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Health Insurance Enrollment Options for 2016

By Rene Girard – Hesed Insurance Solutions

Q: I need health insurance for myself/my family. I know a lot of changes have taken place so I’m wondering if you can help me?

A: I’m here to help. Let’s get up to date then explore a few options.

The Patient Protection and Affordable Care Act (PPACA), sometimes called the Affordable Care Act (ACA) or Obamacare, was signed into law in 2010 and was mostly upheld by the Supreme Court in 2012. Now every long term health insurance plan sold in the USA must be PPACA compliant by providing Minimum Essential Coverage – a host of health benefits including maternity and prescription coverage. So what does that mean for you? It depends on your particular circumstances.

 Changes to non-employer based plans for individuals and families only:

  • UNDERWRITING: You can no longer be denied coverage for preexisting conditions. Because health issues are a non-factor, this means applications are approved for just about everyone. Tobacco users will still pay more.
  • COST: Healthier people now pay more for coverage in order to offset the medical costs of those who are less healthy. Men no longer pay less than women. Rates vary by age, zip code, tobacco usage, and plan coverage.
  • PLANS: All new long term major medical plans are “Metallic”: Platinum, Gold, Silver and Bronze. Many PPO plans are being replaced by EPO or HMO plans in 2016. People under 30 or with hardship exemptions may purchase Catastrophic Plans which have the lowest monthly premiums with the highest annual deductibles.
  • AGE RANGE: Plans are available for ages 0-64. Dependent children can remain on their parent’s plan until their 26th birthday. From age 65 onward the Government offers Medicare insurance.
  • MEDICARE: The rules for Medicare recipients are not the same as those for the PPACA. Medicare makes its own changes each year. For 2016, Medicare Part B premiums and the annual Part B deductible are expected to increase up to 52%. Please see my Ask an Expert article from September/ October 2014 entitled “Understanding the Various Types of Medicare Insurance” on the CAP website (http://www.bit.ly/CAP-MedicareInfo).
  • MEDICAID: Medicaid is directly affected by the PPACA. Medicaid expansion for low income individuals was encouraged and expected by the federal government. Many states voluntarily expanded; however, as of this writing, the following states have not: AL, FL, GA, ID, KS, LA, ME, MS, MO, NE, NC, OK, SC, SD, TN, TX, UT, VA, WI, WY. The federal government encourages states to seek reimbursement – this could be from your estate after death, or a lien on your home while you’re alive. Be sure to consult with an experienced attorney before applying for Medicaid.
  • SUBSIDIES: Some health plans are subsidized by the Government and others are not. These subsidies for financial assistance are based upon total household income and number of household residents. Subsidized plans are “On” the Public Exchange. Think of an “exchange” as an online marketplace. Premiums/Prices are based upon projected income. If your income increases, you may be required to reimburse the government for subsidies received.  Non-subsidized plans are “Off” the Public Exchange as part of the Private Exchange. Premiums are the full responsibility of the  insured – just like it has been for decades. There are no IRS forms or income qualifications.

           Note: Hesed Insurance Solutions offers only off-exchange, non-subsidized plans.

  • ENROLLMENT: Healthcare.gov is the now infamous Government website where individuals are encouraged to enroll online. The website helps to determine if you may or may not qualify for Government subsidies to reduce your monthly premiums. Enrollment is possible over the phone, on other insurance websites, or with a paper application.
  • OPEN ENROLLMENT PERIOD: Individuals and families can no longer enroll anytime of the year because now there is an official Open Enrollment Period (OEP). The next OEP is from Nov. 1st 2015 to Jan 31st 2016. If you need coverage and miss this OEP, then you may be penalized.
  • PENALTIES: If a person does not have “minimum essential coverage” then there is an IRS penalty. For 2015: $325 per adult + $162.50 per child not to exceed $975 total, or the greater of 2% of annual household income. For 2016 $695 per adult + $347.50 per child not to exceed $2085 total, or the greater of 2.5% of annual household income. (The maximum penalty is the national average premium for a Bronze plan. If you’re uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you’re uninsured. If you lacked coverage for no more than two continuous months of the year, there is no penalty.)
  • SPECIAL ENROLLMENT PERIODS: If you lose health coverage from an employer, you may qualify for a 60-day Special Enrollment Period (SEP). An SEP allows you to apply for new health insurance coverage if you missed the OEP. Other factors that may trigger an SEP include: marriage or divorce, gain or loss of a dependent, change of residence, change in disability status, loss of Medicaid eligibility, loss of COBRA, and more.
  • EXEMPTIONS: It is possible to be exempt from Obamacare for a number of reasons including: the minimum amount you must pay for health insurance is greater than 8% of your household income; your annual income is below the income tax return filing requirement; financial or domestic hardship; incarceration; not lawfully present in the U.S.; you are a member of an Indian tribe or a religious sect that opposes insurance benefits, or you are enrolled in a health care sharing ministry.

