Health Insurance Archives - Hanover Mortgages

November 8, 2021

How to Restructure Your Assets to Qualify for Medicaid

There’s a common misperception that Medicaid is only for poor and low-income seniors. But actually, with a little proper and thoughtful estate planning, all but the very wealthiest people can often qualify for program benefits.

In 1965, Congress established the Medicare program to enhance insurance coverage and ensure greater financial solvency for seniors — regardless of income, current health status or past medical history. At the same time, they outlined parameters for Medicaid —a state-managed, means-based program to provide additional coverage to low-income and disabled individuals and families.

Unlike Medicare, however, Medicaid is not a federally run program. Operating within broad federal guidelines, each individual state decides its own Medicaid eligibility criteria, eligible coverage groups, services covered, administrative and operating procedures, and payment levels.

What makes the Medicaid program especially attractive, however, is its ability to cover long-term nursing home care costs and many home health care costs — things not covered by Medicare. Imagine working, saving and investing over a lifetime, only to see your wealth quickly wiped out by the costs of long-term care — assets that otherwise could provide a meaningful legacy to your family.

Strategies to meet income requirements

Given both the cost and growing need for long-term care, Medicaid has become a highly prized benefit, providing coverage for long-term nursing care as well as many home health services. But the current income limit for Medicaid waivers in most (but not all) states is $2,382/month ($28,584 per year) per individual.

If your income exceeds your state’s Medicaid eligibility threshold, there are two commonly used trusts that can be used to divert excess income in order to maintain your program eligibility:

Qualified Income Trusts (QITs): Also known as a “Miller trust,” this is an irrevocable trust into which your income is deposited and subsequently controlled by a trustee whom you select. There are very tight restrictions on what the income placed in the trust can be used for (e.g., both a personal and if applicable a spousal “needs allowance,” as well as any medical care costs, including the cost of private health insurance premiums). But because the funds are legally owned by the trust (rather than you individually), they no longer count against your Medicaid income eligibility.
Pooled Income Trusts: Similar to QITs, these are irrevocable trusts into which your “surplus income” can be diverted to maintain Medicaid eligibility. In order to take advantage of a pooled income trust, however, you must qualify as disabled. Your income is pooled together with the income of others, and managed by a non-profit charitable organization that acts as trustee and makes monthly disbursements to pay expenses on behalf of the individuals for whom the trust was created. Any funds remaining in the trust upon your death are then used to help other disabled persons in the trust.

Essentially, these income trusts are specifically designed to create a legal pathway to Medicaid eligibility for those with too much income to qualify for assistance, but not enough wealth to pay for the rising cost of much-needed care.

Strategies to meet asset requirements

Like income limitations, the Medicaid “asset test” is complicated and varies from state to state. Generally, your home’s value (up to a maximum amount) is exempt as long as you still live there or intend to return. Beyond that, however, most states require you to spend down other assets to around $2,000/person ($4,000/married couple) to qualify.

You could choose to simply transfer ownership of your assets to other family members. But that introduces a number of new risks — from losing those assets as a result of that person getting divorced, experiencing a bankruptcy/lawsuit, or dying before you. Plus, you’re relying on that individual to be both trustworthy and financially prudent. And it’s not as simple as it sounds, considering Medicaid’s five-year look-back period (more on that in a bit).

Alternatively, you may want to consider:

Asset Protection Trusts: You can transfer most or all of your assets to a trust which, if properly designed, removes those assets from your estate. Often referred to as “Medicaid Trusts,” these asset protection structures can help you not only to qualify for Medicaid benefits, but also protects your assets from other potential creditors. If income-generating assets (like stocks and bonds) are placed in the trust, you can choose to still receive the income from those assets. You can even transfer your home to the trust and retain the right to live in it for the duration of your life. Then, upon your death, the assets will be distributed to your beneficiaries according to the trust documents. What’s more, beneficiaries will enjoy a “step up” in basis on any trust assets when they receive them — avoiding capital gains on the increase in value accrued during your life.
Spousal Transfers and Refusals: Medicaid laws permit the transfer of assets between spouses — without being subject to the five-year look-back period or any penalties. Married couples, therefore, can transfer any assets in the name of the spouse who needs care to the other spouse. A few states (e.g., New York and Florida) even permit something called “spousal refusal” — where the healthy spouse can legally refuse to provide support for the spouse needing care, making them immediately eligible for Medicaid services. While Medicaid does have a right to request that a healthy spouse financially contribute to a spouse who’s receiving care, they sometimes opt not to go through the required legal action to seek payment. Even if they do, they’re generally willing to significantly discount the cost of services. So this could prove an effective strategy.

One other option you might want to consider for reducing your “countable assets” is the establishment of an irrevocable funeral trust, which allows both you and your spouse to prepay funeral and burial expenses. Some very wealthy couples even opt to pursue a Medicaid Divorce, where the couple legally divorces solely for the purposes of protecting their assets for the healthy spouse.

Why planning well in advance matters

It’s never too late to begin creating a health care plan. But like all planning, the more time you have, the more flexibility you’ll have and the easier it will be. Medicare employs a five-year look-back period when investigating an applicant’s finances.

Transfers of certain assets made less than five years before you require home care or enter a nursing home or assisting living facility may be disallowed. This means, for Medicaid purposes, you’ll still be deemed to own them and required to spend them down before qualifying for program coverage. And transfers to a trust — just like transfers to individuals — are still subject to this look-back period.

Keep in mind that Medicaid gives you little to no choice regarding where you receive care. Only facilities with Medicaid-approved beds can accept you, and your ability to remain in your own home when receiving care decreases, since many states only cover limited home health care services through their Medicaid programs. So it’s a good idea to sit down with your financial adviser to carefully explore your various long-term care insurance options before deciding on a strategy.

Thirty states and the District of Columbia offer state tax incentives to residents who purchase long-term care insurance policies. And almost all states participate in the long-term care partnership program, which allows people who’ve purchased long-term care insurance to qualify for Medicaid while preserving some of their assets rather than spending them down.

Janney Montgomery Scott LLC, its affiliates, and its employees are not in the business of providing tax, regulatory, accounting or legal advice. These materials and any tax-related statements are not intended or written to be used, and cannot be used or relied upon, by any taxpayer for the purpose of avoiding tax penalties. Any such taxpayer should seek advice based on the taxpayer’s particular circumstances from an independent tax adviser.

This article was written by and presents the views of our contributing adviser, not the Kiplinger editorial staff. You can check adviser records with the SEC or with FINRA.

Vice President & Head of Wealth Planning, Janney Montgomery Scott

Martin Schamis is the head of wealth planning at Janney Montgomery Scott, a full-service financial services firm, providing comprehensive financial advice and service to individual, corporate and institutional investors. In his current role, he is responsible for the strategic direction of the Wealth Planning Team, supporting more than 850 financial advisers who advise Janney’s private retail client base. Martin is a Certified Financial Planner™ professional.

Source: kiplinger.com

October 26, 2021

Billed for a COVID-19 Vaccine? Don’t Pay

The COVID-19 vaccination—along with the recently rolled out booster shot—is absolutely free, thanks to the Coronavirus Aid, Relief and Economic Security (CARES) Act. Even so, nearly one-third of unvaccinated adults say they’re concerned about out-of-pocket costs, according to a Kaiser Family Foundation survey. Those concerns aren’t helped by reports that some people have been billed for their vaccination appointment.

