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Medical Insurance

As the time comes for open enrollment or to renew your health insurance, here are some helpful hints to look at before your purchase a plan.

Look before you renew
As the landscape for health insurance continues to change it is important that you make sure that your fully check out your options before opting to renew. Not only do the options available in your plan change from year to year but your personal circumstances change. You may have moved, found a new job, or had a child and all of these can change what you need from your provider. Also, if your plan is being replaced make sure you fully look over what it is being replaced with so you are not surprised later down the road and find that what you need is not covered.

Doctors and prescriptions, oh my…
You will want to make sure that your preferred doctor accepts that coverage before you enroll. And going to a doctor outside of your coverage can cost you substantially more that going in your plan. Also, you will want to know what your prescription medication is going to cost you. Most companies will assign medications to a different level or tier so that between different companies the medication you need may be covered but it may be on a different tier and therefore would cost you much more.

Consult an insurance broker
When the Affordable Care Act come into effect its purpose was to let people comparison shop relatively easily for different health care options. However, the health care market is wide and varied and you can very easily not see a special savings or find out that what you need is not covered when it is too late. Health Insurance brokers are working hard to stay ahead of the changes in the law, know all the different nuances of plans being offered and want to help you find your best fit. Contact us at Bernardini & Donovan and let us help you look beyond the bare essentials to finding a package that fits you and your family perfectly.

There are some people in the world that just know things. They are the mavens that can rattle off facts, dates and details that the rest of the population just never grasped. This blog post is not for them. This post is for those of us who don’t know the first thing about Medicare and the deadlines needed to sign up.

So first things first. You become eligible for Medicare when you turn 65. But the deadlines for signing up extend to the months that surround you birthday. However, there is an exception if you already are receiving Social Security benefits you are automatically enrolled in Medicare A and B. But if that is not the case then you need to sign up yourself. You have a window of enrollment that last seven months. The seven month window begins three months before your birthday month, goes through your birthday month and continues on for the next three months after your birthday. So if your birthday was in June you could sign up for Medicare starting March 1st and it would end September 30th. If you miss this deadline you can join during open enrollment from January 1 to March 31 each year.

The reason that you will want to make sure that you sign up during these seven months is so you will avoid any fees that come with signing up late. The monthly Part B premiums will be raised by 10% for each 12 month period you wait to sign up for Medicare. “The idea behind the penalty is to give people a financial incentive to enroll in insurance from the get-go as opposed to waiting until they have some kind of negative health event,” says Mark Duggan, an economics professor at Stanford University.

It is important to note that if you or your spouse are still working for an insurance providing company when you or your spouse turn 65 it is not mandatory to enroll at that time, you can stay with your current provider. However, once the household member that they insurance is provided through retires then you will need to enroll. You will have an 8 month period enrollment time. The 8 month time period starts the month after the employment ends or when your insurance coverage from that job ends.

We hope this information helps, but if you have more questions please feel free to contact us at Bernardini & Donovan

Most people assume that our healthcare systems are paid for through private funds. Those private funds coming from health insurance premiums or from employer based coverage. However, a recent study shows that in California, that is just not the case. In fact about 71% of all funds paying for California’s healthcare comes from public funds, meaning California’s taxpayers are paying for a majority of the state’s health coverage. In 2016 it is estimated that $367 billion will be spent on health care. With these numbers that means that roughly around $260 billion will come from taxpayer money.

But California seems to be a unique case. When looking at the country as a whole, it was estimated that only 45% of the $3 trillion spent on health care comes from public funds. So what has made California stand out so much from the national average? Well there are a few factors to look at. One is that the national average is estimated to be much lower than what is actually being used. The American Journal of Public Health estimates that a more accurate picture of national spending is around 65% of public funds are put towards health care. The second aspect is that California does have some unique cases. UCLA’s study on California’s expenditures states that “health spending through county public health expenditures, new Affordable Care Act subsidies and tax subsidies for employer-based health insurance drives the proportion of care paid for by the public well beyond the CMS estimate” California also has had a larger expansion of Medi-Cal coverage showing around ⅓ of the state’s population is covered through this low income program.

What does this mean for you? Researchers are now beginning to question what it would look like to have a single payer health care system because we are already leaning towards that end of the spectrum as it stands. But we will have to wait and see how things continue to change with our aging generations and shifting political systems.

