MAKING HEALTH INSURANCE MAKE SENSE

MAKING HEALTH INSURANCE MAKE SENSE

i Nov 30th No Comments by

Answers to Some of the Most Commonly Asked Questions

Q:    Can you explain what the Medicare Part A and Part B premiums will be in 2016?

 A:   For most beneficiaries, the answer is simple:  they will be the same in 2016 as they were in 2015.  That’s because there will be no Social Security cost-of-living increase in 2016 benefits.  As a result, most people will pay the same premium for Part B, as long as the premium is withheld from their Social Security benefit check. That’s about 70% of all people on Medicare. Also, since 99% of beneficiaries get Part A Medicare coverage without a premium (since they or their spouse have at least 40 calendar quarters of Medicare-covered employment during their lives), that won’t change, either.

Q:  What about people who don’t qualify for the no increase in 2016 in their Medicare Part B Premiums?  How much will they pay?

 A:  Some beneficiaries will not qualify for the rule that keeps their Part B premium unchanged.  These include:  people who do not yet collect Social Security benefits; people who will become  new beneficiaries in 2016;  people who have their Part B premiums paid through a different process, such as Federal retirees; and people who pay an additional premium already, because of their income.  People on both Medicare and Medicaid, whose premiums are paid by their States, are also ineligible for unchanged premiums.  All beneficiaries in those categories will see an increase in their Part B premiums to $121.80 per month (higher for those with income-related surcharges).  These groups together account for about 30% of Medicare’s 52 million beneficiaries.

Q:  Are Medicare Part A and B deductibles going up, too?  Will some people be exempt from those increases?

 A:  The Part A deductible for an inpatient hospital admission is going up from $1,260 in 2015 to $1,288 in 2016.  Co-insurance for stays beyond 60 days, and for stays in a skilled nursing facility following an inpatient admission will also increase, by a modest 2.2% in 2016.

The Part B deductible is increasing from $147 in 2015 to $166 in 2016.  This is the first increase in the Part B deductible in 3 years.  These increases will apply to all beneficiaries; those exempt from premium increases will still be subject to the new deductible and co-pay amounts in 2016.

For more information about 2016 premiums and deductibles, you can go to www.medicare.gov, or call Medicare any time of day or night, at 1-800-MEDICARE [1-800-633-4227].

 

Q:  For those consumers who do not have Medicare, or other health insurance, I hear that it is Open Enrollment again through January 31, through the Health Insurance Marketplace; can you tell me about this?

 A:  Yes, Open Enrollment for 2016 Health Insurance Marketplace coverage at healthcare.gov started November 1, and goes through January 31. If you want coverage to begin January 1, you need to enroll before December 15.

The Health Insurance Marketplace is a way for those without health insurance or those who want to look for a better option to find health care coverage from private health insurance plans that fits their budgets and their needs, and you can’t be turned down because of a pre-existing condition – which before the Affordable Care Act law, you could. The Health Insurance Marketplace is not for those who already have or who are eligible for Medicare.

Financial help is available to make coverage more affordable. About 8 out of 10 people who are eligible for Marketplace coverage qualify for financial assistance to lower the cost of their monthly premiums.  And, for many consumers premium increases from last year will be offset because they receive tax credits to make their coverage more affordable.

If you are already enrolled in a Marketplace plan and your plan is still going to be available in 2016, and you want to keep it then you do not have to do anything. However, it pays to shop. You might find a plan that saves you money or has better coverage or both. Last year, those who switched plans within the same level of coverage from the year before, saved an average of nearly $400 on their annual premiums after tax credits.

It is important too that consumers who already enrolled and who are receiving the Advanced Premium Tax Credits, (help with monthly premiums) or the Cost Sharing Reductions, (help with other out of pocket costs) update their applications with their current household income and household size, from last year so that they do not run the risk of losing this help or having to pay back some of the assistance when they file their income taxes next year.

The Affordable Care Act law says that individuals of all ages, including children, have to have minimum essential health coverage, or qualify for an exemption from it, such as making too little to file income taxes, or pay a penalty when filing his or her federal income tax return, as those without health insurance cause insurance premiums to rise, for those who do have health insurance, when the uninsured utilize the health care system.

Coming up in 2016, the penalty for not having health insurance will be 2.5% of your income or $695 per person, whichever is higher and the bottom line is you still won’t have peace of mind coverage if and when you need health care if you don’t enroll in health insurance.

The Affordable Care Act makes quality health insurance available to millions of people who were previously locked out or priced out of the health insurance market.

Free, confidential expert help is available.