OTHER COVERAGE OPTIONS:

OPTION #1: HEALTH CARE SHARING MINISTRIES

Christians can be exempt from Obamacare if they maintain health coverage through a health care sharing ministry such as Medi-Share or Samaritan Ministries. This is not insurance! This is a way for devout non-tobacco using Christians to share each other’s financial burdens. Monthly dues are used to pay immediate needs. Medi-Share administration receives monies and sends checks to qualifying members. Samaritan Ministries members send checks directly to other members. Both encourage writing notes and praying for other members. Significant qualifying needs are publicized in newsletters. Medi-Share negotiates on your behalf to lower the amount you owe. Samaritan Ministries makes participation easier and more affordable. There are quite a few similarities and differences between these two organizations that serve individuals, families, and groups. Unlike insurance, there are no guarantees that the amount of money you need to pay your bills will be there when you need it; however, with tens of thousands of committed believers as members, it is possible to receive all that you need and more.

OPTION #2: SHORT TERM HEALTH INSURANCE

Some companies offer short term health insurance plans that last from 1 to 12 months. Rates may be more affordable than regular long term health insurance, but the plans do not necessarily cover any preexisting conditions and do not count as creditable coverage to avoid the IRS penalties of Obamacare. Electronic enrollment is quick and easy any time of the year and coverage can sometimes start the next day.

OPTION #3: EMPLOYER INSURANCE

We direct employers to a Christian agency partner. Employees need to revisit all options available through their employer before searching elsewhere. A change of employment in order to attain a more desirable income or improved healthcare benefits may also be worth serious consideration.

The preceding information is neither comprehensive nor complete. If you would like more information on any of these topics, please visit my website: InsureMyParts.com, where you can also compare non-subsidized health insurance plans and prices from some of the largest insurance companies in the nation (varies by state). This Self-Serve Insurance® website is safe and secure, allowing you to enroll online 24/7 from the comfort and convenience of home. There are also special links for the Health Care Sharing Ministries mentioned above. Both Hesed Insurance Solutions and CAP will benefit should you decide to enroll in any of the available plans at the same low prices as going direct.

 No access to the internet? Call my office: 1 (619) 730-HELP. No nationwide calling? My call center’s phone number: 1-800-9-800-342.

Whether you have regular insurance or decide to try a Health Care Sharing Ministry, make sure those you care about have coverage “just in case.”

 Mr. R. Girard has been selling insurance since 2004 and is now doing business as Hesed Insurance Solutions. By offering a wide variety of insurance and financial products to residents of all 50 states, Mr. Girard and his team are here to meet your needs with free consultations courtesy of CAP member benefits.

 

                                                     ENROLLMENT PERIODS AT A GLANCE

                                                    Annual Open Enrollment Period                         SEP

Under 65 Health                         Nov 1/2015 – Jan 31/2016                                                   Yes

Medicare Part C Advantage      Oct 15 – Dec 7                                                                      Yes

Medicare Part D                          Oct 15 – Dec 7                                                                        Yes

Medicare Supplement                None (Enroll/Switch when able)                                     No

Senior’s Choice                            None (Enroll anytime)                                                         No

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Options for Long-Term Care

ASK AN EXPERT

Q: I’m not sure if I need Long Term Care insurance, or what kind I should get. How much does it cost, and what do you recommend?