The skepticism isn’t surprising, because a free service is “kind of an anomaly in the American health care system,” says Caitlin Donovan, senior director of public relations at the nonprofit Patient Advocate Foundation. But as far as the COVID-19 vaccines are concerned, she says, “nobody should be billed for the vaccine. Not a provider fee, no co-pay, nothing.”

Individuals may be charged for COVID-19 vaccinations because providers bill them directly, instead of their insurers, or due to human error in medical billing systems. In either case, Donovan says, you should call your provider directly and dispute the charges. Your insurer also may be willing to help you get the bill waived.

If you’re concerned about being charged, Donovan recommends getting your vaccination at a public facility, such as a community center, instead of at your doctor’s office or local hospital. To find a center near you, visit www.vaccines.gov.

Source: kiplinger.com

October 1, 2021

Your Guide to Open Enrollment 2022

It has been said that nothing is certain except death and taxes, but you can add a third item to the list: rising health care costs. Large employers expect health care expenses to increase 6% in 2022, for a total of about $16,300 per employee (including contributions from both the employee and employer), according to the Business Group on Health’s annual survey. Although large employers expect hospitalizations and other costs associated with COVID-19 to contribute to the increase in health care spending, they predict that treating conditions such as cancer, diabetes and heart disease will have an even greater impact.

Health care costs were flat in 2020 compared with 2019 because the pandemic led consumers to delay everything from elective surgery to annual physicals, and some consumers continued to postpone treatment in 2021. As the pandemic wanes, though, employers expect workers to schedule makeup appointments and surgeries. In addition, more than three-fourths of large employers predict that employees with chronic conditions, such as diabetes and heart disease, will increase their use of health care services, according to the Business Group on Health.

Meanwhile, to keep their health care costs down, some employers are tying premiums, deductibles and other out-of-pocket costs to wages, which means that high earners pay more for their coverage. In 2021, 40% of large employers offered some sort of wage-based cost-sharing, according to the Business Group on Health. And while the survey didn’t ask employers about their plans for 2022, that number is likely to grow.

Compare employer plans

For most people with employer-provided coverage, high-deductible health care plans will still be the name of the game. Consumers can expect to be offered one or two high-deductible plans and possibly a preferred provider organization (PPO) plan or a health maintenance organization (HMO) plan, says Mark Hope, employee benefits expert with Willis Towers Watson, a global human resources consultant. An HMO plan typically provides little or no coverage for out-of-network care. You may also need a referral from your primary care doctor to get coverage for specialist visits.

If you’re a relatively healthy individual who only needs coverage for yourself or for you and your spouse, a high-deductible health plan is probably your least-expensive option. The premiums tend to be lower than those for a traditional PPO or HMO plan. To help offset the costs of meeting a deductible, high-deductible plans typically come with a health savings account (HSA) that your employer may contribute to. Contributions are pretax (or tax-deductible for HSAs that aren’t employer-sponsored), money in the account grows tax-deferred, and withdrawals are tax-free for qualified medical expenses.

To qualify for an HSA, your 2022 plan must have a minimum deductible of $1,400 for self-only coverage or $2,800 for family coverage (the same minimums apply to 2021 plans). Before you sign up for this lower-premium plan, make sure you understand how the deductibles work, whether you have coinsurance or co-payments, and whether the coinsurance or co-payments count toward your deductible.

Co-payments are typically fixed costs tied to a specific service—say, $25 each time you see your primary-care doctor or $40 when you see a specialist. Coinsurance works on a percentage basis. You may, for example, be responsible for 10% or 20% of the total cost of the service provided, with your insurance provider picking up the rest.

For 2022 high-deductible plans, the maximum out-of-pocket cost is $7,050 for self-only coverage or $14,100 for family coverage. Keep in mind, though, that these plans are required to cover most of your preventive care, such as blood-pressure screenings, mammograms and immunizations, at no cost to you. They also may consider certain treatments connected to chronic care—for example, statins for high cholesterol and insulin for diabetes—as part of preventive treatment, meaning you can receive care at reduced or no cost without having met your deductible.

However, if you have a chronic health issue that requires you to see a doctor frequently (and it’s not part of the high-deductible plan’s preventive-care list) or you have a family, a PPO plan, if available, could be the better choice, says Patricia Graves, an employee benefits expert with the Society of Human Resource Management. The premium is higher, but the deductibles are typically lower, and the plans cover a portion of out-of-network care.

That’s what Jasmine Moore, 30, of Chattanooga considered when she recently switched employers and had to choose among two high-deductible health care plans and a PPO. Although the lower premium for a high-deductible plan was appealing, Moore decided that paying the higher PPO premium was worth it because she needs to see an allergist on a weekly basis and requires coverage for five prescription drugs.

To get a more complete picture of your total costs, your employer may provide a calculator that compares premiums and out-of-pocket costs for various plans based on your expected health care needs throughout the year. If you kept any explanation of benefit (EOB) forms from the past two to three years, along with any other receipts related to medical care, look them over to see what you’ve spent—especially if you put off appointments due to COVID-19. Your 2020 and even 2021 spending may not be a true reflection of what you and your family typically spend on health care in any given year.

Spotlight on mental health

The pandemic may be slowly coming to an end, but mental health problems will likely continue. Returning to the office, watching kids go to school or reading about world events has put many Americans on edge. They’re also more open to tapping virtual mental health services. In a May poll conducted by the American Psychiatric Association, nearly 60% of Americans said they would use teletherapy services, up from 49% in 2020. Employers are taking notice. About 90% of large employers are concerned about their employees’ long-term mental health, and 62% added new mental health benefits in 2021, including teletherapy, according to the most recent survey by the Business Group on Health. Those services are likely to remain available in 2022.

For 2022, employers are also hyper-focused on addressing the cost and stigma surrounding mental health issues. Employees with access to an employer-sponsored health care plan can expect to have access to free or low-cost telehealth counseling, along with mental health webinars. Employers are also expected to beef up family therapy options.

If you’ve been seeing a therapist throughout the pandemic, or you want to start, pay attention to whether the therapist is in your plan’s network. Although nearly half of large employers say they’re planning to expand their plan’s mental health network, your current mental health specialist may not make the cut for the 2022 plan year. If that’s the case, make sure you understand what an out-of-network therapist will cost you.

You can use funds from an HSA or a flexible spending account to cover teletherapy and in-person sessions if you are diagnosed with a mental health issue and treatment is deemed necessary. “If you want marriage counseling, for example, just to reconnect with your spouse, your HSA or FSA money generally won’t cover that,” says Jody Dietel, senior vice president of advocacy and government affairs at HealthEquity, which helps employers manage employee benefits. But if you’re diagnosed with depression and your therapist recommends that your spouse come to therapy with you, that would probably be covered under both HSA and FSA rules, she says.

More telehealth, at a cost

Workers with employer-provided health care plans can expect to see expanded access to telemedicine for everything from diabetes care to dermatology. In 2020, the average telehealth visit cost $40 to $50, according to Mercer, a benefits consulting firm. But prices are rising, particularly with respect to virtual mental and behavioral health therapy. And if you end up choosing a high-deductible health plan, you may be required to pay for any telehealth service in full until you meet your deductible, as is already the case with in-person visits.

Under the Coronavirus Aid, Relief and Economic Security (CARES) Act signed into law in 2020, insurers were allowed to waive co-payments or requirements to meet a deductible for telehealth visits without jeopardizing the tax status of their plans. This provision is set to expire on January 1, 2022, which means you could be on the hook for the cost of all telehealth services until you meet your deductible. However, health care advocates are lobbying Congress to extend the telehealth provisions.