  • Apply by phone. Call 1-800-318-2596, 24 hours a day to enroll over the phone, and get help in up to 150 different languages.
  • Apply in person. Free in person help is also available in your community at localhelp.healthcare.gov
  • Apply online at healthcare.gov or gov
  • You can also, Apply by mail. Complete a paper application and mail it in. You can download the paper application form and instructions from HealthCare.gov

 

December 2015 Fraud Prevention Fact

i Nov 30th No Comments by

Does the term MSN mean anything to you? If you are on Original Medicare, it should. The letters MSN stand for Medicare Summary Notice, the form that Medicare sends every three months for Part A and Part B-covered services. The MSN shows all your services or supplies that providers and suppliers billed to Medicare during the three-month period, what Medicare paid, and the maximum amount you may owe the provider. This information can help you figure out if someone is billing Medicare for a service you did NOT receive.

Now this same information is available to you online. You may choose to receive an electronic MSN instead of the paper copies.  With the eMSN, you can get the information monthly instead of quarterly. You can see your claims anywhere and anytime you have access to the Internet. All you need to do is to sign into Medicare.gov with your username and password. The eMSN cannot get lost or stolen in the mail.

The eMSN means you will be able to check your claims and spot billing errors more quickly. If you find and report errors, Medicare can act on the information sooner, stop payment, and go after the bad guys.

If you opt for eMSN’s, you are helping the government save money. If just 7 percent of people on Medicare opted for eMSN’s, the federal government could save $44 million in just five years.

Whether you sign up for the electronic MSN or get the paper copy in the mail, always pay attention to the information on them. They will tell you how much Medicare has paid each provider for each service.  If you believe that Medicare was billed for a service or product you did not receive, you may question your provider first, and then call Medicare for help. Call the Missouri SMP – the Senior Medicare Patrol – at (888)515-6565 if you suspect you are the victim of Medicare fraud or abuse.

SMPs are funded through the U.S. Department of Health and Human Services, Administration for Community Living, Administration on Aging.

 

Medicare Open Enrollment: Five Things You Need to Do

i Nov 30th No Comments by

Routines help keep us focused, organized, and even healthy. However, if your health routine doesn’t include preparing for Medicare’s Open Enrollment, now’s the time to kick-start a new healthy habit.

If you have a Medicare health or prescription drug plan, you should review and compare coverage options. The Open Enrollment runs through December 7 and is the time you can make changes to your plan. Even if you’re happy with your current coverage, you might find a better fit for your budget or your health needs. If you miss an Open Enrollment deadline, you’ll most likely have to wait a full year before you can change your plan.

Here are five things every Medicare beneficiary can do to get in the Medicare Open Enrollment routine.

  1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network.
  1. Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Does your current plan cover your new medications? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change.
  1. Find out if you qualify for help paying for your Medicare. Learn about programs in your state to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and co-payments, and Medicare prescription drug coverage costs. Visit Medicare.gov or make an appointment with a local State Health Insurance Assistance Program (SHIP) counselor if you need help.
  1. Shop for plans that meet your needs and fit your budget. You can use the Medicare Plan Finder tool to see what other plans are offered in your area. A new plan may:
  • Cost less;
  • Cover your drugs costs; or
  • Let you use the providers you want, like your doctor or pharmacy.

If you find that your current coverage still meets your needs, then you don’t need to make any changes. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.

  1. Check your plan’s star rating before you enroll. The Medicare Plan Finder includes Star Ratings for the 2016 Medicare health and prescription drug plans. Plans are rated for quality on a one- to five-star scale: one star represents poor performance and five stars represent excellent performance. Be sure to use the ratings to compare the quality of any health and drug plans you are considering.

These are a few easy ways to get a jump-start on your Medicare Open Enrollment. For more information, call 1-800-MEDICARE (1-800-633-4227) and say “Agent.” TTY users should call 1-877-486-2048. Help is available 24 hours a day, including weekends. If you need help in a language other than English or Spanish, let the customer service representative know the language. You can also visit a local SHIP counselor. SHIP counselors provide free, one-on-one, non-biased Medicare assistance. Get free personalized health insurance counseling by calling your SHIP at the number listed on the Medicare contacts page or call 1-800-MEDICARE.

This post originally ran on the Social Security Administration’s blog. To see the original post, visit http://blog.socialsecurity.gov/medicare-open-enrollment-five-things-you-need-to-do/

Medicare Questions? We have Answers!

i Nov 25th No Comments by

CLAIM Facebook ad 1

 

  1. What do I do if I am enrolled in Medicare but not enrolled in a Medicare Part D Plan?

It is important to sign up for a Medicare Part D Drug plan when you are first eligible. If you do not sign up when first eligible you will most likely have to pay a late penalty.  If you have creditable drug coverage (coverage that is as good as or better than Medicare) you will not have a late penalty.

