ARC’s Vice President of Sales Operations Luke Boemker covers a few health insurance terms that you should know about.
Watch the video below!
ARC’s Vice President of Sales Operations Luke Boemker covers a few health insurance terms that you should know about.
Watch the video below!
It’s almost the new year, which means it’s time to review the details of your health plan for 2021 so you can maximize your savings. We have put together a quick checklist that you can use to review your current health insurance and any changes or items to be aware of for the upcoming year. As always, contact your ARC representative with any questions you may have about your health insurance plan!
November is National Diabetes Month so we rounded up some resources from reputable sources for more information about preventing diabetes, managing diabetes during the COVID-19 pandemic, how to help your children and teens who have diabetes, and more.
“The ADA is doing all we can to protect our community during COVID-19.” Click here for more information.
The NIDDK has provided a flyer with tips to help children and teens who have diabetes. Click here to download the flyer.
“Although there are certain factors you can’t change —such as your genes, age or past behaviors—there are many actions you can take to reduce the risk of diabetes. Here are 13 ways to avoid getting diabetes.” Click here to read the full article.
“Diabetes care and education specialists are found in accredited programs across the country. They work with you to develop a plan to stay healthy, and give you the tools and ongoing support to make that plan a regular part of your life. Search for an accredited diabetes education program in your area.” Click here to find a program.
Did you know? Recently, the Centers for Medicare and Medicaid Services (CMS) announced that participating enhanced Part D prescription drug plans will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, from the beginning of the year through the Part D coverage gap.
We want to help you find a plan that works well for your budget and provides the resources that you need to manage your diabetes. Contact us today to find a plan.
It’s that wonderful time of year when every other commercial advertises health insurance options for you to consider above all others, or your mailbox is giving way to the latest shipment of junk mail promising you $0 premiums, extra benefits at no cost to you with outstanding coverage that is all centered on your happiness. What to do, what to do?
There are some things to consider before taking the leap to enroll. Are you currently working with an agent that you trust to confirm that your doctors, hospitals, and medications are covered? A true insurance professional has your interests at heart, and will break down benefits and restrictions so you know what you are buying. Their professional reputation is on the line with every sale.
When reviewing Medicare plans, there are a few things for you to consider. Has anything changed in the past year regarding your health, doctors, or medications? If so, you should reach out to your agent with the changes and discuss what you liked and disliked about your current coverage.
Your current health insurance carrier should be sending you what the new benefits will be for the upcoming year, and if there are any changes to the benefits, premiums, etc. You usually receive this well before your agent has access to them. It is best to reach out to them early in October to discuss.
If you currently have a Medicare Supplement, you do not need to shop for a new supplement plan, since those plans do not change from year to year. If you do decide to change carriers, you may have to go through underwriting and could be declined for the new plan, but still be able to keep your current plan.
On the other hand, if your medications change or you do not like your current plan, you do have the option to switch plans from October 15 through December 7 of each year with the new plan beginning on the first of the following year. I highly recommend that you email your agent with the changes in medications so they can provide you accurate quotes as soon as possible. If you like your plan and nothing really changes, you do not have to do anything; your plan will automatically renew.
If you are not Medicare eligible, you do have the ability to look at individual coverage from November through December 15 of every year, with the effective date starting the first of the following year.
The same rules apply as far as changes in doctors, medications, and, in this case, income if you qualify for an Advanced Premium Tax Credit (APTC) to reduce your premium cost. If you do qualify for APTC, you should update your income every year, since benchmarks change from year to year, as well as the calculations of income, age, location, and smoker status. Obviously, you will be looking at the upcoming year for income, which, for the most part, will be a guess. You do have the ability to adjust your income during the course of the year if there have been significant changes. Otherwise, you will be required to reconcile your APTC every year with your taxes. If you make more, you may need to pay some of the APTC back to the government, but if you make less, you may receive a bigger refund check.
If you do not qualify for any assistance through the Affordable Care Act and you like your plan, you can just allow it to renew.
As always, your agent will be your go-to person regarding any changes for the upcoming year, and their services are at no cost to you. As an agent I recommend getting in touch with us as soon as possible, since the enrollment window is short and website systems do go down the closer you get to the end of the election period.
