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Health Coverage Options for Pre-Medicare-Age Spouses

Medicare does not offer coverage for younger spouses or dependent children when the other spouse qualifies for Medicare. No one may receive Medicare benefits prior to the age of 65, unless eligible at a younger age due to a disability. What can be done to cover the younger spouse?

There are some options that may be considered for the younger spouse who is not ready to retire. Those options include planning on working past the retirement age of 65, if that is at all possible, which would permit the younger spouse to continue to be covered under an employer health insurance plan until they are eligible for Medicare.

Failing that option as a possibility, there may be employer options open, such as the employer providing retiree health benefits. This is something that would need to be checked with the benefits administrator along with asking whether or not your spouse may continue under their plan as well. In addition, if your spouse is employed, they may switch to their employer’s provided health care plan.

Individual health insurance through the Health Insurance Marketplace, or Obamacare, may be worth considering as well, especially since the proposed health care plan by the current White House administration did not pass, keeping the health care plan in place. Thus, insurance pricing is currently very competitive. The policies offer comprehensive health coverage, insurers cannot deny coverage or charge extra for pre-existing conditions.

An option to consider is COBRA. If you work for a firm that has 20 or more workers, once you make the change to Medicare, your younger spouse could stay with the company insurance for 18 to 36 months. While this is an expensive option, it may work for you depending on your circumstances. If the company has fewer than 20 workers, continued coverage may be available provided your particular state has what is referred to as “mini-COBRA.”

If your income is below the 400 percent poverty level ($64,080 for couples, $27,520 for individuals) then you may be able to receive a tax credit to reduce the amount you will have to pay for a health insurance policy.

For information on insurance plans in your state visit https://www.healthcare.gov/ or call the toll-free helpline at 800-318-2596.

Posted on Wednesday, August 16th, 2017. Filed under Health Insurance.

What you might not know about the ACA?

Many Americans are hoping for a reform in the health insurance system. They are hoping that the Trump administration delivers on its promises regarding health care. People want choices and perhaps that is what the incoming administration is planning to accomplish. It is not clear what changes may be made yet.

What most do no know is that in many states people only had one choice for their health insurance. What is worse is that in other states people had no choice in health insurance. Moreover, many of those who did sign up for insurance through the ACA, were unable to pay their premiums. Many people who qualified for the ACA, did not qualify for government subsidies.

The idea of the ACA was to get the young and healthy people to sign up to provide a cushion for those older Americans who do need health insurance more often. This, however, was not very successful. Young people were priced out of the market, as current wages do not keep up with the rising cost of living.

Obviously the health care system is incredibly imbalanced and a ponderously expensive entity that needs work to make it function well. Much like immigration reform, a replacement for the ACA is going to take some foresight and careful consideration.

Posted on Tuesday, February 28th, 2017. Filed under Health Insurance.

The Affordable Care Act May Not Be So Affordable

Before the Affordable Care Act (ACA) came into being there was a four tier co-pay plan in place. When the ACA was passed people had to know their insurance plan very well, in order to make the most informed decision about switching healthcare.

While there is a great deal of speculation as to what may or may not replace the ACA, it is clear that it was challenging for many people who were used to the previous health care system. Before it was implemented, the four tier co-pay plan was clear: a set price for Tier 1 (preferred generic) and another price for Tier 2 (non-preferred generic).

When the ACA arrived, Americans had to pay close attention to their insurance plans. Many plans stated generic drugs were at no cost; Tier 2 through Tier 4 did not have a co-pay (only after the deductible is reached). Bronze and Silver plans use a major medical deductible before you get the co-pay for brand name drugs. Many of these changes, however, are proving to be costly for individuals and families.

Tier 3 had a certain dollar amount for preferred brand name drugs and Tier 4 may have had a higher set price or an option of paying 25 percent of a drugs listed price. Some individuals may have had a separate deductible for brand name drugs. Health Savings Accounts were in effect prior to the ACA’s arrival, but there was not separate deductible for brand name drugs.

In or out of network was a hard choice due to the costs. An example would be a woman who chose to go out of network on a Preferred Provider Organization plan (PPO). Once out of the network, out-of-pocket expenses and deductibles double. Put another way, going out of the network not only significantly hiked costs but some services are not covered. This means you pay thousands of dollars for medical care and none of it would be applied toward your out-of-pocket maximum.

