage gaps. If you’re in traditional Medicare, be sure you have supplemental insurance, which protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans:
      • Commercial health plans that contract with Medicare
      • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans often charge an additional premium, a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. These costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.
      • Medicare Advantage plans can be less costly than traditional Medicare if you see doctors in the network and do not have a complex condition requiring substantial health care services.
      • When people need costly services, Medicare Advantage plans may restrict access to the doctors and hospitals people want to use, and out-of-pocket costs can easily reach the $6,850 limit for in-network care. These costs can be even higher if people are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if people want to use specialists out of network.

    If you’re in a Medicare Advantage plan now:

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also check to make sure your doctors and hospital are still in the network.
    • It’s also wise to look at your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you do want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.
    • If you are unhappy with your Medicare Advantage plan choice, you have the right to disenroll any time between January 1 and February 14 and switch into traditional Medicare.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch plans, your new coverage will begin on January 1.

    Here’s more from just Care:

  • Long-term care insurance likely won’t deliver what you need

    Long-term care insurance likely won’t deliver what you need

    You may already know that seven in ten of us will eventually need some type of long-term care services and supports. But, you may not know that most people today receive that care at home and not in a nursing home. The inevitable question is how to pay for it when it is needed, and is it worth getting long-term care insurance as a way to afford this care?

    Long term care insurance may not deliver what you need. Fewer than one in ten people now buy this insurance and there are many good reasons why they do not. Judith Graham explains for Kaiser Health News that this insurance is often very expensive, and it primarily covers nursing home care and not the home care people want.

    Indeed, long-term care insurance may never meet people’s needs, both in terms of cost and coverage. Some people believe that long-term care insurance would be less expensive if it only covered home care. Nationally, home care is less costly on average than nursing home care, $46,000 (daily for about six hours a day) v. $82,000 a year. But, home care can be extremely costly if it is needed round the clock, and costs vary by community.

    Moreover, the cost of care has risen rapidly, far faster than inflation. Even a five percent inflation adjustment in a long-term care policy is likely not to keep up with rising costs. You could not count on a policy with a one-percent inflation adjuster, which some plans now offer, to meet your needs. And, unless you can foresee being able to pay an ever increasing premium over ten to twenty or more years—“level premiums” can and too often do rise significantly—you will likely be throwing away your money.

    Similarly, if you do not buy as much home care coverage as you will need, you will likely be wasting your money. More than a quarter of people needing long-term care services will need these services for as long as two years. Around one in eight of them will need services for between two and four years. And, one in seven of them will need these services for more than five years.

    Unless you have family you can count on for round-the clock care, you take a gamble with partial coverage from a long-term care policy. People wealthy enough to afford round-the-clock home care may be better off simply setting aside the money than buying long-term care insurance. And, millions of older adults qualify for Medicaid coverage of long-term care.

    If you have limited income and assets, depending upon where you live, Medicaid will often cover your long-term care needs. In many states, even if your income and assets are too high to qualify for Medicaid, you can spend down to the Medicaid eligibility level once you need a lot of care.

    So, before spending the time and resources to consider a long-term care policy, speak to an independent expert, such as a State Health Insurance Program (SHIP) counselor. Do not rely on the advice of an insurance agent or long-term care insurance salesperson.

    It’s important to plan ahead. The U.S. Department of Health and Human Services estimates that more than six million people over 65 have a “high need” for home care or nursing home care. They need help with two of five activities of daily living such as eating, bathing, toiletting, dressing or moving from their beds to a chair for 90 days or more. Or, they need a lot of help because they have dementia.

    Here’s more from Just Care:

  • Check your medical bills before paying them

    Check your medical bills before paying them

    All it takes is a visit to the doctor and a few tests or pretty much any visit to the hospital and you’re very likely to see a large number of medical bills. They just seem to keep rolling in, even when you’re relatively healthy. Expert advice is to check your medical bills before paying them–carefully–as they may be wrong.

    All kinds of factors can cause errors, including simple human data inputting mistakes or miscoding by health care providers. So much information is collected and reported that it’s inevitable that there will be mistakes.

