More on Shrinking Out-Of-Network Benefits – The Claims Filing Deadline Trap

In an earlier communication we addressed the value, although dwindling value, of the out-of-network benefit. Remember, if you don’t have out-of-network coverage, and seek care from a provider outside of your Plan’s network, you won’t be covered. As a result, out-of-network benefits are an important protection even though payment rates from insurers have been driven down. Another issue to remember when using out-of-network benefits is your Plan’s claims filing deadline. Unlike in-network claims which are filed by the provider directly to the

Obamacare Moving Ahead Despite Setbacks

On July 2nd, the Obama administration announced a one year delay in implementing the requirement that large employers, those with 50 or more employees, provide employees health insurance or pay a fine. The delay is an embarrassment to the administration and follows delays in implementing small business insurance exchanges in most states and abandoning the Affordable Care Act’s long term care program altogether. Nevertheless no one should doubt that on (or perhaps near) October 1st, 2013, insurance exchanges in each state will

Long Term Care Coverage – Q&A

What is Long Term Care Coverage? Long Term Care Coverage is an insurance product that provides coverage for nursing home stays and home health care service. Will my Medical or Medicare coverage pay for those services? Only when you are recovering from an illness or injury and need short-term services from skilled professionals. Services covered through long term care policies are typically provided by individuals who lend you assistance for so-called activities of daily living because you are too frail to do them

Medicare and Obamacare 2014

We have received many inquiries from those on Medicare wondering what they have to do to prepare for the provisions of the Affordable Care Act (Obamacare) going into effect on January 1, 2014. The short answer is, NOTHING. It’s not that Obamacare doesn’t affect individuals on Medicare, but the primary provisions of Obamacare that take effect in 2014 are: Everyone will qualify for insurance, regardless of health status. Coverage will meet minimum essential benefits. Neither of these apply to those on Medicare. We have received other questions from

Doctors Abandoning Medicare?

The Wall Street Journal reported on July 19, 2013, that 9,539 doctors opted out of Medicare in 2012 according to the Center for Medicare and Medicaid Services. Should this be a concern to those on Medicare? Yes and no. Out of a nationwide pool of some 685,000 doctors, 9,539 is about 1.4%, a rather miniscule number. But the trend is scary because it is triple the number of doctors who opted out several years ago and “Baby Boomers” are now aging on

The Dumb Myth that Young Americans Don’t Need Health Insurance

“I’m young and healthy and can’t afford health insurance. I’m getting off to a reasonable start but just making ends meet. If I get sick, they have to treat me in the emergency room, right? And I don’t have any assets, so there’s nothing for a hospital or doctor to take if they come after me for money.” This attitude is foolhardy madness. Here’s why. Illness and Injury Young adults are not all in perfect health. They are prone to many types of

State Health Insurance Marketplaces Not For Seniors

On August 26, a Kaiser Health News article clarified the fact that those on Medicare should not be shopping for health insurance on the new insurance marketplaces which are open as of October 1st. This is correct. People on Medicare should not shop on the new state insurance exchanges. The Wall Street Journal recently reported that IBM retirees on Medicare will be shopping for their retiree coverage on private exchanges but those private exchanges have nothing to do with the

Health Care Coverage and DOMA – – No News Yet

In June of 2013, the Supreme Court overturned DOMA, the Defense of Marriage Act. Prior to this Supreme Court ruling, only heterosexual couples were recognized by federal law as being married. As a result of the ruling, the Treasury Department announced in August that gay and lesbian couples who are married can file joint Federal tax returns. The IRS has indicated that is true even for couples who currently reside in states which don’t recognize same-sex marriage. Thirteen states and the

Annual Medicare Part D Open Enrollment Begins

Every year, those who have enrolled in a Medicare Part D prescription drug plan may select a new plan between October 15th and December 7th for an effective date for January 1st. Should I Consider Changing Plans? Every individual who has experienced service problems with a plan; goes into the donut hole or gap (the part of the year you pay more of the cost of your prescription medications); or has concerns about a plan because it’s been sanctioned by the government,

Shopping for Coverage for 2014

As everyone has heard, the website experienced many problems when it launched in October. The administration has stated operations should be smoother by late November. In most states, residents are relying on, the federal website, to shop for insurance coverage for 2014. The following states and DC are not relying on These states are operating state exchanges for their residents: California Kentucky New Mexico Colorado Maryland New York Connecticut Massachusetts Oregon DC Minnesota Rhode Island Idaho Nevada