Dental, vision, prescriptions

Once your medical needs are out of the way, don’t forget to check out your options for dental and vision care. Those are usually separate policies, with employers often offering two dental plan options and one vision plan.

This year, don’t be too quick to sign up for the cheapest dental option, or skip the coverage altogether. Regular dental and vision screenings are important, because changes in eye, tooth and gum health can signal other medical problems. If the pandemic caused you to delay some of these appointments, your dentist or optometrist may find some problems that require immediate attention.

For example, if you skipped dental appointments during the pandemic, you may need treatment—such as a crown on a decayed tooth—that could have been treated at a lower cost had it been discovered earlier. If pandemic-related stress led you to grind your teeth, you may want to explore whether your dental plan covers a mouth guard that your dentist molds to your teeth.

When signing up for a prescription drug plan, check for any changes in your coverage. Typically, coverage is split into categories, with generic drugs requiring the lowest co-payment from you. Co-payments for nonpreferred, brand-name drugs are usually higher, and some drugs may not be covered at all.

And when you check your prescriptions, keep in mind that it may be less expensive to pay cash at a big retailer, such as Walmart, than to fork over the co-payment your insurance plan requires.

HSA (and FSA) perks

You can use your health savings account to pay for a long list of out-of-pocket costs, from co-payments to contact lenses. For 2022, the HSA annual contribution limit for self-only coverage increases from $3,600 to $3,650. If you have family coverage, the limit jumps from $7,200 to $7,300 next year. If you’re 55 or older at the end of 2022, you can put in an extra $1,000 in “catch up” contributions.

Your employer may also offer a health care flexible spending account, which allows you to set aside pretax money for qualified out-of-pocket medical expenses. In 2021, you could stash $2,750 in an FSA; 2022 limits hadn’t been announced at press time.

HSA and FSA funds can also be used to purchase personal protection equipment, such as N-95 masks, hand sanitizer and self-diagnostic COVID-19 tests. You can also use HSA and FSA funds to buy over-the-counter medications to treat COVID-19 symptoms, says Dietel. (Note that you can’t have both an HSA and an FSA.)

COBRA and the marketplace

If you lost your job or left voluntarily during the pandemic, you have two options for health care: Keep your employer-sponsored coverage through COBRA (which stands for the Consolidated Omnibus Budget Reconciliation Act), or buy a policy on the individual marketplace. With COBRA, you can keep your doctors for up to 18 months, but premiums are high—an average of $600 to $700 a month for self-only coverage, or more than $1,700 a month for a family. That’s because you’re on the hook for the employer portion of your premium along with your own, plus a 2% administration fee. The American Rescue Plan offered a COBRA subsidy to laid-off workers, but it’s set to expire September 30.

The more cost-effective route is to go to the individual marketplace and sign up for a plan under the Affordable Care Act. Open enrollment starts November 1 and ends December 15. This year brings changes that could lower the cost of your premiums.

The American Rescue Plan expanded ACA subsidies, lowering premiums for individuals at every income level and eliminating them for some households. If your estimated modified adjusted gross income (MAGI) for 2021 is between 100% and 150% of the federal poverty level ($17,420 to $26,130 for a two-person household), you’ll be able to get an enhanced silver-level plan at no cost. (Generally, bronze plans have the lowest premiums and highest deductibles, platinum plans have the highest premiums and lowest deductibles, and silver and gold plans fall in between.)

Those with 2021 income of 150% to 400% of the federal poverty level will see a decline in premiums, and households with income that exceeds 400% of the FPL—$69,680 for a two-person household—will qualify for the most significant drop in cost, because the amount they pay for premiums is capped at 8.5% of their MAGI.

These changes are also a boon for young adults who are turning 26, which means they are no longer eligible for their parents’ health plan and must sign up for health care on their own. A single individual qualifies for a no-cost enhanced silver plan if his or her 2021 estimated income is between $12,880 and $19,230 for a one-person household.

To search for a plan, go to www.healthcare.gov/get-coverage and select your state from the drop-down menu. If your state runs its own health care exchange, you’ll be directed to its website. Otherwise, you’ll pick a policy through HealthCare.gov, which provides plans that are compliant with the Affordable Care Act. You can consult an ACA navigator to help you pick the best plan for you at www.healthcare.gov/find-assistance. You can also find help at www.nahu.org or www.getcoveredamerica.org.

Source: kiplinger.com

May 1, 2021

How to Budget for Insurance

The cost of insurance can be a big hit to your personal bottom line. That’s especially true when you consider all the types of coverage you may need to pay for, including auto, health, and life insurance plans. Here are some tips for how to budget for insurance without compromising your lifestyle.

Steps for Budgeting for Insurance

In addition to being legally required in many instances, insurance is often a good investment for your wallet and your peace of mind. The expense of insurance can actually save you money in the long run.

Budgeting for insurance may seem complicated, but it really comes down to two simple actions: First, decide what type of insurance you need. Then, start budgeting for it. Here are five steps for incorporating insurance into your personal finances.

1. Decide how much insurance you need

For each type of insurance you decide to get, you’ll need to decide how much coverage to buy. When it comes to insurance, cost shouldn’t be the only factor in your purchase decision. Instead, think critically about how much coverage you need. If you’re not sure how much insurance or what type to get, consider talking with an insurance agent for advice.

Do you need your homeowner’s insurance to include liability in case someone else is injured on your property? Is term life or whole life insurance better for your situation? Who needs to be covered by your auto insurance?

2. Get quotes from agents or online

Once you know what type of insurance you want and how much coverage you need, get some quotes. Shop around and get quotes from multiple companies. Remember to compare the coverage and not just the premium price—you might find that you’re getting a much better value when paying only a little more a month with one company over another.

3. Find out what the payment schedule is

Discuss the payment schedule before you agree to an insurance policy. It’s common for auto insurance companies to offer a significant discount if you can pay for six months of insurance at a time, for example. Here are some common pay schedule options for various types of coverage.

Home Insurance: Paid annually or biannually, often out of escrow if you have a current mortgage
Car insurance: Paid every six months or monthly
Life insurance: Paid monthly
Health insurance: Paid monthly or via pretax deductions from your paycheck if the coverage is through your employer

Understanding the payment schedule will help you budget for insurance more effectively.

4. Set aside enough money monthly

However you plan to pay for insurance, break the amount down into a monthly budgeted amount. For example, if your home insurance is $900 every six months, set aside $150 every month. It’s much easier to budget for $150 than it is to come up with $900 all at once.

5. “Pay” the bill monthly

If you do pay monthly, go ahead and budget so that you can pay your insurance bill at least a week before it’s due. That leaves you plenty of wiggle room if something ever comes up.

If you don’t pay monthly, act like you do. Move the monthly budgeted amount into a savings account and don’t touch it. Act like it’s not there so you’re not tempted to use it on something else and risk not having the money when the bill comes due.

How to Budget for Different Types of Insurance

Trying to include a large insurance expense in an already tight budget can be difficult. Here are some tips for making various types of insurance potentially more affordable so they are easier to budget for.

Car Insurance

The average American pays around $2,388 per year on auto insurance. But your actual expense can vary widely depending on your age, state of residence, type of car, credit score, and many other factors. Here are some tips for saving money on car insurance.