There are 2 ways to receive a Medicare Prescription Drug Plan or a Part D plan:

You can add drug coverage to Original Medicare (Part A and B is called Original Medicare)

You can get a Medicare Advantage Plan with drug Coverage.  Advantage Plans are HMO’s or PPO’s you get your Part A and B and Drug Coverage through Advantage Plans

For more information or to enroll contact your State Health Insurance Assistance Program (SHIP) for Missouri the number is 1-800-390-3330.

 

2. What do I do if I am enrolled in a non-benchmark Medicare Plan, but found out that I am eligible to enroll into a “Benchmark” plan.

There are 4 benchmark plans in 2016 that a beneficiary receiving extra help can enroll.  The premium for the benchmark plan will be zero and there is no deductible.  If a beneficiary, who receives full extra help, enrolls in a non-benchmark plan then the premium will be reduced and the beneficiary will be required to pay that monthly premium.

Also, another important reason to work with a SHIP Counselor, and to have the Counselor enter the current drugs that the Beneficiary takes, is to make certain that all drugs are on the ‘Benchmark’ Plan’s Formulary!!  Even though a Beneficiary is eligible and could enroll into a $0 Premium plan, if their drugs are not covered by the Benchmark Plan’s formulary, this could cause a much bigger issue.  The cost of those drugs that are not covered, could end up causing the Beneficiary to pay a great deal of money out of pocket!

 

3. What do I do if I am already enrolled in Medicare, but also have employer-sponsored or other third-party insurance plan? 

If a beneficiary, 65 years or older, is enrolled in Medicare while he/she is still working and is also enrolled in their employer sponsored plan, the employer plan will be primary to Medicare, in many cases.  In order for this statement to be true for the employee and/or 65 year old spouse, there has to be 20 or more employees, and the beneficiary must still be actively working.  If the employee (or spouse) is under the age of 65 and is enrolled in Medicare due to a disability, in order for the employer plan to be primary in this situation, there must be 100 or more employees.  If the employer plan IS primary to Medicare, the beneficiary is able to delay Part B, or if already enrolled, could drop Part B, without incurring a penalty.  While the employee is still working, he or she may sign up for Part B at any time.  When the Beneficiary decides to end employment, they will then receive a Special Enrollment Period to enroll (or re-enroll) into Part B.  This Special Enrollment Period will last up to 8 months after employment ends, or until the employer insurance ends, whichever comes first.

 

4. What do I do if I enroll in a Medicare plan and later have to make an adjustment because of a major life event?

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook.  In Missouri, call 1-800-390-3330. Almost all major life events will have a Special Enrollment Period (SEP). This will let you make the changes you need for Medicare coverage. Call to find out if a Special Enrollment Period can work for you.

 

5. What do I do if I want to change to a different Part D Plan? 

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook.  In Missouri, call 1-800-390-3330.  Have your Medicare card and list of medications ready.

 

6. What do I do if I need help paying for Medicare Part D Plan premiums, deductibles, and co-pays?

Medicare has a program called Extra Help to help reduce Part D premiums, deductibles, co-pays, and eliminate the coverage gap.  This program is income & resource based, even if your income & resources are slightly higher than the limits, you are encouraged to apply.

You will need to check with your state to see if this program exists in your area.

You can find more information about this Program on the CLAIM website www.missouriclaim.org or by contacting your states’ State Health Insurance Assistance Program (SHIP). In Missouri the number is 1-800-390-3330

Missouri Rx is another program that can help save money on prescriptions.  Missouri Rx covers 50% of the Medicare Part D “gap” and pays 50% of the Medicare Part D Co-pays.

This is the only assistance program that does not count your resources.

To learn more about this program contact your local State Health Insurance Assistance Program (SHIP), go to our website Missouriclaim.org.

 

7. Who do I contact to help me enroll in a Part D Plan?

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook.  In Missouri, call 1-800-390-3330.  Have your Medicare card and list of medications ready.  The SHIP volunteer will help you choose the best plan for you based on your current medications, pharmacy of choice, least restrictions and best prices.

 

8. Who do I contact for information about Long Term Care assistance? 

To obtain the most accurate and helpful information regarding Long Term Care Insurance, I would start with Missouri Department of Insurance.  The department’s website is http://insurance.mo.gov/consumers/LongTerm.  On this site you will find information such as Frequently Asked Questions, Long Term Care Costs, and a variety of additional links and resources.

 

9. Who can I contact to learn more about Medicare enrollment and benefits?  

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. We refer your call to a trained SHIP counselor in your area who will know the local program(s) you seek. We have 300 counselors statewide to help you.