When speaking with your agent, be prepared with your doctor’s names, dates of birth, smoker or non-smoker, preferred hospitals, medications, and income (including the sources) since your agent is very busy trying to help all of their clients in this short election window.
We wish you all a wonderful election period, and will be happy to help you along the way—just give us a call.
Have you ever gone to an appointment and then got smacked with a $4,000 medical bill? It probably looks a little something like this…
Receiving those bills can be overwhelming and it might seem easier to just tuck it away in your inbox and never think about it. But, your bill won’t just go away if you ignore it. Often, providers will send your bill to a collection agency and eventually your credit file if not resolved in a timely manner. It’s best to confront the bill head on and form a plan to resolve it.
You do have options in these situations. Here is what to do when you’re faced with a high-dollar medical bill:
In some cases, the high cost of services can be due to an accounting error, such as a wrong billing code or even the wrong claim code. It’s important to comb through your bill to ensure that everything was properly calculated.
Your EOB will show you the amount you are responsible for paying to the provider as well as discounts and negotiated rates. Always compare the bill from your medical provider to the EOB to ensure that the services you received and the charges listed are correct. Be sure to also keep these documents on file for future reference.
Your doctor may offer financial assistance based upon income. Contact your medical provider to find out what options are available to you.
Your health insurance agent is your advocate and can help you resolve escalated issues in a timely manner. They can communicate on your behalf directly with the insurance company to help save you time and frustration when dealing with these issues.
You don’t have to face these issues alone. Your ARC licensed sales agent is available to help you with your health insurance plan, including helping you map out a plan to tackle a high-dollar medical bill. Contact us today.
If you are turning 65 in the next six months, you have likely started receiving post cards, letters, advertisements, and phone calls from insurance companies and insurance agencies offering to help with your upcoming senior moment: the day you are eligible for Medicare.
If you are aging into Medicare, you have a seven-month window of eligibility to enroll. You can sign up for Original Medicare (Part A and Part B) three months prior to turning age 65, the month you turn age 65, and three months after your birth month. With some exceptions, if you fail to sign up during your initial open enrollment period, you will be subject to late enrollment penalties.
Medicare Part A provides coverage for hospital expenses while Medicare Part B covers doctor and outpatient expenses and additional costs that are not covered by Part A.
Once you are enrolled in Original Medicare, your plan will pay a large portion of your medical expenses, though it does not pay for everything. Many Medicare beneficiaries consider secondary coverage to provide additional financial security and fill in the gaps for the costly medical bills that Original Medicare does not cover.
There are two distinct options for secondary coverage: Medicare Supplement and Medicare Advantage. Both options have a very distinct approach for moderating the exposure to medical costs not paid by Original Medicare.
Let’s take a look at both options…
In some cases, Medicare supplement plans, which are offered by private insurance companies, are referred to as “Medigap” or a “gap plan”. Medicare Supplements are designed to provide coverage for some or nearly all of the remaining claim amounts that are not paid by Original Medicare. However, Original Medicare does not include Medicare Part D prescription drug coverage, so it is important to add a Part D plan based on your current medications.
Medicare Supplements are considered standardized plans. In total, there are ten standardized supplements available, including Plan A, Plan B, Plan C, Plan D, Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N. Each plan will pay some or nearly all claim amounts not paid for by Original Medicare.
Insurance companies offering supplement plans are not required to offer all plans in all areas. By law, the Medicare benefit of each standardized plan is identical no matter which insurance company is offering the supplement plan. However, each insurance company can charge a different monthly premium amount for the same standardized plan. Your licensed health insurance agent can help you save costs with a premium price comparison. Your agent can also assist you with the application process.
Another significant feature of having a Medicare Supplement is that there is no provider network requirement. Beneficiaries covered by Original Medicare and a Medicare Supplement can go to any doctor and/or medical facility in the United States, as long as the doctor or facility accepts Original Medicare.
The second option for secondary coverage is a Medicare Advantage plan. Medicare Advantage, also known as Medicare Part C, is available with Part D prescription drug coverage and can also include preventive dental, vision, and hearing coverage, as well as other benefits not included with Original Medicare. These plans are also offered by private insurance companies under an annual contract with Medicare. Medicare Advantage plans are available today with a $0 monthly premium.