Increase your deductible. You may need to shell out a bit more in the event of an accident, but you can save a lot of money on your premiums.
Ask about discounts if you’re married, have multiple cars, are buying different types of insurance from the same company, or are a good driver. Some insurance companies also offer discounts for students with good grades.
Lower your liability amounts. This can reduce premiums, but you should ensure that it’s a good move for you financially overall.

Health Insurance

According to numbers from the Kaiser Family Foundation in 2018, the average amount people were contributing to their employer-sponsored health care plans each year was $1,186 for single coverage. You don’t have to pay that much for health insurance, though. Some ways you can save on this expense, especially if you’re purchasing as an individual through the marketplace, include:

Buy a plan with a higher deductible.
Enter all your income data into the marketplace application form to see if you qualify for subsidies or credits.
Apply for Medicaid if you’re eligible.

Life Insurance

The cost of life insurance depends heavily on your age, the type of insurance, and how much you’re purchasing. If you’re young, you might want to buy a whole-life policy that you can pay for now and still have when you’re older. If you’re older, you may want to opt for term life insurance, which is cheaper than other types.

Homeowner’s or Renter’s Insurance

One of the reasons insurance costs might be lower is because the company sees you as less of a risk. Homeowner’s and renter’s insurance may be cheaper for those that invest in security measures such as home security systems.

The Bottom Line on How to Budget for Insurance

You can get discounts and great deals on insurance if you’re willing to do your research. But, in most cases, insurance may still be a sizeable expense. Planning ahead and budgeting every month for these expenses is one of the best ways to ensure you can afford the coverage you need.

And since your insurance costs are sometimes impacted by your credit score, make sure you’re keeping up on all your other bills and reviewing your credit reports regularly.

DISCLAIMER. The information provided in this article does not, and is not intended to be, legal, financial or credit advice; instead, it is for general informational purposes only.

Source: credit.com

March 1, 2021

Understanding Your Health Insurance Deductible

Most health plans have an annual deductible—the amount you are responsible for paying before your insurance starts to cover you. If you’re lucky, you’ll have a very low deductible, or even none at all.

In many ways, the deductible is what stands in between you and your full health insurance benefits. It’s like the first hurdle you have to clear before your health plan starts to give back those premiums you paid. So, managing your deductible is key to understanding your plan and saving money.

If you’re one of the many people who find it difficult to keep track of where they are on their deductible, you might try one of the new online services, like Simplee or Cake Health, which are designed to make this much easier. In this post, we’ll explain what a health insurance deductible is, what you need to know about them, and more. Use the links below to jump to the section that best answers your query, or read through for a more detailed overview on the subject.

What is a Health Insurance Deductible?

Health Insurance Deductible Definition: A health insurance deductible is defined by HealthCare.gov as the minimum balance you pay before your insurance company starts to cover medical costs. If your deductible is $2,500 and your medical visit costs $5,000, for example, you would be responsible for the $2,500 portion. In other words, you are responsible for paying a certain amount of your medical expenses yourself, and your insurance company will begin to cover costs only after you have paid that deductible.

How do Deductibles Work?

After you’ve met your deductible, your provider will typically only ask that you cover a portion through coinsurance or copayment while they handle the rest. Keep in mind, every insurance plan is different, so it’s important that you not only understand how deductibles work, but also how they fit into your plan specifically.

Certain insurance plans will cover services such as checkups or preventative care even before your deductible is met, so be sure that you know your plan details through and through before you do or do not seek care.

Example of health insurance deductible

Let’s take a look at an example of how deductibles work to get a clearer understanding:

Let’s pretend that you have a health insurance plan with a $700 deductible. One day, you require a medical procedure that costs $7,000, which is covered in your plan. Your health insurance provider will help pay for these costs, but only after you’ve met your $700 deductible. Here’s what happens next:

You pay your $700 deductible out of pocket to the provider
Then, after you meet the deductible, your health insurance plan begins to cover the remaining balance of $6,300
Depending on your plan’s copay or coinsurance policies, you may still be required to pay a percentage of these costs

High-deductible plans vs. low-deductible plans

High-Deductible Health Plans (HDHPs) have higher deductible rates than most insurance policies, but offer up some flexibility and tax advantages that can come in handy for some individuals, plus, HDHPs typically have lower monthly premiums. HDHPs come with a Health Savings Account or a Health Reimbursement Arrangement (HRA), a tax free account where you can deposit money specifically to be used for future medical costs. Aim to have saved in your Health Savings Account at least as much as the deductible. What counts as an HDHP? For 2021, the deductible is at least $1,400 for individual plans or $2,800 for family.
Low-Deductible Health Plans typically have lower deductibles but lower monthly premiums than plans with higher deductibles. If you need a considerable amount of care or require expensive medical services, a low-deductible plan may be worth considering because your insurer will start covering costs at a lower rate than high-deductible plans.

Essential Things to Know About Your Annual Deductible

Enrolling in a healthcare plan can be an overwhelming experience — from unfamiliar terminology to crunching costs, there’s a lot to learn before you can find the best coverage for your needs. Whether you’re planning to enroll soon or just need to clear up some long-held confusion, here are some of the most important things to know about how deductibles work, and what you should know about yours.

1. How much is your deductible?

You should know how much your deductible is before you ever enroll in a plan. If the plan has a low premium, there is a good chance the deductible will be high. You should ideally have the money to pay your deductible ready on hand—or at least be saving for it. Remember, before your insurance company will pitch in for your medical expenses, you’ll need to pay the deductible you agreed upon first.

2. The date your deductible rolls over

Health insurance deductibles usually roll over every January, but some plans may use a different date—for example, health plans through schools or universities may use the academic year. This date is important because you may want to plan your appointments and procedures to occur after your deductible is met and before the year rolls over. Or, you may need to budget more money for the early part of the year.

Let’s say you have a $1,000 deductible and you meet it in June. Any other services you get for the rest of the year will only cost you copays or coinsurance. But if you wait until January, you will have to pay $1,000 all over again. You might consider scheduling bigger procedures before January to save you some cash if you are not planning other expensive services (that will again exceed $1,000) for the next year.

3. What doesn’t count towards your deductible

Many health plans waive the deductible for services such as preventive care or the emergency room fee if you are admitted to the hospital. Check your policy so you know where you get a free pass, and take advantage of it.

4. Whether you have different deductibles

Some plans have separate deductibles for in-network care versus out-of-network care. This could cost you more money unnecessarily if you’ve met one deductible and then see a doctor that counts towards the other. So, find out the rules and always check whether providers are in-network before you go (don’t make assumptions—doctors in the same office may not all take the same insurance).

If you have a family policy, check if there are separate or combined deductibles for each member that is covered. The rules can vary on this one, too.

5. How often you actually meet your deductible

Odds are, if you purchased health insurance, you hope that it will pay for the health care you use. So if you find that every year you come close to meeting your deductible but never do, you may be tempted to get a plan with a lower deductible so that you end up paying less out of pocket. Be aware, though: premiums for lower-deductible plans might be higher than you would end up saving. Make sure you consider the full cost spectrum of premiums, copays, coinsurance, and how much health care you expect to get that year when you weigh this decision.

Choosing the Right Deductible Amount

Now that you know how deductibles work, you may be wondering how you should choose the right deductible for your health care needs and financial situation. In this section, we’ll discuss some of the things you may want to consider as you evaluate your health insurance options.

Things to consider when assessing health insurance deductibles:

Necessary coverage: Ultimately, the health care plan that you choose should empower you to get the best care for your needs. Whether you visit the doctor on a frequent or infrequent basis, your health history should be a primary part of your decision-making process. As you weigh your options, think about what the expenses that you’d be liable for would look like with a high, low, or middleroad deductible.