A: I’m glad you asked because many people think that long term care insurance is only for the elderly, yet according to the U.S. Department of Health & Human Services, “Forty (40) percent of people currently receiving long-term care are adults 18 to 64 years old.” (www.longtermcare.gov)

It’s also important to know the factors that increase one’s risk of needing Long-Term Care:

  • Age: The risk generally increases as you get older.
  • Marital Status: Single people are more likely to need care from a paid provider.
  • Gender: Women are at a higher risk, primarily because they tend to live longer.
  • Lifestyle: Poor diet and lack of exercise can increase your risk.
  • Health and Family History: Your general health, genetics, and learned habits can also have a big impact

Long Term Care can cost tens of thousands or even hundreds of thousands of dollars and is not covered by health insurance, including Medicare! While some individuals can afford to risk paying six figures out of pocket, it generally makes more sense to leverage your current assets “just in case.” Let’s look at three options:

Traditional Long Term Care Insurance (LTCi)
Under this coverage, monthly premiums are based upon your age, gender, health status, where you live, the amount of daily benefit you wish to receive ($100, $110, $120, etc.), the amount of time you wish to receive that benefit (one year, two years, three years, etc.), the elimination period (which is like a deductible — it equals the number of days you are willing to pay out of pocket before the coverage begins: 30 days, 90 days, 180 days, etc.), and other factors. Discounts for spouses and annual payments are possible. Average cost is $200 to $500 per month.

In-Home Service Plans
These plans are not insurance policies, they are service contracts. They serve as a supplement to, or an alternative to, traditional Long Term Care insurance. Some LTCi policies only pay for service in a nursing home or similar facility, and some policies have a very long elimination period. With an In-Home Service Plan, a person can receive non-medical assistance in their own home for an extended period of time and then utilize their LTCi policy. Services include assistance with dressing, bathing, meal preparation, laundry, housekeeping, medication reminders, accompaniment to doctor’s appointments, and more.

With an In-Home Service Plan, there are no deductibles, no co-pays, no claim forms, no underwriting, and no age limits. But you must acquire the plan before you need it, then keep it current. The company we use offers spousal discounts, annual payment discounts, and/or will lower monthly payments by 10% each year the plan is kept but unused (up to a 40% discount). Wouldn’t it be nice to see at least one bill go down each year? Monthly payments, before any discounts, start at just $95 for Bronze level up to $475 for Platinum.

EXAMPLE #3 – Zero Cost Long Term Care®
A Zero Cost Long Term Care plan allows a person to leverage his or her current savings in a CD, old annuity, 401k, IRA, etc. (which offer no additional monies for long term care) by simply moving a portion of those funds into either a new annuity or life insurance policy that will provide additional funds if Long Term Care is ever needed.

Policies vary; however, it is not uncommon to earn higher interest rates and still double one’s money for Long Term Care. In some cases, a person may create a benefit of 300%, 400%, 500%, even 600%! Where can you get that kind of return on your money guaranteed in writing? Some policies also offer a money-back guarantee. This is a brilliant way to pay for professional care without paying monthly premiums for LTCi.

PLEASE NOTE: In order to receive compensation or reimbursement, all plans require verification that a policy holder is unable to perform two of the six activities of daily living (ADLs): bathing, dressing, eating, continence, toileting, and transferring.

HESED INSURANCE SOLUTIONS offers all of the above plans to CAP members nationwide. Plans and companies vary by state. Visit HesedInsuranceSolutions.com to learn more, or call 1-800-9-800-342 to discuss your options with a licensed agent.
(Zero Cost Long Term Care® is a trademark of Mr. Mark Dice, used with permission)

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Understanding the Various Types of Medicare Insurance

From Sept./Oct. 2014 issue of CAP Connection.

Q: I see many commercials and receive a lot mail concerning the various types of Medicare Insurance. Can you make it simple to understand so I can determine if I have the right type of coverage for my parents/my spouse/myself?

A: Yes indeed. Please keep in mind that Medicare was never meant to cover all of your doctor and hospital bills. That is why millions opt for additional insurance to help cover expenses that Medicare does not cover. Let’s start with Original Medicare, then visit each additional type of Medicare insurance.

 1] ORIGINAL MEDICARE
This basic insurance coverage is provided by the U.S. Government to most U.S citizens age 65 and older who have “paid into the system” during their working years. It includes Medicare Part A (Hospital coverage) and Medicare Part B (Medical coverage).

Medicare Part A
Covers most of the cost of hospitalization. The 2014 deductible is $1,216. That is the amount you must pay each time you are hospitalized before the insurance begins. Part A will then pay the remaining cost of staying in a hospital room for up to 60 days. After 60 days, you must share in the cost of the room. After 150 days, you are fully responsible for the cost of each new day.

In a skilled nursing facility, Part A will pay the cost for the first 20 days, then you share the cost for days 21-100. After 100 days you must pay the cost of each new day.