The more common Advantage plans available are either HMO or PPO network plans. With the HMO plans, the beneficiary must use in-network doctors and facilities to receive benefits from the plan. With the PPO plans, on the other hand, the beneficiary can use in-network providers with lower out-of-pocket cost for service or choose an out-of-network doctor and pay a higher price for services.
With coverage from a Medicare Advantage plan, there is a schedule of cost for services that the beneficiary pays out of pocket. For example, the cost for a primary care visit might be $10 under one plan and could be more or less under a different plan. Some services have copays, which is a set dollar amount, while other services will have a coinsurance or percentage amount due. The amounts paid out-of-pocket accumulate toward a maximum out-of-pocket limit set by the plan. Unlike Original Medicare, the Advantage plan limits exposure to catastrophic medical costs by putting a cap on annual expenses with the annual maximum out-of-pocket limit.
A Medicare Supplement plan with a Part D drug plan will require a monthly premium, even though you may be presently healthy and not using the health care system. If and when you do need service, Original Medicare will pay its portion and the supplement will pay the remaining costs, according to the benefit schedule of the selected standardized plan. For example, Plan G pays all Medicare-approved amounts after meeting a $198 annual Part B deductible.
With the Medicare Advantage plan, on the other hand, you can enroll in a plan with $0 monthly premium cost, but copayment and coinsurance amounts are due as medical services are rendered. All out-of-pocket medical costs, not including prescription costs, accumulate toward the maximum out-of-pocket limit for the year. The out-of-pocket limit can vary from one plan to the next and can raise or lower from one year to the next. However, once the limit is reached during the calendar year, the plan pays all Medicare-approved amounts above the limit.
The key to finding a plan that works for your budget is knowing your options, but you don’t have to do the work on your own. Contact ARC Benefit Solutions today and our licensed health insurance agents can help you walk through your options, the benefits of each for your situation, and how to take advantage of those plans so you remain in good health.
Originally posted on CMS.gov. Ask your ARC client advisor how they can help you or a loved one make sure their plan will cover diabetic medications for $35 or how to find a new plan that will.
Today, under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. Across the nation, participating enhanced Part D prescription drug plans will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, from the beginning of the year through the Part D coverage gap. The model follows on the Trump Administration’s previously announced 13.5 percent decline in the average monthly basic Part D premium since 2017 to the lowest level in seven years.
Currently, Part D sponsors may offer prescription drug plans that provide lower cost-sharing in the coverage gap; however, when they do, the Part D sponsor accrues costs that pharmaceutical manufacturers would normally pay. These costs are then passed on to beneficiaries in the form of higher premiums. The new insulin model directly addresses this disincentive by doing two things: 1) allowing manufacturers to continue paying their full coverage gap discount for their products, even when a plan offers lower cost-sharing; and 2) requiring participating Part D sponsors’ plans, in part through applying manufacturer rebates, to lowering cost-sharing to no more than $35 for a month’s supply for a broad set of insulins.
Under President Trump’s leadership, for the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries rather than leaving seniors paying 25 percent of the drug’s cost in the coverage gap. Both manufacturers and Part D sponsors responded to this market-based solution in force and seniors that use insulin will reap the benefits.
Based on CMS’s estimates, beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446, or 66 percent, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model. With a robust voluntary response from Part D sponsors, CMS anticipates beneficiaries will have Part D plan options in all 50 states, the District of Columbia, and Puerto Rico, through either a standalone prescription drug plan (PDP) or a Medicare Advantage plan with prescription drug coverage. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021.
“President Trump has forged partnerships with pharmaceutical manufacturers and plans to deliver lower priced insulin to our nation’s seniors,” said CMS Administrator Seema Verma. “This market-based solution, in which insulin manufacturers and Part D sponsors compete to provide lower costs and higher quality for patients, will allow seniors to choose a Part D plan that covers their insulin at an average 66 percent lower out-of-pocket cost throughout the year.”
The Part D Senior Savings Model – which was announced on March 11, 2020 – is a voluntary model that tests the impact on insulin access and care by participating Part D enhanced alternative plans offering lower out-of-pocket costs, at a maximum $35 copay for a month’s supply, for a broad range of insulins.