Budget: Not only does your health insurance determine the kind of care you’re entitled to, but it’s also a major financial commitment. In addition to deductible costs, consumers are responsible for premiums and other out-of-pocket costs. Before selecting a health insurance plan, be sure to consider the full insurance terms as well as all of the costs you may be held responsible for.

Note: As you calculate your budget and insurance costs, don’t forget that there are ways to maximize your health care deductions to lessen the financial burden.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.

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January 25, 2021

What to Do When You Lose Your Health Insurance

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Losing your job is stressful. Losing your health insurance on top of that is even worse. And whether you have health concerns now or want to safeguard yourself and family for the future, you might be worried about how to cover medical expenses if you’re out of work. Find out what to do when you lose your health insurance because you lost your job.

Ask About COBRA

COBRA is a health insurance continuation option that many employers offer. It allows you to voluntarily extend the health coverage you have under your former employer’s plan. If you qualify for COBRA, you must be given the option to extend your coverage up to 18 or 36 months, depending on what event qualified you for COBRA.

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However, your employer does not have to continue
contributing to cover the premiums of this plan as they did when you were
employed. If they elect to not offer contributions to the premium, COBRA
coverage can be fairly expensive.

Check the Health Care Marketplace

Job loss that causes you to lose employer-sponsored or provided health insurance counts as a qualifying event. That means you’re eligible for a special enrollment period.

Normally, you can only sign up for insurance plans through
the health care marketplaces during open enrollment periods, which typically run
from November to January. Exact dates for enrollment depend on the state.

Special enrollment periods occur for people who have a
qualifying event, such as a change in marriage status, a death in the family or
job loss. You qualify for this special period whether you were fired, laid off
or quit your job.

You must apply within 60 days of losing your insurance coverage. If your employee gives you notice and you know you’ll be losing your insurance, you can apply proactively up to 60 days before that happens.

Purchase Short-Term Coverage

Short-term insurance policies are meant to bridge the gap when you’re between jobs. Not all states allow for short-term insurance—eleven states currently prohibit their sale. But, depending on your state, short-term insurance could cover you for up to 364 days. These aren’t qualified plans under the ACA, which means they don’t offer all the benefits that the ACA requires by law. Typically, these are major medical plans meant to help cover the costs of a catastrophic illness or accident and not routine health care.

Make
sure you understand what benefits are included and how the plan works if you
opt for short-term coverage.

See If You
Qualify for Medicaid

A man holds the hand of a young child while they walk down the street.

If you have lost your job, that probably means your income has been reduced. That could mean that you’re eligible for Medicaid or the Children’s Health Insurance Program (CHIP). The income requirements vary by state, but you can find out more about eligibility from the Department of Health and Human Services.

You
can apply for Medicaid and CHIP at any time, but remember that you can lose
your Medicaid benefits if your income changes. Have a plan in place to budget
for health insurance if you get a job that doesn’t offer benefits or has a
waiting period before benefits start.

Go Without Health Insurance

You can choose to go without health insurance until you find another job or until open enrollment happens again. This can be a risky move because a health emergency or accident could lead to mounting medical expenses that leave you in serious debt.

But if you’re healthy and think there’s a good chance you’ll get a new job with coverage soon, you might decide to take the gamble. If you do, it’s a good idea to set aside some money in savings to help cover the cost of doctor’s visits or other necessary medical care should the need arise. For example, during COVD-19, you might use your stimulus check for this purpose.

You Have Options

Losing your job and your health insurance is scary, but you’re not alone. Credit.com has resources to help you through. Check out our additional resources below—and if you need more help, you can reach out to [email protected] for help from Credit Tips with Tiff.

Source: credit.com

January 24, 2021

4 Ways Health Insurance Can Save you Money

December 26, 2019 &• 6 min read by Alice Stevens

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Many health insurance shoppers will consider premium costs when purchasing health insurance. The full cost of a health planalso includes your out-of-pocket expenses, like the deductible, copays, and coinsurance.

As important as it is that your health plan is affordableand that the monthly premiums fit into your budget, it’s also important to consider the value health insurance offers. If you’re considering opting out of health insurance next year, evaluate the value of the following health plan offerings before you finalize your decision:

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I need that peace of mind in my life. What else do you get with ExtraCredit?
It’s basically everything my credit needs. I get 28 FICO® scores, rent and utility reporting, cash rewards and even a discount to one of the leaders in credit repair.
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Discounted rates
Cost-sharing
Preventive care coverage
Additional features

While everyone has a different financial situation with varying constraints, health insurance is a worthwhile investment.

1. Discounted Rates

Health insurance companies negotiate costs directly with hospitals and other medical care providers. These rates are then included with the health plans offered by the company.

Some plans only have negotiated rates for in-network providers. Others have different negotiated rates for in-network care and out-of-network care. All health plans offer coverage for emergency services when a patient is admitted—whether or not the care was received from an in-network provider.

The amount the hospital or clinic usually charges is higher than the negotiated rate. The differences between the negotiated rate and the standard rate varies depending on how the insurance company has negotiated.

However, when you receive an Explanation of Benefits (EOB) with the breakdown of costs, you’ll see:

What the hospital or clinic usually charges
What the negotiated cost actually was
What portion of the bill your health insurance company paid
The amount left for you to pay

2. Cost-Sharing

Health insurance plans come with an annual deductible and annual out-of-pocket maximum. The deductible is the amount of money the insured must pay in cost-sharing over the course of the year before the insurance company takes on a greater responsibility for the costs. The out-of-pocket maximum is higher than the deductible. Once it is reached, the insurance company is responsible for the remainder of your covered medical expenses.

Health insurance plans often have separate deductibles for prescriptions and medical care. Health insurance plans that offer out-of-network coverage will have a different deductible and out-of-pocket expenses maximum for out-of-network care and in-network care.

Health insurance companies determine cost sharing in a few different ways depending on how your plan works. With a traditional plan, you’ll have copays and coinsurance. Coinsurance means that the insured pays a certain percentage of the discounted medical bill.

Copays are a set amount that the insured pay when they receive health care services. There are usually set amounts for prescriptions, primary care visits, specialist visits, and emergency services. Payment may also be required beyond the copay after the bill is processed by the insurance company. The copay contributes to this payment.

High-Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs) work differently. Instead of having copays and coinsurance, you pay for your medical expenses as you receive medical care. You can use the funds in your HSA to pay these costs.

Funds in your HSA roll over year to year and can be invested. The money you put into your HSA is tax-free. The monthly premiums for HDHPs tend to have lower premiums because a greater cost responsibility is on the policyholder. Some people take advantage of these plans while they are healthy and save funds for medical expenses later in life.

The specifics of cost-sharing differ from plan to plan, so carefully reviewing your plan before signing up will help you understand how the cost-sharing works.

3. Preventive Care Coverage

Because of the Affordable Care Act, health insurance plans cover preventive care fully. While the future of the Affordable Care Act is uncertain, coverage for preventive care is an important way that health insurance protects your finances.

Doctors can detect some health problems early on and implement treatment plans to prevent the issue from developing further. Regular visits to the doctor go a long way in avoiding expensive bills later, especially for preventable issues.

It’s especially important for people with some diagnoses and conditions to visit a specialist regularly as needed because some health issues can be managed successfully and future complications can also be avoided.