Hospice care is covered under Part A. Not 100% but close to it.

Medicare Part B
Covers most of the cost from medically necessary treatments received in a doctor’s office, hospital, or other facility. The 2014 deductible is $147 per calendar year. That is the amount you must pay before the insurance begins to pay. Part B will then pay 80% of the Medicare Approved Amount for each item or service billed to Medicare. You are responsible for the remaining 20% plus 100% of any additional costs not covered or approved by Medicare.

Medicare Part A & B can be used with any doctor or hospital in the U.S. that is willing to accept Medicare’s payment for services.

The Cost of Part A is typically $0 per month, although some people pay for Part A.

The Cost of Part B in 2014 is $104.90/month for most people.

The greater your income, the more you could pay.

 2] MEDICARE PART C
Also known as Medicare Advantage, these plans offer at least the same coverage as Medicare Part A & B combined. Typically there are additional benefits, such as built-in prescription drug coverage.

Medicare Part C is offered by insurance companies that receive a Government subsidy to provide coverage to Medicare recipients; therefore, the person who acquires Medicare Part C will have his/her hospital and medical bills paid by an insurance company.

Medicare Advantage (MA) Plans vary by company, state, and region. Medicare recipients can enroll during their Initial Enrollment Period, up to 3 months before and after the month they turn age 65, or during the Annual Open Enrollment Period, October 15 to December 7, when they may also switch plans.

MA Plans often have networks of providers; however, all doctors and hospitals are required to accept Medicare Part C in an emergency.

MA Plans have co-pays for office visits and require co-insurance for hospital stays and medical treatments received. There are annual out-of-pocket limits set for each plan to prevent too great a financial burden on the person with Medicare Part C.

Individuals must continue to pay their Part A & B premiums. Each MA Plan has its own premium, sometimes as low as $0 per month.

3] MEDICARE PART D
These stand-alone prescription plans are only available through insurance companies. Each Part D plan must meet minimum government requirements for prescription drug coverage; however, the plans, prices, and formularies (lists of covered medications) varies tremendously and often www.capmemberbenefits.org 13 change each year. Medicare recipients may enroll in a new Part D plan under the same rules as Part C.

 4] MEDICARE SUPPLEMENT INSURANCE
Medicare Supplement insurance is designed to supplement Medicare Part A & B. This insurance is also known as “Medigap” because it fills in the gaps for A & B (such as copays, deductibles, and co-insurance).

Medicare Supplements are standardized and alphabetized (A, B, C, D, E, F, G, etc.) so consumers know exactly what benefits they will receive no matter what insurance company provides the coverage. Not all letters of the alphabet are represented, and some plans available in the past are no longer offered for sale.

Medicare Supplement insurance pays secondary to Medicare, can be used anywhere in the U.S. with any doctor or hospital that takes Medicare, and some plans offer emergency coverage outside the U.S.

The most comprehensive Medicare Supplement is Plan F. It is also the most widely sold new plan because it fills in every gap for all Medicare approved services and hospital stays, including Excess Charge coverage, which is up to an additional 15% above the 80/20 split between Medicare and you.

One of the most frequent complaints about Medicare Supplement insurance is the cost because premiums typically increase each year. Insurance companies can’t raise premiums based on individual claims and can only drop people from coverage if they don’t pay the premium due.

Medicare Supplements have a six-month Open Enrollment Period that begins on the first day of the month a person turns 65 and/or enrolls in Medicare Part B. Medicare recipients may then acquire or switch plans any time they can pass through underwriting.

CONCLUSION
This information is neither exhaustive nor complete. You can find more information at Medicare.gov by reading the 2014 Medicare & You booklet from CMS (the Centers for Medicare & Medicaid Services), and/or discussing your situation with a licensed agent who specializes in Medicare insurance.


Mr. Réne Evan Girard dba Hesed Insurance Solutions has been offering Medicare Supplements & Rx Plans to seniors since 2004. Initially licensed in Texas, Mr. Girard moved to California in 2009 and now offers a wide variety of insurance and financial products to residents of 46 states + D.C. CAP members are invited to visit his website MedicareOpenEnrollment.com to gather more information, run hassle-free quotes 24/7 nationwide from multiple insurance companies, or call toll free 1-800-980-0342 with any questions or concerns. Mr. Girard and his team are here to meet your needs with free consultations courtesy of CAP member benefits.

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