 

10. What happens if I miss the enrollment deadline? What do I do?

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330.  We will evaluate your situation and see if you might qualify for a Special Enrollment Period.  No promises but we will try!

 

2016 Medicare Parts A & B Premiums and Deductibles Announced

i Nov 12th No Comments by

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

Part B Premiums/Deductibles

As the Social Security Administration previously announced, there will no Social Security cost of living increase for 2016. As a result, by law, most people with Medicare Part B will be “held harmless” from any increase in premiums in 2016 and will pay the same monthly premium as last year, which is $104.90.

Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016.

“Our goal is to keep Medicare Part B premiums affordable. Thanks to the leadership of Congress and President Obama, the premiums for 52 million Americans enrolled in Medicare Part B will be either flat or substantially less than they otherwise would have been,” said CMS Acting Administrator Andy Slavitt. “Affordability for Medicare enrollees is a key goal of our work building a health care system that delivers better care and spends health care dollars more wisely.”

Because of slow growth in medical costs and inflation, Medicare Part B premiums were unchanged for the 2013, 2014, and 2015 calendar years. The “hold harmless” provision would have required the approximately 30 percent of beneficiaries not held harmless in 2016 to pay an estimated base monthly Part B premium of $159.30 in part to make up for lost contingency reserves, according to the 2015 Trustees Report. However, the Bipartisan Budget Act of 2015 mitigated the Part B premium increase for these beneficiaries and states, which have programs that pay some or all of the premiums and cost-sharing for certain people who have Medicare and limited incomes. The CMS Office of the Actuary estimates that states will save $1.8 billion as a result of this premium mitigation.

CMS also announced that the annual deductible for all Part B beneficiaries will be $166.00 in 2016. Premiums for Medicare Advantage and Medicare Prescription Drug plans already finalized are unaffected by this announcement.

To get more information about state-by-state savings, visit the CMS website at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-11-10.html.

Since 2007, beneficiaries with higher incomes have paid higher Part B monthly premiums.  These income-related monthly adjustment amount (IRMAA) affect fewer than 5 percent of people with Medicare. Under the Part B section of the Bipartisan Budget Act of 2015, high income beneficiaries will pay an additional amount. The IRMAA, additional amounts, and total Part B premiums for high income beneficiaries for 2016 are shown in the following table:

Beneficiaries who file an individual tax return with income: Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000 Less than or equal to $170,000

$0.00

$121.80

Greater than $85,000 and less than or equal to $107,000 Greater than $170,000 and less than or equal to $214,000

48.70

170.50

Greater than $107,000 and less than or equal to $160,000 Greater than $214,000 and less than or equal to $320,000

121.80

243.60

Greater than $160,000 and less than or equal to $214,000 Greater than $320,000 and less than or equal to $428,000

194.90

316.70

Greater than $214,000 Greater than $428,000

268.00

389.80

 

Premiums for beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000

$0.00

$121.80

Greater than $85,000 and less than or equal to $129,000

194.90

316.70

Greater than $129,000

268.00

389.80

Part A Premiums/Deductibles

Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment.

The Medicare Part A annual deductible that beneficiaries pay when admitted to the hospital will be $1,288.00 in 2016, a small increase from $1,260.00 in 2015. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. The daily coinsurance amounts will be $322 for the 61st through 90th day of hospitalization in a benefit period and $644 for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 in a benefit period will be $161.00 in 2016 ($157.50 in 2015).

Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to receive coverage under Part A. Individuals with 30-39 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $226.00 in 2016, a $2.00 increase from 2015. Those with less than 30 quarters of coverage pay the full premium, which will be $411.00 a month, a $4.00 increase from 2015.

 

Deductibles and Coinsurance for 2016

Part A Deductible and Coinsurance Amounts for
Calendar Years 2015 and 2016
Type of Cost Sharing 

2015

2016

Inpatient hospital deductible

$1,260

$1,288

Daily coinsurance for 61st-90th Day

315

322

Daily coinsurance for lifetime reserve days

630

644

SNF coinsurance

157.50

161.00

 

For more information on the 2016 Medicare Parts A and B premiums and deductibles (CMS-8059-N, CMS-8060-N, and CMS-8061-N), visit: https://www.federalregister.gov/public-inspection.  

A Veterans Day salute

i Nov 11th No Comments by

Veterans Day image

Join us for a Veterans Day Thunderclap!

November 11th is set aside every year to honor those who have served our country through military service. What better way to recognize their service than by deploying in your community in their honor? Find a way to serve in your local community. Let a veteran know that you are serving in his or her honor.

In addition, help us salute the nation’s honored veterans today by taking part in the #HonoringVets Thunderclap on Social Media: https://www.thunderclap.it/projects/33003-honoringvets-on-veterans-day?locale=en