When the Affordable Care Act was signed into law in 2010 there were so many predictions going on. This will never last…. How can we possibly sustain this… This will change everything… Whether you were for the Affordable Care Act or against it we have seen some drastic changes in our country because of it. We have seen people who were not insured be penalized on their federal income taxes for not signing up. We have seen families adjusting to different expenditures on their health care. We have seen many who never had health insurance now be covered. But one of the questions that you may be asking (along with many other Americans) is the Affordable Care Act here to stay?

This is an excellent question and depending on who you ask you may receive two drastically different answers. The Los Angeles time recently reported on a study done by the Urban Institute which gathers and studies information about economics and social policy. Their recent study about the Patient Protection and Affordable Care Act started in 2011. Their studies show “a widespread slowdown in spending growth expenditure projections and the cost of the ACA” Meaning that the projection of spending for the years 2014 – 2019 is $2.6 trillion lower than what was originally thought to be needed. Which leads many people to speculate that the Affordable Care Act is working and therefore here to stay.

However, in June of this year we saw House Speaker Paul Ryan calling for and presenting his plan for healthcare reform. His plan detailed that they would like to “repeal Obamacare, Provide Americans with more choices, lower cost and greater flexibility as well as protect our nation’s most vulnerable and spur innovation in healthcare.” Paul Ryan also said that he wants to shift from Obamacare’s focus on quantity and how many people are covered to quality and ensuring that people receive the care they want. However, this plan has come under attack because the plan lacked specifics on how they would make these changes.

It seems that this debate will be continuing for some time. But know that we at Bernardini & Donovan plan on staying ahead of the curve so that with each change we can equip you with all the information that you need and the help design health coverage plans for you and your family.

Last summer we saw a huge announcement within our health providers when the Big Five national health providers announced that they would become the Big Three with a merger between Anthem and Cigna and a merger between Aetna and Humana. However, as soon as the announcement was made there were outcries against these mergers. There has been concern that if these five large companies which provide much of the innovation within the health industry are not working to stand out or outperform their competitors then the innovations such as new programs for consumers, seniors, and formerly uninsured will stop as well as the possibility of insurance premiums going up. And just recently the US Attorney General Loretta E. Lynch, announced that they had filed lawsuits against these mergers with the purpose of blocking these deals. Their main concern is that these mergers “would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies… If these mergers were to take place, the competition among insurers that has pushed them to provide lower premiums, higher-quality care and better benefits would be eliminated,” said Lynch.

This last month we have also watched at Aetna has started to withdraw their services from certain markets in the United States. This is allow many Americans more limited options for their health care providers and in some cases leaving them with only one option if they are to receive health insurance. These changes will mean that many people will need to change their doctors or their prefered treatment facility to what will be covered under their new plans.

What does this mean for us? It’s hard to say at this time what these changes mean for us. While there are concerns of loss of innovation and rising premium costs, the insurance companies have continue to insist that that will not be the case. But at the very least this is one of the most politicized antitrust cases to be seen in some time.

There are so many benefits to having health insurance. From the simple fact that when you are feeling not at your best you have a place to go to get some care. Even having the peace of mind of knowing that when your baby won’t stop coughing you have an expert at hand who will give you everything you need to take care of your little one. But did you know that there are many additional benefits to your health insurance besides your basic doctor visits, prescription drugs and hospital care.

  • Online access – How many times have you lost your ID card and need to call to get a new one mailed to you. With online access you can print out a new ID card immediately. You can also see your claims, changed doctors, and never be on hold for over an hour again. You can do all of these and more online.
  • Gym Membership – Many insurance companies are now offering gym memberships, discounts on gym membership or even reimbursement on a gym membership if you check in a certain number of times at the gym per month. They may also offer discounts on gym equipment. So if you are looking to invest in an elliptical or a treadmill check to see if you get a discount.

  • Diet plans – You may find a discount on certain weight loss and diet plans such as Weight Watchers, Jenny Craig or Nutrisystem.

  • Homeopathic Medicine – more insurance programs are covering homeopathic remedies such as acupuncture or chiropractic care. If they don’t completely cover it they may also offer to add it on for a small fee.
  • 24 hours nurse care – small children always seem to get every cold that is out there. And with this service you can call a nurse hotline and get advice if it is enough of an emergency situation to go to urgent care or emergency room.

  • Employee Assistance Program – get financial advice for today or for your future financial planning.

  • Mental Health – Talk to someone via telephone as well as in person visits if needed.

Health insurance costs are continuing to go up but there are other benefits available to you that adds to the value to your health insurance plans.