All ACA plans must have ten health benefits compared to the “other” system which included seven benefits.

ACA Must Have Benefits:

  • Outpatient care
  • Emergency room care
  • Hospital care
  • Prescription drugs
  • Recovery services
  • Lab work, blood work
  • Preventative care

Private (Individual Market) Plan Benefits:

  • Outpatient care
  • Emergency room care
  • Hospital care
  • Prescription drugs
  • Recovery services
  • Lab work, blood work
  • Preventative care (a moving target in terms of what is/is not covered)
  • Mental health (optional)
  • Maternity (optional)
  • Pediatric dental (optional)

Many Americans wondered why their costs soared instead of dropped. The answer lies in the way the ACA reform was funded. To fund such changes, there were multiple federally mandated fees (five to be exact) that began to show up on premiums in 2014. The fees were billed to insurance companies and in turn were passed along to the healthcare user.

Will the private, individual market plans return? Would a return to the old system benefit Americans? Would a blend of the old and new systems work best? Only time will tell.

Posted on Friday, February 24th, 2017. Filed under Health Insurance.

What Does the Affordable Care Act Really Mean?

With the United States facing significant changes in many areas, including health care, trying to understand what the Patient Protection Affordable Care Act (ACA) may evolve into is an unknown.

According to many industry watchers, since the ACA was enacted, over five millions people saw their health insurance policies discontinued because they did not meet ACA standards. Those plans were labeled as being unsatisfactory. However many scrapped plans offered more and were more valuable to customers than what was being sold under the auspices of the ACA.

What are the possible differences between the ACA and what may happen if it is repealed?

  • The ACA plans are focused on preventive care
  • According to the law, many of the services are covered without co-pay
  • Many of the services are not subject to co-insurance
  • Many of the services do not have a deductible
  • These services are supposedly free, but as benefits, they add to premium costs
  • Added premium costs are paid for by policy holders on the front end
  • Health Savings Account-like plans are in the Bronze category under the ACA with a family deductible of over $12,000

The number of claims an insurance carrier gets determines premium costs. There is no underwriting under the ACA, which increases an insurance company’s claim expenses. Increased costs for the increased risks translate into higher premiums. To bring costs down many carriers have restricted their networks of hospitals and doctors — a turn of events that means Americans may have to change doctors or change insurance carriers.

If the ACA is repealed and a different kind of health care system comes into play, such as the system in existence before the ACA was passed into law, the following may be implemented:

  • Insurance plans would focus on major medical
  • Health Savings Accounts with a High Deductible Health Plan or plans similar in nature may return
  • Prescription drug coverage and doctor visit co-pays were applied to the deductible
  • Monies in the savings account could pay for drugs and doctor visits
  • Many people can pay $100 to $200 to visit a doctor

The possible repeal of the ACA and what would replace it is unknown. If the old system is revitalized, consumers may well see more choices and competitive rates and plans.

While the repeal of ACA is ongoing, the prospect for more fair insurance rates and a return to better plans may be hovering on the horizon.

Posted on Monday, February 20th, 2017. Filed under Health Insurance.

Repeal and replace the ACA?

The incoming administration is determined to repeal and replace the Affordable Care Act (ACA). It is difficult to know yet, what is to replace it and how the new system will work. Some provisions from the ACA may be kept in place like keeping kids on a parent’s health plan until they are 26 years-old and not denying people health insurance if they have pre-existing conditions. But the question remains how is the Trump administration going to accomplish this?

Because there is no established system that keeps track of who signed up for insurance and who did not. The question is how to determine who did get insurance, who did not, who was possibly forced into buying it and who still does not have insurance.

Some pundits claim that the ACA gave coverage to 20 million Americans who had never had insurance before. Others say, that it was 14 million counting those who were insured but lost their insurance and had to buy new plans under the ACA. Many people feel cheated and overcharged with their health insurance plans under the ACA.

What is next? Some Americans hope that the Trump administration will repeal the and replace the current healthcare system with something that will lower insurance costs, lower premiums and open the market up with more insurance choices.

Posted on Monday, February 6th, 2017. Filed under Health Insurance.

What Health Care in the United States May Look Like in the Future

According to president-elect Donald Trump, Americans have suffered under the weight of a massive economic burden brought about by the Affordable Care Act (ACA).

