Tag Archives: coinsurance

National Financial Wellness Month

National Financial Wellness Month

It’s National Financial Wellness Month, and we have tips about taking care of your finances, especially as they relate to health insurance.

Using Your FSA

If your health insurance features a flexible spending account (FSA), you could save on all kinds of health services and products.

Your FSA and the New Year

 

Health savings accounts (HSAs) are becoming more common, and if your plan has one, it could help you with your medical expenses and offset high deductibles. 

Saving with an HSA

 

You might not realize how much money you’re losing going to the emergency room when you should be going to urgent care. Know where to go and save.

Skipping the ER

 

You know you pay a premium for your health insurance, but do you understand all of your out-of-pocket costs, like deductibles, copays, and coinsurance? Make sense of what you pay.

Paying Out-of-Pocket Costs

 

Do you know what happens after you get care? Make sense of the claims process, how your doctor gets paid, and what you’ll owe.

Paying Healthcare Costs

 

Making financial plans for your future can help you be ready for retirement, Medicare, and medical emergencies. Be prepared.

Making Financial Plans

 

Financial wellness can impact other parts of your health too. These tips can help you track your spending, set goals, and more.

Safe Travel Each Step of the Way

Safe Travel

Summer travel season is upon us, and preparing for safe travel is important, especially if you have an illness.

First, learn about your destination to check for any local health notices or immunizations you might need first.

Safety Wherever You Go

 

Think about your health before you book. From illness and surgery recovery to pregnancy, check if you’re safe to fly.

Fly Smart

 

See a doctor before you take off to make sure you’re up-to-date on key shots or healthy enough for planned activities.

Vaccines for Travel

 

Pack carefully to protect yourself, especially if you need medicines or care while you’re traveling.

Pack for Your Health

 

Be prepared for the signs and what to do if you know you’re at higher risk of health issues while traveling.

Healthy and Prepared on Vacation

 

Make sure your family or friends (and government entities depending on where you’re traveling) know your travel plan.

Share Your Travel Plan

 

Know you’re covered with a copayment or coinsurance for ER and urgent care if you get sick while traveling.

And check out Assist America, which helps connect you to services when you get sick while traveling.

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Medicare Basics Without an App

Vantage Point: There’s Not an App for That – But We Can Help!

Personal fitness trackers—like the Fitbit® or Jawbone®—are popular devices to help you keep your New Year’s resolutions and stay fit all year long. The fitness tracker collects data and sends it to a phone app that tracks physical activity, calorie intake, and sleep quality. Wouldn’t it be cool if the device included an insurance tab to help people navigate their Medicare benefits, too?

Could you imagine how you’d feel slipping on the device if it said,
• “You have adequate coverage for your current health.”
• “Your doctor is in-network, and the out-of-pocket cost for your upcoming appointment is $10.”
• “Warning, you are nearing the prescription coverage gap.”

Until that technology comes along, Health Alliance Medicare can help explain Medicare basics. Most people paid for Medicare Part A through their payroll taxes while they were working, so they don’t pay a premium now. Part A covers inpatient hospital procedures, but not the doctor who does the procedure.

Medicare Part B covers the doctor and requires a monthly premium. Both A and B have deductibles (what you pay before your coverage kicks in) and coinsurance (a percentage of total cost that you pay). Figuring out coinsurance is tricky because it’s hard to plan what the overall doctor visit or hospital cost will be.

Medicare Part D is for prescription drug coverage. If you don’t choose Part D when you become eligible for Medicare, you could pay a penalty, called the Late Enrollment Penalty, if you add it later. If you pay a lot for your medicine, it’s important to read your monthly Explanation of Benefits to see if and when you’ll fall into the coverage gap.

Medicare Advantage plans, like Health Alliance Medicare, are called Part C and cover every benefit of Original Medicare and more, plus you can add prescription drug coverage. Medicare Advantage plans can be an easy transition for those turning 65 because they look a lot like employer insurance plans.

Until someone invents a Medicare app, consider Health Alliance Medicare your source for information. Helping people get started with the right information to avoid common and costly pitfalls later is the best part of our jobs.

AEP Autumn

Vantage Point: It’s That Time of Year

Days are warm and evenings crisp. Orchards bustle during the pear and apple harvest. It is my favorite time of year, but for seniors it can be stressful because of Medicare’s Annual Enrollment Period (AEP), which runs from October 15 through December 7. This is the time of year when most Medicare beneficiaries can choose or change their Medicare coverage.

Better-than-ever health care coupled with healthier lifestyles means people are living longer. With that, living on a fixed income means many seniors worry about having affordable health care for years to come.

One of the most common questions we hear in our Wenatchee office is, “What is the difference between a Medicare Supplement and Medicare Advantage plan (also known as Part C)?” Learning about each product can help people understand what best fits their lifestyles, pocket books, and health care needs.

Whether choosing a Supplement or Advantage plan, you must continue to pay your part B premium.

Medicare Supplements work much like a secondary insurance. They pick up their share of the covered health care cost after Medicare pays, depending on what plan you purchase. For example, it may pick up 10 percent of the 20 percent coinsurance (meaning you would still pay 10 percent). Supplements will not cover any cost Medicare denies, and some Supplements require medical underwriting to gauge the health of the individual. Premiums, or the cost you pay for the coverage each month, are generally more expensive. Like with Original Medicare, you can see any doctor who accepts Medicare.