4. Additional Features

Health insurance companies also offer the following helpful features with their plans:

Telemedicine
Nurse help lines
Care management

These additional features are helpful resources for people. Telemedicine allows plan members to work with a doctor over the phone or through video chat in non-emergency situations. Some companies offer this service to plan members for free, like Oscar. Other companies also offer it as an a la carte supplement to health insurance, like GoHealth.

Others may charge a fee when you use the telemedicine service. The fee for the telemedicine service may vary based on your plan and your insurer and can be cheaper and faster than setting an appointment with your doctor or visiting an urgent care.

Nurse help lines are another common offering among health insurance companies, including Cigna. This hotline gives people quick access to a nurse without needing to leave their home. In non-emergency situations, the nurse can answer questions and give advice on scheduling appointments.

While these benefits are nice and do not require you to establish care with a doctor, you can always call your doctor’s office with questions to get similar assistance. If the doctor can’t take your call, one of the assistants can take a message and get back to you with a response in a non-emergency situation. Even after hours, there’s usually a doctor on-call.

Another benefit some health insurers offer is care management. These can be helpful to people who want support with improving their health. Companies like Kaiser Permanente offer this with many of their plans to help members with chronic conditions.

Is the Investment Worth It?

It’s easy to see how much your health insurance plan saves you on medical care when you review the EOB.

It’s trickier to determine if the cost of monthly premiums is worth the savings. If you have health insurance, you can keep track of how much you are spending on medical care, prescriptions, and premiums. Evaluate you EOBs over the course of the year to understand what the costs would have been without insurance.

Medical procedures, surgeries, and emergency medical treatment are more expensive than preventive care. Some of these events can be planned for in advance, but many cannot.

Because of the high financial cost of these services, not having health insurance is a risk for your financial stability.

Alice Stevens loves learning languages and traveling. She currently manages content for BestCompany.com, specializing in personal finance, health insurance, Medicare, and life insurance.

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January 24, 2021

How Much Does Long-Term Care Insurance Cost?

How Much Does Long-Term Care Insurance Cost? – SmartAsset

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A 55-year-old can expect to pay a long-term care insurance premium of $2,050 per year on average, according to a 2019 price index survey of leading insurers conducted by the American Association for Long-Term Care Insurance (AALTC). That will cover $164,000 in benefits when the policyholder takes out the insurance and $386,500 at age 85. (Policies often include an inflation rider.) However, long-term care insurance costs vary widely, depending on factors like your age, health condition and the specific policies of your insurance carrier. The AALTC estimates that a single 55-year-old can pay around $1,325 to $2,550 a year for a policy. That’s why it’s important to shop around to find the best rates and terms. You should also speak with a financial advisor who can help you plan the future.

How Much Does Long-Term Care Insurance Cost?

The AALTC provides the following estimates of annual premiums based on its 2019 study of different long-term care insurance carriers.

Annual Premium Estimates
Single Male	55	$2,050
Single Female	55	$2,700
Couple	55	$3,050 (Combined cost)

Keep in mind, though, that these are only averages based on a pool of data gathered from leading insurance carriers. The costs of long-term care insurance can vary widely, depending on several key factors. We explore some of these below.

Health: Some medical conditions will disqualify you from even being able to purchase a policy, including muscular dystrophy, cystic fibrosis and dementia. That’s because insurers will likely lose money on those policies. Generally, the healthier you are, the less likely you’ll ever need to file a claim – and so the lower your premium.

Age: In general, you’ll pay more in long-term care insurance if you take out a policy when you’re older, since you’re probably less healthy and you’re closer to needing the assistance the policy covers. This is why the AALTCI recommends you begin shopping for long-term care insurance between the ages of 52 of 64.

Marital status: When combined, premiums tend to be lower for married couples than they would be for individuals paying for a personal policy.

Gender: Because women tend to live longer than men and make claims more frequently than their male counter parts, women tend to pay more for insurance premiums. The AALTCI study showed that a single female pays an annual premium of $3,050 on average while the single man that age paid $2,050.

Carrier policies: Each insurance carrier sets its own rates and underwriting standards. In fact, costs for the same services can vary widely from one company to another. This is why you should gather quotes from various carriers. You can also work with an experienced long-term care insurance agent who can gather these for you and help you understand the differences between insurance policies. They can also help you determine the kind of coverage you’re likely to need, so you don’t over-insure.

Should I Get Long-Term Care Insurance?

The average 65-year-old today has a 70% chance of needing some kind of long-term care eventually, according to the Urban Institute and the U.S. Department of Health and Human Services. Of those who need it, most would use it for about two years, but around 20% would require it for more than five years.

The smart money, then, would prepare for this significant cost. To give you a sense of how much bills can run, below are the estimated annual costs of different types of long-term care services, according to Genworth Financial, which has been tracking them since 2004.

Estimated Annual Costs
Private room nursing home	$102,000
Assisted living facility	$48,612
Home care aide	$52,624
Home care homemaker	$51,480

What’s more, costs have been rising faster than even inflation. Genworth found that the average cost of home-care services increased about $892 annually each year between 2004 and 2019. The average cost for a private room in a nursing home jumped by about $2,468 each year during the same time period, currently putting the average cost of a semi-private room in a nursing home at $89,297 per year. As noted before, about 20% of Americans will require more than five years of care.

Unfortunately, with these costs, many retirement nest eggs will come up short. And contrary to popular belief, Medicare covers only limited medical costs, e.g., brief nursing home stays and narrow amounts of skilled nursing or rehabilitation services. The scope for Medicaid is even smaller. On average, it covers about 22 days of home care services if you meet very low income thresholds.

Of course, there’s no way of knowing how much long-term care coverage you’ll need. But knowing what long-term care insurance does and doesn’t cover is key to making sure you’re not over- or under-protected.

What Does Long-Term Care Insurance Cover?

Long-term health insurance typically covers services not provided for by regular health insurance. This can include assistance with completing daily tasks like eating, bathing and moving around. In the industry, these are known as activities of daily living (ADLs). Long-term care insurance policies generally would reimburse you for these services in such locations as:

Some policies also cover care related to chronic medical conditions such as Alzheimer’s disease and other cognitive disorders.

But keep in mind that these are generalizations. There is no industry standard that sets ADL requirements for claim eligibility or what kinds of illnesses long-term care insurance will cover. Each insurance carrier makes its own rules.

So it’s essential to understand when coverage kicks in – and for how long. Policies used to provide coverage for life, but now most cap benefits at one to five years. If possible, some experts recommend extending the initial period when you are not compensated for costs (it’s often 90 days) in exchange for a longer period on the other end of receiving benefits. You also will want to know how premiums may increase over time and whether the cap on benefits will, too. Some carriers allow you to place an inflation rider that increases your daily benefit every year. That increase can be up to 3%.

How Does Long-Term Care Insurance Work?

After you apply for long-term care insurance, the insurer may request your medical records and ask you some questions about your health. You can choose the type of coverage you want, but the insurer must approve you.

When the company issues you a policy, you begin paying premiums every year. Once you qualify for benefits, which is often defined by not being able to perform a set number of ADLs, and the required waiting period has passed, you can file a claim. The insurance company then reviews your submitted medical records and may send a nurse to perform an evaluation before approving a payout. Once approved, you will be reimbursed for paid services, up to the cap on your policy.

Ideally, you’ll stay healthy and your long-term care needs will be minimal. Though your premiums will add up over time, this is one situation where you hope not to get your money’s worth. On the bright side, to lessen the hit to your wallet, the government may give you a tax break.

