Tag Archives: health insurance

Making Sense of Medicare Advantage and Medicare Supplement

Vantage Point: Medicare Supplement or Medicare Advantage? What’s the Difference?

Have you ever had a conversation with a friend or family member where you were both thinking that you’re talking about the same thing, but then you realize (usually after much confusion and the conversation has drifted a bit), that you’re in fact not talking about the same thing?

The conversation comes to the point where you find that you’re talking about two different things, an “apples and oranges” conversation.

I think that there are a lot of “apples and oranges” conversations when it comes to what Medicare Supplement and  Medicare Advantage plans are. We’re talking about insurance with both, but they are different things.

Medicare Supplement plans, also known as Medigap plans, work with Original Medicare, which is Part A (hospital) and Part B (medical) coverage. They help pay for all or part of the 20% that Original Medicare doesn’t pay for, depending on what plan you choose. Medicare Supplement plans do not include prescription drug coverage, so if you want that, you’ll have to pick up a prescription drug plan separately.

Medicare Advantage, also known as Part C, are plans where a private insurance company replaces Original Medicare. Medicare Advantage plans have the same Part A hospital coverage and Part B medical coverage that you’d get with Original Medicare. (Remember, you’d still pay your Part B premium if you get a Medicare Advantage plan.) Plus, Part D prescription drug coverage is included in many Medicare Advantage plans. That means you’d have hospital, medical, and drug coverage together in one plan. Medicare Advantage plans may come with extras as well.

Now that the Annual Enrollment Period is here, you’ll be better equipped to have the “apples and oranges” conversations if they come up. If you still want more direction when it comes to your options, there’s a great local service available called SHIBA (Statewide Health Insurance Benefits Advisors). SHIBA is a free service of the Washington State Office of the Insurance Commissioner, Consumer Protection Division and can be reached at 509-902-1114 or 1-800-562-6900  It has great volunteers who can help you.

You can also come into our local office in Creekside Business Park, and we can go over anything you’re confused about in person, bit by bit.

We at Health Alliance Northwest in Yakima are here to help our community learn what the various parts of Medicare are to help each person make informed decisions that are the best for them. (The best choice might not be us, and we’re okay with that!)    

Breck Obermeyer is a community liaison with Health Alliance Northwest, serving Yakima County. She is a small-town girl from Naches and has a great husband who can fix anything and 2 kids who are her world.

Changing with the Seasons for AEP

Covered Bridge: It’s That Time Again: AEP

There is a lot of publicity to remind folks to check their smoke detector batteries when daylight saving time is over. It makes sense to tie that chore to something that occurs on a regular basis (why not Valentine’s Day?), but I almost always forget to do it.

It seems there are always other more pressing duties on the to-do list, like finishing up in the yard, switching out those summer clothes, or putting up the storm windows (if you are unlucky enough to still have storm windows).

Another reminder comes along this time of year. Medicare-eligible individuals’ mailboxes are bombarded with mail for the Annual Enrollment Period (AEP). While it can be annoying and overwhelming, it’s incredibly important for them to review their healthcare coverage every year to see if their current plan still meets their needs. The days of one-size-fits-all are over.

If you are a caregiver, a change in your loved one’s situation may indicate the need for different coverage. Have they started traveling more? Less? Have their medication needs changed, like new prescriptions or treatments for a chronic illness? Did their primary care provider retire or relocate? Did their current plan change, and does it still suit their needs? It’s time to explore their options.

We know you are busy, so let’s look at a few resources.

A great one is Medicare.gov. This site is easy to navigate and packed with information. You can check the plan’s Star Rating while you’re at it.

Another great resource is your state’s Department on Aging. It offers impartial counseling services for people who are Medicare-eligible.

Your local Area Agency on Aging is a gold mine. Find one near you at n4a.org.

HealthAllianceMedicare.org is also easy to navigate and gives a nice overview of the options we offer in your county.  

The AEP for 2019 is October 15 through December 7. The sooner you review your needs and gather information, the better equipped you will be to make an informed choice. When you’re done, you can move onto something really important, like cleaning out the junk drawer in the kitchen (like that’s going to happen).

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.

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.

Time for Change

Long View: Is It Time for a Change?

“Everyone appreciates the long, light evenings. Everyone laments their shortage as Autumn approaches; and nearly everyone has given utterance to regret that the clear, bright light of an early morning during Spring and Summer months is so seldom seen or used.”

This was written by a London builder named William Willett, who proposed daylight saving time from an idea conceived by Benjamin Franklin.

“Spring forward. Fall back,” was how I learned it! I remember daylight saving time when I was a child was a big deal. The Saturday night before the official time change would take place, my entire family worked together to make sure that all the clocks and watches in our household were set, not to mention the clocks in my parents’ cars. It never failed. There was always that tiny clock on the top of our stove that we would miss. My mom always caught it when she went to set the oven timer!

Then, once the clocks were all set, my sister and I pondered whether we lost or gained an hour of sleep. We always had to sit there for a minute or 2 and do the math before coming up with the answer.

