Tag Archives: deductible

Happy Medicare New Year

Steps to a Happy “Medicare” New Year

Winter preparations are done. Winter festivals have ended, and end-of-year holiday celebrations are over. Just when you think you can sit back and relax, there is still one last item you may need to consider.

If you made any Medicare changes during the past Annual Enrollment Period (October 15 to December 7), there are some actions you can take that may help you have a happy Medicare new year.

If you enrolled in a new plan or your plan had changes during the Annual Enrollment Period, you should make sure you’ve received your new member ID card. This card contains the newest info for your 2019 care. Be sure to show your new ID card to the doctor’s office and pharmacist on your first visit of the new year so that they have your newest information on file. It’s also worth mentioning that with the new cards for the new year can come new deductibles (depending on the plan you choose), which start over at the beginning of the year.

If you decided to stay with Original Medicare, you’ll still use your Medicare card for hospital and doctor services. If you have not received the new Medicare card that the Centers for Medicare and Medicaid Services began issuing in April 2018, be on the lookout because they are all scheduled to be mailed by April 2019.

If you joined a Medicare prescription drug plan that works with Original Medicare, then the plan will mail you a card so you can fill your prescriptions. If you joined a Medicare Advantage plan (like an HMO, PPO, or POS), you’ll also get a new card to use for both healthcare visits (doctor and hospital) and for picking up your prescriptions.

If you need medical care or need to fill a prescription before you receive the ID card but after the effective coverage date, you may be able to use other proof of plan membership. Some examples are the welcome letter you got from the plan or even your enrollment confirmation number and the plan name and phone number.

If you elected to have your plan premium withheld from your Social Security check, don’t be alarmed if you don’t see it deducted right away. It may take up to 3 months from the time you made the premium withhold request before you start seeing your premium withheld from your Social Security payment.

The 2019 year is a great time to take advantage of your one-time “Welcome to Medicare” or annual wellness visit your plan offers to you. This benefit is usually no cost to you! It is designed as a preventive measure to help you take charge of your health, be advised of future needed preventive services, and establish a baseline for personalized care. And speaking of preventive measures, many Medicare Advantage plans come with a fitness benefit or provide access to physical fitness activities at no cost to you.

I wish you all a happy and healthy 2019!

Morgan Gunder is a community and broker liaison for Reid Health Alliance. Born in the South and raised in the Midwest, she is a wife and mother with a passion for traveling, learning, and technology.

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.
Young Invincibles Growing Up

Young Invincibles Feel the Love for Health Insurance

Young Invincibles

Young invincibles are young, healthy, independent, and don’t have a lot of cash to throw around, but, like everyone else, they need help when it comes to:

  • Understanding their options under the new health care law
  • Choosing the plan that’s best for them
  • Listening to their mother

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Conventional Wisdom

All kidding aside, the conventional wisdom surrounding young invincibles in need of insurance isn’t so conventional, after all. Sure, they aren’t flocking to the exchanges in droves, but they aren’t avoiding them, either.

In fact, according to this article by Aaron Smith, co-founder and executive director of Young Invincibles, as well as this press release from his organization’s website, it seems these youngsters are signing up in numbers proportional to the overall population, and possibly even at a higher rate than their older and wiser counterparts.

So good job, Mom—it turns out you raised them right!

What’s the Deal?

This may be their first time around the health insurance block, but the appeal to reason, and their very limited budgets, is bringing youthful buyers to the table. One small car or bike accident, sports injury, or even a bad case of mono could add up to HUGE medical bills that a struggling student or first-rung employee could never afford.

While many feared the typical response to the pay premiums vs. pay a tax penalty debate would be to just pay the penalty, stats show many young invincibles can do the math:

Paying a penalty and all of their potential medical costs for a year is not a good deal.

Not so Invincible, After All

It’s important to note that young invincible isn’t a title these people gave themselves. Obviously, they’re well aware it’s a big, dangerous world out there, and the smart play is getting yourself covered.

In fact, not only are your super-smart kids signing up to protect their wallets, they’re actually signing up to protect their (gasp!) health. They’re taking advantage of subsidies to buy up from the high-deductible catastrophic plans many assumed they would purchase, and investing in more benefit-rich Silver, and even Gold and Platinum, plans.

And why wouldn’t they? With many plan premiums starting under $100 a month, it’s a small price to pay for peace of mind and financial security.

Take Good Care of My Baby

So Mom, while we know you always want to take care of your kids, maybe it’s OK to let them leave the nest. And here’s something else that might ease your mind:

We’re here to help.

Keeping your family healthy and safe is a priority for us, too. Maybe you already have our group or individual plans, or know someone else who does. After all, we’ve been helping people find plans that meet their needs and situations for over 30 years, since before most of the young invincibles were even a gleam in anyone’s eye!

We have great plans, a great network of doctors and hospitals, and great people ready to explain the options, answer questions, and find the right match for your babies, as if they were our own.

Get signed up. To learn more or shop for plans, call 1-888-382-9771, visit us online at HealthAlliance.org, or stop by our Anthony Drive location in Champaign today!

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