Of all the government assistance programs out there, people tend to have the most questions about Medicare. It’s true that this government-run health insurance plan can be confusing, because it is so detailed. However, if you just know a few basics about it, it will make learning the rest so much easier.

First of all, you become eligible for Medicare at age 65, regardless of whether or not you are still working or have retired. You can use it in conjunction with your employer-sponsored health insurance while you’re still working, or if you’re able to retain that insurance after you retire. Medicare then acts like a backup insurance plan to cover the things your primary insurance doesn’t cover, such as co-pays. You can also get Medicare if you are legally disabled, regardless of your age.

When you first become eligible for Medicare, you are automatically signed up for Part A. Part A covers hospitalization and all the expenses involved with a hospital trip or stay. Part A is free. You have the option of signing up for Part B when you enroll in Part A, though it’s not required. Part B covers doctor visits, lab work, and any medical work outside of a hospital, except prescriptions. You have to pay a small monthly premium for Part B.

If you don’t sign up for Part B when you first get Medicare, you have the option of signing up for it during the open enrollment period each year. However, the longer you wait, the higher your premium will be, so it’s best to get it right away. Another important thing to remember is that if you’re legally disabled and getting disability payments from the government, you must wait two years after becoming legally disabled before you become eligible for Medicare.

For more information about Medicare in California, please contact Bernardini & Donovan Insurance Services in Redlands!

Considering Medicare Supplement Insurance Plans? Here are few factors that could help you make a sound decision:

1. Medicare Supplement plans do not replace the government Medicare programs. Supplement plans, also known as Part C plans, cover additional benefits not covered by Medicare Parts A & B.

2. Part C plans do not cover prescription drugs. You need a Medicare Part D plan, usually sold separately, to gain prescription benefits.

3. Although you may have heard otherwise, the Affordable Care Act (Obamacare) has not eliminated Part C plans. The new health law does affect how insurers are reimbursed, which could lead some plans to change or eliminate some services.

4. Every Medicare Supplement insurer offers the same standard benefits. You should choose a plan based on its reputation, customer service and cost.

5. Medicare Supplement Insurance has an Open Enrollment window. The first takes place within three months before or after you turn 65. If you change your mind about having Medicare Supplement Insurance after that, you can add coverage or go back to standard Medicare during an annual Open Enrollment window.

Bernardini & Donovan Insurance Services can help you review your options and decide what kind of Medicare coverage works for you. To learn more or make an appointment, contact us.

Medicare offers older Americans many health benefits to offset the high cost of medical care. The following guidelines can help you determine if you qualify for what Medicare has to offer.

Individuals age 65 or over qualify for Medicare if:

  • They are U.S. citizens or permanent legal residents and
  • They or their spouse are eligible for Social Security benefits, even if they’re not receiving them yet. (Applicants must have earned at least 40 credits for approximately 10 years of employment)
  • They are government employees or retirees who have paid Medicare taxes during employment
  • Applicants can qualify on their spouse’s employment record if their spouse is 62 and they are 65 or older. This includes a divorced spouse or one who is deceased. Individuals qualifying for Medicare through same sex marriages must live in a state that recognizes this status.

Individuals under 65 qualify for Medicare if:

  • They have been receiving SS disability benefits for 2 years or receive disability benefits from the Railroad Retirement Board
  • They have Lou Gehrig’s disease
  • They suffer from kidney failure and have paid SS taxes for a specific time period.

For more information on Medicare eligibility as a health insurance option in California, contact Bernardini & Donovan Insurance Services located in Redlands, CA.

Subsidies will be reducing the overall price that many lower income Americans need to pay in regards to their newly mandatory health insurance policies. While health insurance policies are set to become more affordable as of January 1, 2014, many individuals still feel as though the monthly cost could potentially be out of reach. As a consequence, many individuals may wish to pursue the subsidies available to them.

When the Affordable Care Act is implemented, all individuals will be required to carry health insurance. This includes those that do not have employer-provided health insurance. Today, the costs of individual health insurance can be quite high, but in the future it is expected that insurance policies will become more affordable.

Those that have an income of less than four times the poverty level will be able to qualify for health insurance subsidies from the federal government so that they can afford basic health insurance. In addition to this, the standards of health insurance will be raised so that they are more beneficial to policy holders.

For more information about the individual subsidies available for individual health insurance contact Bernardini & Donovan Insurance Services, experts in the Affordable Care Act and individual health insurance needs.