For most of us today, time changes are not nearly as complicated as they used to be. Our world is much more hurried, and automation is everywhere. It’s accepted that almost every clock, watch, appliance, iPhone, and computer is programmed for daylight saving time. We really don’t have to worry about making sure all of our timepieces make the change. With our schedules so full, we don’t even realize we’ve gained an hour or lost an hour of sleep.

Just like the time change happens each November, Medicare’s Annual Enrollment Period (AEP) happens each October. Medicare beneficiaries can review their current plan and make any changes they feel are needed from October 15 through December 7.

Every year, the AEP is a good time to check your drugs and review upcoming services with your doctor, then make sure the plan you’re on is still the best fit. You might even want to get your family together to make sure you didn’t miss anything.

Some resources available to help you this AEP include Medicare.gov, which is easy to navigate and packed with information, and Illinois’ very own Senior Health Insurance Program (SHIP). The Illinois Department of Insurance offers this free, impartial counseling service for people who are Medicare-eligible. Visit Insurance.Illinois.gov or call them at 1-800-548-9034. You can also find the nearest SHIP office in this directory, or, in Iowa.

And don’t forget to check out your current insurance info at HealthAllianceMedicare.org. If you need to research plan options, you can “fall back” on us! We’re ready to help with any questions you may have for the upcoming plan year.

Mervet Adams is a community liaison with Health Alliance. She loves her grandson, family, nature, and fashion.

Answers to Your Health Insurance Questions

Vantage Point: Time to Answer Important Health Insurance Questions

It’s that time of year again. My husband comes home with a huge packet of healthcare information. Yep, it’s open enrollment for his employer health plan. It’s time for us to look at the options and choices that best suit our family in the coming year.

Every year, Medicare beneficiaries get this kind of event too. It’s called the Annual Enrollment Period (AEP). Each year from October 15 to December 7, they have the opportunity to look at the options available in their service area and choose which plan is the best for them and their health.

This is an important time for everyone. As we age, our health may change too. Understanding and knowing what coverage is best for you can be a daunting task, so you should ask yourself some very important questions each and every year.

Am I happy with my current plan? What’s changing for the new year? Is the premium going up on the plan I currently have? Do I need more coverage?

I understand that as Medicare members, you’re sent an enormous amount of marketing material during this time of year. All the Medicare Advantage, Medicare Supplement, and prescription drug plan companies are trying to get your attention and your business.

How do you weed through all the material? And even more important questions come up for you each year. Do I know the difference between Medicare Advantage and Medicare Supplement? Is the prescription drug plan I’m currently on the best value for the prescription drugs I’m taking? Finding the answers can be confusing and frustrating.

The answers you seek can be found quickly and easily. Visit our website or call us directly for answers to your health insurance questions. There are also independent brokers available to you, like GHB Insurance located right in Olympia, to help you with all the plan information you receive. In the Thurston County area, there are also SHIBA (Statewide Health Insurance Benefit Advisors) representatives who volunteer their time to help you understand Medicare and all the parts associated with it. They can be found at both the Lacey and Olympia senior centers.

So never fear, your Medicare questions can be answered here. Or at least, we can assist you in getting the answers you need. Remember, you have resources available to you. All you have to do is use them.

Joy Stanford is a community liaison with Health Alliance, serving Thurston County. She’s been involved with Medicare for 20+ years and truly enjoys it. She enjoys gospel, R&B, and country music, and she owns over 100 pairs of shoes.

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

SaveSave
Legal Advice: The Right Time for a Professional

Long View: Leaving Some Things to the Professionals

I have to admit the health insurance business is complicated and often difficult to understand. So many regulations are involved, and then there are the exceptions, annual plan changes, and the wide variety of policies that are available.

We help our Health Alliance members navigate the wonderful world of health insurance every day. Another arena that seems especially complicated to me is the law.

In central Illinois, there are resources for people who need legal advice for civil cases (not criminal), which are provided at no cost to those who qualify. One of these is called Prairie State Legal Services. Its mission is “to ensure equal access to justice and fair treatment under the law by providing legal advice and representation, advocacy, education, and outreach that serve to protect basic human needs and enforce or uphold rights.”

Adrian Barr is the Managing Attorney for Prairie State. He told me, “The legal system is a very difficult place to navigate for people who do not have attorneys. It is almost as if we in the legal community speak and write in a different language.”

“Having the opportunity to consult with an attorney about one’s legal situation can be an invaluable resource,” he said. “Prairie State will discuss a person’s legal situation with them and provide legal advice. Prairie State will also provide representation for important legal issues, including those that affect a person’s finances, safety, housing, or their health.”

Lora Felger is my co-worker in Iowa. She is very sharp, but knows legal questions are best left to the professionals. Lora suggests Iowans start with their local Area Agency on Aging. Iowa’s 6 regional Area Agencies on Aging partner with Iowa Legal Aid to offer free legal services to eligible seniors with the Legal Assistance Program. This program “serves persons 60 years of age and older by providing legal advice and representation, information and education, and referrals in civil legal matters throughout the state.”

I think I will have to be satisfied with my expertise in the field of health insurance. I feel justified in my decision to let the professionals handle any legal question that might come up. My personal experience also tells me it would be prudent to use a professional electrician whenever the need arises. I accidentally created an arc welder one time, but that’s a subject for another column.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.