Apparently the Affordable Care Act was passed into law without much foresight, resulting in out-of-control costs, non-functional websites, higher premiums, less competition in the insurance industry and a greater rationing of care. As a result of the legislation, every American was allegedly faced with uncertainty of the ACA collapsing, causing even greater economic concern and hardship when it came to health care.

President Donald Trump’s administration suggests that on day one of a new administration free market reforms would be introduced into the health care industry by completely repealing the ACA. Replacing the repealed legislation would be the next task and the administration indicates it would have such reforms ready that closely follow free market principles geared to restore certainty and economic freedom to all Americans. Free market principles combined with sound public policy are intended to broaden health care access, improve the quality of care and make it more affordable.

The proposed seven-point plan touted by president-elect Donald Trump to make health care more affordable for all Americans will allegedly:

  • Lower health care costs for every American
  • Remove uncertainty about health care
  • Offer financial security for Americans
  • Tackle other policy revisions to lower the cost of health care
  • Enforce immigration laws to relieve economic pressures on Americans in health care
  • Stop fraud and waste and energize the American economy
  • Reduce the number of people accessing programs such as Children’s Health Insurance, Medicaid
  • Work on growing the economy by bringing jobs and capital back to the United States
  • Reform mental health services

It appears that the plan to reform health care in the United States is ambitious and may result in some significant changes for Americans. While it is not precisely clear how many of the proposed reforms are to be implemented and what may be designed to replace existing health care legislation, there are many industry pundits who feel that change may be a good thing to stimulate the economy.

The country is on the brink of a new era and it appears that approaching health care with a different point-of-view may produce some interesting results, not only for the people, but also for the insurance industry as a whole.

Posted on Tuesday, January 31st, 2017. Filed under Health Insurance.

The Affordable Care Act’s future for 2017

With a new administration promising to repeal the Affordable Care Act (ACA), 2017 may be a different year. However, with all large changes that may be coming, it is virtually guaranteed that repealing the ACA and replacing it with something else requires, in the words of House Speaker Paul Ryan, “a good transition period.” No matter how much Americans want change that change will need to accommodate the over 20 million people who did buy health insurance under the ACA.

A replacement plan has to be put into place before the ACA could be repealed. While there is a replacement plan on the table, it is not clear if that plan will be sufficient for American families and seniors to keep affordable health insurance that suits their needs. In the meantime, things remain unaffected, pending changes.

One portion of the ACA, referring to coverage for individuals with pre-existing conditions and young adults staying on their parents insurance until they turn 26 may be kept and/or tweaked as new plans are formulated.

Speaker Ryan was not clear on how long a transition period would last, but some reports indicate that it might take up to three years to accomplish the kind of massive shift in health care.

Posted on Monday, January 23rd, 2017. Filed under Health Insurance.

Trump Health Care May be Different

According to president-elect Donald Trump, there is a pressing need for free market reforms in the health care industry. It appears from campaign speeches and recent media interviews that in order to create a free market for health care Obamacare may be repealed.

Mr. Trump has suggested this will happen on day one of his administration taking office. Although he has stated he would seek a total repeal of all aspects of Obamacare, recent media coverage suggests he has taken a slightly different stance on the matter and may agree to retain some aspects of it, such as extending health care coverage to students.

Mr. Trump has stated that by adhering to free market principles his government intends to restore economic freedom and certainty to Americans. He plans to make health care affordable, improve the quality of care available and broaden access to health care.

Health care under a Trump administration may allegedly be accomplished by:

• Congress repealing all or parts of Obamacare. No one should be forced to buy insurance.
• Modifying existing laws inhibiting the sale of health insurance across state lines. Full competition in the industry drives prices down.
• Permit Americans to deduct health insurance premium from tax returns.
• Review Medicaid basic options to allow those who want health insurance to access it.
• Permit Americans to use Health Savings Accounts (HSAs), ensuring they are tax-free and allowed to accumulate.
• Mandate price transparency for all medical professionals, particularly physicians, clinics and hospitals. Americans should be allowed to shop for the best price for procedures, exams or any medical procedure.
• Stop-grant Medicaid to states. State governments can manage Medicaid administration without federal interference. States will be offered incentives to reduce waste and eliminate fraud.
• Remove free market barriers for drug makers that offer reliable, less expensive and safe products. Americans should have more options open to them and be allowed access to less expensive, imported, dependable and safe drugs.

Posted on Monday, December 12th, 2016. Filed under Health Insurance.
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