Saturday, July 26, 2014

Medicare Health Plans 2015

So what can we expect for 2015? Are Medicare health plans going to remain pretty much the same? Will there be any surprises?

It's early and companies are still in the "file and wait" mode. In other words, rates and plans have been filed with the insurance commissioners but approvals are still pending. My guesses are --

Monthly premium rates will change. Established plans with reasonable claims experience are likely to keep their rates close to the 2014 prices. Plans new to to the Medicare market often "buy" business with low rates but sometimes get stuck with "the gooey end of the lollipop." Watch for those carriers to play catch-up with higher rates and/or more streamlined benefit plans.

How long will the zero premium plans be with us? For the last three years I have said they cannot be sustained forever. Don't be surprised if your "free" Medicare health plan suddenly starts charging a monthly premium. If they do, they may sweeten the offering. Read the details.

Some plans are very "plain Jane" with their benefits package. Others are starting to understand that people appreciate the Silver Sneakers program, preventive dental, vision benefits (exam and hardware with $100 or $125/year toward glasses or contacts) and hearing aid discounts. Don't chase the bells and whistles. Look for solid customer service and a network you can live with.

HMO, PPO or Medigap
Most Medicare Advantage plans are based on the HMO or Health Maintenance Organization platform. PPO or Preferred Provider Organization plans are not as prevalent but are popular with folks that don't like being confined to a limited network. If you qualify, a Medigap policy offers the most freedom and portability. Medigap policies are a bit more expensive but can be set up with no deductibles, no office copays and no coinsurance for you to pay out of pocket.

Go Direct or Use A Professional Agent
By all means, use a professional agent that is licensed, trained and certified to help you find the Medicare health plan that 1) is accepted by your provider (s), 2) meets your needs, 3) covers your prescription medicines and 4) is within your budget. An agent is compensated by the carrier and there is no extra charge or premium to you for using an agent. Do it!

Open Enrollment
If you are currently in a Medicare Advantage plan you are "locked in" until the first of the year. Open enrollment runs from October 15th to December 7th and is the time for you to meet with your agent to see if you are in the right plan or should consider switching to something else. If you have gone direct, this is the time to connect with an agent and have him/her help you.


Wednesday, July 23, 2014

Brief Consumer Guide to Health Law Court Decisions

Jul 22, 2014
This KHN story can be republished for free. (details)
On Tuesday July 22, 2014 two U.S. appeals courts issued conflicting rulings on a subject that’s important to millions of people:  the availability of subsidies to help purchase coverage under the health-care law.  KHN’s Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers.
Q: What did the courts decide?
A:  In a blow to the health law, the U.S. Court of Appeals for the District of Columbia Circuit ruled that the health law’s subsidies are available only to individuals in the 14 states and the District of Columbia now operating their own health insurance exchanges.  The federal government now runs the exchanges in 36 states.  Judge Thomas Griffith, writing the majority opinion in the 2-1 decision, said they concluded "that the ACA unambiguously restricts" the subsidies to "exchanges 'established by the state.' "
In a separate ruling, a three-judge panel for the Fourth Circuit Court of Appeals in Richmond, Va., ruled unanimously for the Obama administration, allowing subsidies to be available to residents in all states.  Judge Roger Gregory, writing the opinion, said while the health law is "ambiguous and subject to multiple interpretations," the court decided to uphold the IRS's interpretation of the law that residents of states using the federal exchange are entitled to subsidies.
Q: What was the issue the courts decided on?
A:  The case centers on a brief description in the health law that says subsidies will be available "through an exchange established by the state."
In implementing the law, the Internal Revenue Service (IRS) interpreted the law to allow eligible consumers to receive subsidies to help purchase coverage, regardless of whether they are in an exchange run by their state or by the federal government.
Opponents of the law questioned that interpretation, saying that the law as written clearly directs subsidies to state-based exchanges only.  But proponents– including several lawmakers who helped write it – said lawmakers fully intended that subsidies be offered on all exchanges no matter if they were administered by the feds or state officials.
Q  I don’t know if my state runs its own exchange. Which states do?
A: California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont, Washington and the District of Columbia all run their own exchanges. 
Idaho and New Mexico intend to set up their own marketplace for the next enrollment period, which begins in November, but used this year.
Q: I live in a state with a federally run exchange, and I get a subsidy to help me buy coverage. Am I going to lose it?
A: Nothing is happening immediately.  Justice Department officials said Tuesday they plan to seek an en banc review from the D.C. Appeals Court, meaning that the panel’s full contingent of 11 judges would hear the case.  Six of the court’s judges would have to agree for the full panel to review the case. The full panel is dominated by judges appointed by Democrats, 7-4.
Eventually the case could be considered by the Supreme Court, but the current subsidies would likely remain in place until there is a final legal decision on the matter.
"In the meantime, to be clear, people getting premium tax credits should know that nothing has changed; tax credits remain available," said Emily Pierce, deputy director of the Justice Department's office of public affairs.
White House spokesman Josh Earnest said the administration was confident it would prevail. "You don't need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace."
Supporters of the court challenge to the IRS interpretation on subsidies also maintain their case is strong. "The executive branch does not get to rewrite statutes just because it thinks those statutes would work better a certain way," said Michael Cannon, director of health policy studies at the libertarian Cato Institute who championed the subsidy appeals. "If people lose those subsidies it is because the courts have ruled that those subsidies are and always have been unlawful -- that the administration had no authority to administer those in the first place."
Q: Are these the only two court cases?
A: No. There are two other similar cases pending in courts in Oklahoma and Indiana.
Q: If there are legal disputes ongoing about who qualifies to receive a subsidy, do I still have to buy health insurance?
A: Yes.  The law's "individual mandate," which requires most people to purchase health insurance or pay a fine, is still in place.
Q. What if I get my insurance through work?
This decision applies only to policies sold on the online marketplaces. It does not affect work-based insurance, Medicare or Medicaid, regardless of where you live.

Thursday, July 10, 2014

What is a "Letter of Entitlement"?

From time to time I am referred to people turning 65 that have not applied for Medicare until just before their intended effective date. It can take two to three weeks for Medicare to send out the card indicating enrollment in Part A and Part B.

All Medicare health plans require the person be enrolled to Medicare Part A and Part B. In fact, the agent/broker must copy the card information onto the enrollment application verbatim.

So, what if the person has not received their card and they want to get their application filed on time so their Medicare health plan begins on the desired date?

You can get a "Letter of Entitlement" for proof of Medicare benefits online. Log into "My Social Security" at - create a personal account and print off the letter of entitlement without having to wait for the US Postal Service!

The agent/broker can submit a copy of the letter of entitlement with the insurance application. This prompts the insurance company to pend the application and "ping" (check) the MARx (National Eligibility Database) rather than deny the application.

Thus, if you are close to age 65 and are waiting for your Medicare card to arrive in the mail, you can do an end run on the US Postal Service by using the website above to get your own "Letter of Entitlement."