Tax Relief for Long-Term Care Premiums

Some or all of the long-term care premiums you pay may be tax deductible at the federal and state level. But you must make these payments toward a tax-qualified insurance policy. Also, you must meet certain income thresholds.

Maximum Deductible Premium

40 or under	$420
41 to 50	$790
51 to 60	$1,580
61 to 70	$4,220
71 and over	$5,220

How to Buy Long-Term Care Insurance

You can purchase long-term care insurance directly from carriers or through a sales agent. The agent can help you shop around for comparable rates. This professional can also help you understand how different policies work and what they offer.

Also, you may be able to get long-term care insurance through your employer. Some allow you to purchase policies at discounted group rates. However, you should get quotes from multiple insurance companies. In some cases, you may find better rates for more suitable policies that aren’t through your employer.

How to Calculate Your Long-Term Care Insurance Costs

Some websites such as Genworth Financial provide interactive calculators that can estimate what long-term care premiums may be like in your area. Prices and policies can vary, depending on the state.

Tips on Paying for Long-Term Care

If you have a health savings account (HSA), you may want to start socking away more money in it for long-term care. Also called health IRAs, these plans allow your money to grow tax deferred. (But you have to have a high-deductible health plan to open an HSA). To find out more, check out our report on the best HSAs.
Don’t go it alone. A financial advisor can help you devise an insurance plan and figure out how you’re going to pay for it. If you are in the market to buy insurance now, some advisors are also licensed insurance agents. Use our matching tool to find the right advisor for you.

Javier Simon, CEPF® Javier Simon is a banking, investing and retirement expert for SmartAsset. The personal finance writer’s work has been featured in Investopedia, PLANADVISER and iGrad. Javier is a member of the Society for Advancing Business Editing and Writing. He has a degree in journalism from SUNY Plattsburgh. Javier is passionate about helping others beyond their personal finances. He has volunteered and raised funds for charities including Fight Cancer Together, Children’s Miracle Network Hospitals and the National Center for Missing and Exploited Children.

Questions to Ask When Shopping for Health Insurance

Health Insurance

Whether you are acquiring it through your employer or on your own, shopping for health insurance coverage is a task that many adults will be faced with at some point. Health coverage is not a one-size-fits all amenity, and it comes in many forms such as Point of Service (POS), Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and more.

Find the Right Health Insurance for You!

Attention: Still Open During the Financial Crisis…

Tip: Act now to see if you qualify for lower rates!

Compare free personalized quotes from the nation’s top providers.

Buying health insurance is a big commitment, so do the research and look over all your options before making any hasty decisions. Technical information about different health insurance policies can be overwhelming, which is why seeking the help of a licensed insurance agent or a health insurance broker might be your best bet. In the following sections we will discuss ways you can prepare to meet with a health insurance agent as well as what questions to ask.

How to prepare to meet with a health insurance agent

Health insurance exists to protect us financially when we get sick or injured, which is why it’s so important for you to look at plans that fit the unique needs of you and your family. Whether you are an employer shopping for insurance plans for your employees, or just an individual browsing your options, choosing a caring agent who takes their job seriously is key to finding the right plan. To start, you will want to work with an insurance agent who is experienced, knowledgeable and trustworthy.

Finding the right agent to work with isn’t the only important piece of the puzzle, you’ll also want to do your part as well. Coming prepared to the appointment will help things run more smoothly and will ensure that you to ask the right questions.

Before meeting with the insurance agent, make sure that you:

Know how much you are willing to pay: Before your appointment with an insurance agency, you should consider how much risk you want to assume for yourself versus how much risk you want the insurance company to assume for you. In other words, would you rather make higher monthly insurance payments and have a lower deductible or would you rather pay a lower monthly insurance payment and have a higher deductible? If you’re okay with paying a hefty deductible during a medical crisis, then you might consider choosing a plan with a lower monthly payment. On the other hand, someone who needs more consistent medical care might opt for a plan with a lower deductible.

Research the insurance agency that you will be doing business with: Ask friends and loved ones for feedback on the agencies they’ve worked with and find out how their experience was. If you are an employer, do some research to see what agencies other companies do business with. The important thing is that you choose an agency that you trust.

Know what to bring with you: In order for the agent to help you the best they can, they will need to know as much information as possible about yours and your family’s medical history. The agent will want to know about any of yours or your family’s medical conditions and personal habits such as drinking, smoking, diet, etc. Call in advance and find out exactly what you need to bring. Be truthful and thorough so that your agent can find the best health insurance policy for you.

Make a list of the questions that you will want to ask: It’s easy to get overwhelmed during these appointments. Writing down your questions will not only help you to be more organized, but it will also lower your chances of forgetting to bring up important topics.

Questions to ask your health insurance agents

Before meeting with a licensed insurance agent, you should write down a list of questions that you want to have answered during your appointment. Here are some questions you should be asking your agent about your insurance before buying:

- How much will it cost? This is probably the most dreaded part of the conversation, but it has to be discussed! The overall cost of your health insurance policy will depend on your premium, deductible and out-of-pocket-max. When browsing through plans, you’ll want to take notes on how much these three items will cost up front, because each plan varies in rates.
  - Premium: Health insurance premiums are rates that you will pay every month in order to secure your coverage. The initial payment you receive will be a premium, and will continue monthly.
  - Deductible: If your plan has a deductible of $2,000, then that means you will be responsible for paying the first $2,000 of health care before your plan begins covering certain costs. Once you pay your deductible, you’ll pay significantly less for your health care.

Out-of-pocket max: This is basically the maximum amount of money that you will ever have to be responsible for paying while covered—as long as you stay in-network, that is. Let’s say your out-of-pocket max is $5,000, but you end up needing surgery that costs $30,000. You would only have to worry about paying $5,000. Additionally, if you’ve already reached your $2,000 deductible, then you would only have to pay $3,000. The purpose of an out-of-pocket max is to protect you from having to pay extremely expensive bills, but remember—the surgery would need to happen at a medical facility that is in-network.

Is my current doctor covered? If you’re already receiving health care, you’ll want to know if your current doctor is a part of any prospective insurance company’s network of health providers. This information should be fairly simple to find out but could be an important factor in your decision. If you are currently taking any medications, you’ll also want to ask your agent to check the formulary to see if your prescriptions are covered.

Who do I contact when I have questions? It’s important to find out if your prospective health insurance company has a customer service team you can call or message when you need to inquire about bills, claims, copays or anything else insurance-related. Does the company have a separate phone number to call when you want help finding a health care provider? Is this customer service line automated or will you be speaking to an actual insurance representative? These questions are important to determine what kind of support is available long after you’ve signed a contract.

What happens during an emergency? When going to see a doctor for a normal visit, you have time to plan and make sure that the doctor is in-network. However, during an emergency, we may not have the same luxury. It’s possible that in a case where you need dire medical attention, the closest health care provider may not be in-network. You should ask about your prospective company’s policy on emergencies and what the standard routine consists of.

Source: pocketyourdollars.com

January 23, 2021

What Health Insurance Doesnât Cover: Your Guide

Health Insurance

Insurance of any kind can be confusing, but when it comes to medical insurance, it’s really tricky to tell what’s covered and what isn’t. Whether you’re shopping around for a new plan or recently just got on a new health insurance plan, it’s good to know the ins and outs of your health insurance coverage before you end up with a large stack of medical bills that you can’t afford. In this article, we’ll discuss the things that medical insurance surprisingly doesn’t cover so that you can make better decisions about your medical expenses.