Medicare Advantage plans replace Original Medicare, which means hospital and doctor visits are paid directly by the plan. Many Advantage plans also include prescription coverage making for one tidy package. To be clear, you still keep all your Medicare benefits. There is no medical underwriting, and premiums are generally lower. Advantage plans also cover extras that Medicare does not, like dental and fitness programs. They also work closely with provider offices to help coordinate care. This helps many members stay healthier. Advantage plans have contracts with provider offices so a member normally must chose a doctor within the plan’s network.

Health Alliance takes Medicare seriously, and our Wenatchee office and helpful customer service representatives are a resource you can count on to help make a great decision for you during AEP and beyond.

Visit us at 316 S. Fifth St. in Wenatchee from 8 a.m. to 5 p.m., weekdays. Or call 1-877-561-1463, TTY 711, from 8 a.m. to 8 p.m. daily. That looks like a toll-free number, but our local representatives are on the other end waiting to help.

Terms Jumble

Long View: Don’t Let Lingo Keep You from the Care You Need

When I was (considerably) younger, I read that a concert I wanted to attend was “SRO.” I was certain that meant “Sold Right Out,” and there was no way we could go. I was disappointed, but hey, you can’t win them all. Years later a friend told me another show was “SRO,” and I only then found out it meant “Standing Room Only.” My misunderstanding became the source of much merriment.

Industry-specific terms, acronyms and lingo are common in almost every business. I know the health insurance business has a lot, but have you ever heard two electricians talk? What about computer repair technicians? It’s all foreign to me.

Terminology, acronyms, and lingo are simply shortcuts for information-sharing between people in the same business. They are not meant to exclude others, but they do. The difference between the terms “copayment” and “coinsurance” can seem small, unless you are the person paying the bill. So, what can we insiders do to lessen the impact and be more inclusive?

About two years ago, Health Alliance started an internal plain language push. We took a close look at our written materials—brochures, guidebooks, letters, our website, and more—and realized we could make things easier to understand. We simplify or explain industry lingo, without losing the important information.

If you’re on the receiving end of lingo, stop and ask for clarification. If that is not possible, jot down a note so you can follow up on your own. This is especially important with your health care. Make sure you understand what your doctors tell you. They are insiders to the medical world, so they might not realize you need more explanation. Always ask questions if you’re confused. Your doctor will appreciate you taking the time to make sure you understand so you can take good care of yourself.

I am sure some of you are frightened to know I am learning how to text on my smartphone. Many of you are familiar with this digital language and its acronyms and lingo, but it’s new to me. Don’t worry, I was pointedly told “LOL” doesn’t mean “lots of love.” LAL (Live and Learn).

(Give this word search on commonly used insurance terms and their definitions a try!)

Affordable Care

Crunching Numbers for You

The Affordable Care Act is here to make health care affordable! Let’s run through some facts about the kinds of help you can get paying for your Health Alliance individual insurance plan, called premium tax credits and cost-sharing subsidies.

What’s a premium tax credit?

A premium is what you pay monthly to have insurance. A premium tax credit lowers your cost to make a plan affordable for you.

What is a cost-sharing subsidy?

A cost-sharing subsidy makes other health insurance costs affordable, like your deductible, coinsurance, and out-of-pocket max.

Who qualifies for help?

There’s a little math involved here. First, you need to know your individual or family income. If your income falls between 100% and 400% of the federal poverty level, you can get help from the government.

You can get government help if you’re…
An individual with a gross income* of $12,000-$46,000 a year
A family of four with a gross income of $24,000-$94,000 a year

*Gross income is everything you make in a year, before any taxes or deductions.

What’s the federal poverty level?

The federal poverty level depends on your family’s size. In 2013, it was $11,490 for a single adult and $23,550 for a family of four. You can make up to 4 times that amount and still get help!

How much help will I get?

Again, there’s a little math involved. A few tools online will do the math for you, or a Health Alliance rep can help find your subsidy amount. Call or stop by our Champaign location at 206 W. Anthony Drive, near Alexander’s Steakhouse—we’ll crunch the numbers for you.

How do I apply this help to my bill?

The only thing you have to do is pick a plan from the Public Marketplace. Any public plan will let you apply for government help. The government deals directly with us after you enroll to apply its help to your bill.

What can I do if I don’t qualify for help, but I still don’t have a lot of money? 

  1. Think about your individual risk. Your individual risk is the plan’s medical deductible added to the out-of-pocket max. This is the most you’ll have to pay (besides the monthly premium,) before a plan will cover 100% of your costs. What are you OK with paying if the worst were to happen?
  2. Pay attention to a plan’s deductible and out-of-pocket max. The higher your deductible and out-of-pocket max, the lower your monthly premium. Keep in mind that if you get sick or hurt, you will have to pay for all your medical costs until you meet your plan’s deductible.
  3. Call or stop by. It’s not a sign of weakness. It’s smart. When you need medical advice, you call the doctor. When you need health insurance insight, you talk to our helpful reps.