    So, check to make sure that your medical bills are for services you actually received. If you’re not sure, call your doctor to find out. And, make sure you understand your health insurer’s deductibles and copays. They can change from one year to the next.

    Beware of surprise medical bills, bills you don’t expect from doctors who are not in your insurer’s network. Too often, people get care from out-of-network doctors who are working in an in-network hospital. If you get a surprise medical bill, here’s how to protect yourself and contest it.

    And, if your insurer denies coverage, you should appeal. If you have Medicare, it’s easy, costs you nothing, and you have a high likelihood of winning and getting Medicare to pay. With traditional Medicare, all you need do is return the Medicare summary notice to Medicare, circle the denial and fill out the section at the bottom of the MSN for the Medicare insurance carrier to review the denial. For more information, read this post from Just Care on how to fight back and appeal if your health plan denies coverage.

    If you have Medicare, State Health Insurance assistance Programs, SHIPs, provide free counseling to help advise you on your medical bills. You can find the number for your state’s SHIP online or by calling  800-677-1116. You can also contact the Medicare Rights Center, which provides free Medicare counseling services, at 1-800-333-4114. For information on other free and low-cost services, visit the Just Care Get Help page.

    Here’s more from Just Care:

  • Turning 65? Make sure you’re not involuntary enrolled in a Medicare Advantage plan

    Turning 65? Make sure you’re not involuntary enrolled in a Medicare Advantage plan

    An increasing number of people first going on Medicare are being involuntarily enrolled in Medicare Advantage plans when they turn 65. The Centers for Medicare and Medicaid Services, CMS, has given their health insurers the right to enroll them in the insurers’ Medicare Advantage plans–commercial insurance plans that offer Medicare benefits under special conditions–without their permission. If you’re turning 65, make sure you’re not involuntary enrolled in a Medicare Advantage plan.

    To date, CMS already has approved proposals from 27 insurance companies to “seamlessly enroll” their Medicaid and commercial members in their Medicare Advantage plans once they become eligible for Medicare. Aetna, UnitedHealth Group, Health First, Anthem and Blue Cross Blue Shield of Michigan are among the companies with permission. For the full list, click here.

    These insurers have permission from CMS to enroll their members who become eligible for Medicare in their Medicare Advantage plans without signed authorization from their members. These enrollments should be described as “troubling,” not “seamless.” The insurers’ Medicare Advantage plans generally have different doctor and hospital networks and different cost structures from the pre-Medicare health plans they offer members.

    This automatic and troubling Medicare Advantage enrollment undermines people’s choice and jeopardizes their continuity of care, leaving them at significant financial and health risk. Indeed, traditional Medicare is the only choice that maximizes the likelihood of that continuity of care.

    People who turn 65 should be able to assume they are enrolled in traditional Medicare, which has been the case. Historically, people who don’t affirmatively choose to enroll in a Medicare Advantage plan by signing up with one are enrolled in traditional Medicare. If they are enrolled in a Medicare Advantage plan without their knowledge, it can wreak havoc on their lives.

    When people believe they are enrolled in traditional Medicare–and they are not–they will use whichever doctors and hospitals they please. Since these providers are likely not in the Medicare Advantage plan’s network into which they have been involuntarily enrolled, they can get hit with huge out-of-network charges.

    CMS does not notify the people who are involuntarily enrolled in their health plans’ Medicare Advantage plans that they are no longer in traditional Medicare. CMS relies on the insurers to notify their members. But, people may not read mail from their insurers once they’ve signed up for Medicare. Instead, they may assume they are enrolled in traditional Medicare, seek care, and rack up huge costs from out-of-network providers.

    By allowing the insurers to automatically involuntarily enroll people in their Medicare Advantage plans, CMS is working against the interests of people with Medicare; it is disregarding its own advice to people choosing a Medicare plan to compare their options carefully. People are only protected if they receive and read the required health plan notification informing them of their automatic enrollment and their right to opt out within 60 days.

    Enrollment in a Medicare Advantage plan must be voluntary. So, if you or anyone you know is enrolled in Medicare Advantage plan involuntarily and unknowingly racks up bills from out-of-network doctors and hospitals, call your local State Health Insurance Assistance Program or SHIP for assistance disenrolling.