Find the Right Health Insurance for You!

Attention: Still Open During the Financial Crisis…

Tip: Act now to see if you qualify for lower rates!

Compare free personalized quotes from the nation’s top providers.

What health insurance does cover

In accordance with the Affordable Care Act (ACA), the Health Insurance Marketplace must now cover a specific set of services at little or no out-of-pocket expense to you. They are also required to cover at least 10 essential health benefits. These essential health benefits (EHBs) include:

Ambulatory patient services
Emergency services
Hospitalization and surgery
Maternity and newborn healthcare
Mental health treatment and substance abuse disorders including counseling and psychiatric treatment
Pharmaceutical drugs
Rehabilitation services that provide care for those suffering from disabilities and injuries.
Laboratory services (blood and urine testing, etc.)
Preventative and wellness services
Pediatric services

In short, a lot of the basic care that you will get on a regular basis should be covered by your health plan. Most of the time your doctor won’t suggest treatments that are not covered by your insurance. In a lot of cases, they will try to familiarize themselves with your health insurance plan so that they can lead you in the right direction. However, don’t leave the all the responsibility in the hands of your doctor. It’s important that you make time to read through your health insurance policy and look for any holes before getting services.

What health insurance doesn’t cover

If you have a good insurance plan, most of your basic medical needs will be covered, but you might be surprised to know the services that generally are. Here is a list of services that health insurance does not cover:

Nursing home services: Most nursing home services are not covered by standard health insurance or even Medicare. However, nursing home care is covered by Medicaid. Many people are confused about this, because they confuse short-term care from a skilled nursing facility with long-term nursing home care. These two things are very different. For example, if you were to suffer from a fall or some other type of injury that required you to get surgery, you would need short-term care in a rehabilitative facility to help you get back on your feet. That kind of care is covered. Full-fledge nursing home care on the other hand, wouldn’t be covered because most health insurance providers place time limits on how long they will cover nursing home services. That being said, Medicare will only cover skilled nursing if the patient stayed for at least three days before staying in the skilled nursing facility. Additionally, the patient must be admitted to the facility for the purpose of seeking treatment for a short-term illness or injury as opposed to a chronic one.

The shots you get before traveling abroad: At some point, health insurance companies decided that they would only cover services and procedures considered to be medically necessary, and travel vaccines didn’t make the cut. Now, we’re not talking about your standard health vaccines like the tetanus or flu shot; those are covered. But for those of you who like to travel, the cost of your Typhoid or Yellow Fever vaccine is coming out of your own pocket. This rule of thumb goes for the vast majority of health insurance policies, including Medicare.

Cosmetic surgery: Once again, health insurance policies will usually only cover what is “medically necessary.” It’s safe to say that Botox and lip injections will not be covered by your health insurance policy. However, there are certain surgeries that dance on the line between medically necessary and cosmetic. For example, if you wanted plastic surgery on your nose because you thought it was too big, that’s considered cosmetic. But if you had to get work done on your nose due to issues with your sinuses, then that’s probably going to be considered medically necessary.

Acupuncture & alternative therapies: The rules surrounding acupuncture and other types of alternative therapies such as chiropractic care aren’t as black and white. Coverage for such services like massage therapy, acupuncture, and chiropractic care aren’t part of the requirements for most individual health care plans. However, depending on what state you live in, your health insurance plan might cover chiropractic costs. Say you are involved in a car accident that caused you to suffer from back injuries as a result. There is a good chance that your health insurance plan will cover these services. However, if you are a regular at the chiropractor just because you enjoy it, then it probably won’t be. While the standard Medicare plan does not cover acupuncture, there are some Medicare Advantage cans that can. Keep in mind that with most plans who do cover these types of services, there is usually a limit on how many visits you get.

Dental, Vision & Hearing: If you are shopping around for health insurance plans with your employer, note that dental, vision and hearing services are not covered under a regular health insurance policy. If you want to get insured for these services, you will have to buy separate insurance plans for each one. Keep in mind that a lot of times, these insurance policies don’t have any limits on how much they can charge you in out-of-pocket expenses, so research different dental offices before receiving services. Some people choose to not include a dental plan at all. If you wear glasses or contacts, however, it’s probably worth looking into your options for vision insurance.

Weight loss surgery: If you’re considering having weight loss surgery, you might be in luck if you have Medicare or Medicaid. While there is currently not a requirement at the federal level for health insurance plans to cover bariatric surgery, Medicare and many Medicaid plans do cover it. Aside from those two plans, more than half of the states in the U.S. do require there to be at least partial coverage for bariatric survey as an essential health benefit (EHB). Remember that even if the state you live in mandates coverage for this procedure, you may still be responsible for some of the medical bills related to your weight loss surgery.

Preventative screenings: Before we go any further, there are A LOT of preventative tests that are covered by your health insurance policy, but there are some that aren’t. This is where things get confusing for a lot of people. For example, mammograms, cholesterol screenings, and colonoscopies will be covered. But if you need to get Prostate Specific Antigen (PSA) screening, it most likely will not be covered.
Certain medications: Once again, there are a ton of prescription medications that are covered by most health insurance plans, since pharmaceutical services are one of the essential health benefits (EHBs). However, health insurers get to choose what to cover and what not to cover. Most healthcare insurance plans will choose to cover the minimum. This means that they will pick a drug from each class to cover, and not cover the rest. Many times, the generic version of the drug you are prescribed will be covered by your health insurance, while the name brand will not.

Source: pocketyourdollars.com

Strategies to meet income requirements

Strategies to meet asset requirements

Why planning well in advance matters

Compare employer plans

Spotlight on mental health

More telehealth, at a cost

Dental, vision, prescriptions

HSA (and FSA) perks

COBRA and the marketplace

Steps for Budgeting for Insurance

1. Decide how much insurance you need

2. Get quotes from agents or online

3. Find out what the payment schedule is

4. Set aside enough money monthly

5. “Pay” the bill monthly

How to Budget for Different Types of Insurance

Car Insurance

Health Insurance

Life Insurance

Homeowner’s or Renter’s Insurance

The Bottom Line on How to Budget for Insurance

What is a Health Insurance Deductible?

How do Deductibles Work?

Example of health insurance deductible

High-deductible plans vs. low-deductible plans

Essential Things to Know About Your Annual Deductible

1. How much is your deductible?

2. The date your deductible rolls over

3. What doesn’t count towards your deductible

4. Whether you have different deductibles

5. How often you actually meet your deductible

Choosing the Right Deductible Amount

Ask About COBRA

Check the Health Care Marketplace

Purchase Short-Term Coverage

See If You Qualify for Medicaid

Go Without Health Insurance

You Have Options

1. Discounted Rates

2. Cost-Sharing

3. Preventive Care Coverage

4. Additional Features

Is the Investment Worth It?

How Much Does Long-Term Care Insurance Cost?

Should I Get Long-Term Care Insurance?

What Does Long-Term Care Insurance Cover?

How Does Long-Term Care Insurance Work?

Tax Relief for Long-Term Care Premiums

How to Buy Long-Term Care Insurance

How to Calculate Your Long-Term Care Insurance Costs

Tips on Paying for Long-Term Care

Categories

Find the Right Health Insurance for You!

How to prepare to meet with a health insurance agent

Questions to ask your health insurance agents

Find the Right Health Insurance for You!

What health insurance does cover

What health insurance doesn’t cover

See If You
Qualify for Medicaid