Part D sponsors that participate in the model will offer beneficiaries Part D prescription drug plans that provide supplemental benefits for a broad range of insulins, including both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins. Participating pharmaceutical manufacturers will continue to pay their current 70 percent discount in the coverage gap for their insulins that are included in the model, and based on the model’s waiver of current regulations, those manufacturer discount payments will be calculated before the application of supplemental benefits under the model – which will reduce the out-of-pocket cost of insulin for Medicare beneficiaries.
One in every three Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For some of these beneficiaries, access to insulin is a critical component of their medical management, with gaps in access increasing risk of serious complications, ranging from vision loss to kidney failure to foot ulcers to heart attacks. Unfortunately, the costs of insulin can be a major barrier to appropriate medical management of diabetes.
A beneficiary’s out-of-pocket costs for insulin in Medicare’s Part D prescription drug benefit can fluctuate from one month to the next, in part due to the different rules applying for each phase of the Part D benefit. This can be challenging for beneficiaries when budgeting for their drug costs. These challenges can in turn lead to beneficiaries not being able to afford their medicine or resorting to medication rationing, resulting in worse health outcomes over time. The model aims to address this with stable, predictable costs for insulin that beneficiaries know up front by staying in or choosing a model-participating plan during open enrollment.
Part D sponsors that applied must submit their calendar year 2021 plan benefits to CMS by June 1, 2020 to designate their participation in the model. CMS anticipates releasing the premiums and costs for specific Medicare health and drug plans for the 2021 calendar year in September 2020, including final information on the model.
Beneficiaries will be able to find a Part D plan participating in the Part D Senior Savings Model in the 2021 plan year through the Medicare Plan Finder on Medicare.gov during the annual open enrollment period, which begins on October 15, 2020 and ends December 7, 2020. CMS will enhance the Medicare Plan Finder to include a filter to identify plans that will offer capped out-of-pocket costs for insulin in the model so beneficiaries can easily find those plans during open enrollment in the Fall. The Medicare Plan Finder, which was upgraded for the first time in a decade last year, is the most used tool on Medicare.gov and allows users to shop and compare Medicare Advantage and Part D plans.
The Part D Senior Savings Model builds on steps the Trump Administration has already taken to strengthen Medicare and improve the quality of care for patients with diabetes. CMS has taken the following actions to address the needs of beneficiaries with diabetes:
To respond to the coronavirus disease 2019 (COVID-19) public health emergency, CMS has taken additional actions to ensure that beneficiaries with diabetes have access to treatment and care by:
More information on the Part D Senior Savings Model can be viewed at: https://innovation.cms.gov/initiatives/part-d-savings-model
To read a New England Journal of Medicine perspective on Medicare Part D and insulin affordability, please visit: https://www.nejm.org/doi/full/10.1056/NEJMp2001649.
It’s summer. The sun is shining, the grass is green, and we’re all still maintaining social distancing guidelines. Even with the current restrictions, there are still plenty of family activities that you can do to stay active and keep the kids entertained. Here are four activities to spice up your summer.
A nice 30-minute walk or bike ride with the whole family is a great way to get in some light activity and catch some sun. Don’t forget your sunscreen!
There’s so much to discover, even in your own backyard. This interactive activity is easy to put together, it’s great for both the indoors and outdoors, and it can be educational. Here are some good scavenger hunt ideas from Good Housekeeping that you can try. Make it even more interesting with a small prize at the end of the hunt!
Find your best checkered blanket and prepare some cool lemonade—it’s time for a picnic! Take some time to put together a nice picnic lunch with the kids help and enjoy it at a park or in your own backyard.
Who doesn’t love a good theme night? Create a fun theme each night for dinner and have everyone show up dressed for that theme. This is a creative and interactive way to spur their creativity and change up the typical dinner routine. Try a Star Wars night, an 80s night, a luau night, or have your kids come up with the theme!
COVID-19 has taught us the importance of securing proper health insurance. Financial planners and other experts have emphasized the need for health insurance for years and many Americans have taken heed, yet some still do not prioritize purchasing adequate coverage for themselves or their families, citing expensive premiums and deductibles, a lack of access to preferred doctors, or the notion that they “never get sick.” Yet, financial hardship related to medical expenses affected almost 137.1 million Americans in 2018, according to the Journal of General and Intermedicine.
This hardship may be even greater for those without insurance who have been hospitalized over the last several weeks due to COVID-19. Budgeting for health insurance should be given as much consideration (if not more) as purchasing a vehicle, starting a mortgage on a house, or even planning a wedding.
Let’s take a moment to re-examine some pertinent reasons for buying health insurance:
Most, if not all, health insurance companies have decided to waive the cost for COVID-19 testing. In these cases, a member will not be charged their deductible or a copay to find out if they have the virus. Some carriers went further and stated that they will even cover treatments a member needs, like an office visit to their doctor (in person or virtually) or a trip to the emergency room. Not having coverage during this pandemic could lead to catastrophic financial losses if one is uninsured.
The 2018 statistic above estimating that nearly one-third of the country faced medical financial hardship is astounding. Further, a study from 2001 in five states found that just above 45 percent of all bankruptcies were related to a medical problem. Dylan Roby, associate professor of Health Services Administration at the University Of Maryland School Of Public Health, says “A cancer diagnosis, car accident, or even a broken leg can cost thousands of dollars out-of-pocket.”
Many Americans do not have several thousands of dollars saved up to face the challenge of even one major health incident. Even with health insurance, they would still face some high costs, but not be subject to the devastation of having no coverage at all.
Many employer-based insurances or individual plans through the Affordable Care Act cover quite a few preventative services (often covered at 100 percent) to help members become proactive about their health. The hope here is to eliminate the fear of high costs from doctor visits and possible diagnosis of a medical issue. Pre-emptive measures taken to discover potential diseases early on can lead to better chances of successful treatment with lower costs compared to the expenses for treatment methods for advanced illnesses .
The landscape of health insurance may look drastically different after the upcoming 2020 presidential election, but right now our society may need to have a mentality shift towards health insurance, with more of us giving it a higher priority in our budgets than we once did. College students, though mostly young and healthy, will want to make sure they have health coverage through their school or individually, as this expense should be taken into account as much as tuition, books, rent, and other costs. Those looking for employment will need to give strong consideration to companies that offer group health insurances versus ones that do not. Those considering self-employment will need to evaluate the risks of purchasing individual coverage, as this market may create more out-of-pocket exposure compared to working for an employer and having group coverage.
All in all, if most of us decide to buy health insurance, collectively, we may be able to reduce some health care costs for everyone and give more access to care for those who need it, especially in these uncertain times.
Telemedicine is a cost-effective and accessible option that involves electronic communication and software to provide clinical services to patients without an in-person visit. Many people opt for telemedicine because it can be done from the comfort of your own home or anywhere else like work, vacation, the park, etc. You do not have to bring yourself or your children in contact with illnesses that you may encounter at the doctor’s office.
Moreover, every physician you see using telemedicine communications will be considered in network no matter where you are. Physicians can prescribe certain medications through telemedicine, including medications for allergies, arthritic pain, asthma, bronchitis, colds and flu, diarrhea, infections, and insect bites. Regardless of location, your telemedicine doctor will be able to find the closest in-network pharmacy for you to pick up your medications.
Depending on the carrier, how telemedicine operates can vary. In most cases, you log into your carrier’s website, enter your member identification number, and answer any questions that your doctor may need to provide a diagnosis. Using your insurance carrier’s telemedicine services, you are able to speak with a physician in real time from one computer screen to another through a HIPAA compliant video conferencing tool. Most telemedicine options also allow you to take pictures so the doctors can review your case.
It is important to note that telemedicine is not an appropriate communication channel for all cases and conditions. Your physician will make a judgement call on the communication that will be most effective for you and your situation. The cost of using telemedicine services will, depending on your carrier, often match what you would pay as copay for a normal doctor’s visit on your plan. If you have a Health Savings Account (HSA), the cost will be a lot less in most cases because there is set copay (which goes toward your deductible) for the visit.
Telemedicine might be a good option for you as we navigate the COVID-19 orders for social distancing. Contact your ARC representative today to learn more about your telemedicine options and how you can use it to your advantage.