Women can’t be complacent about their Medicare choices – the cost is too high – National Consumers League

This post originally appeared at Huff Post.

With all the news and controversy surrounding the Affordable Care Act (ACA) enrollment period, it’s easy to lose sight of the fact that Medicare open enrollment is also in full swing from now through December 7. This is the time for retirees to decide whether they should remain on their current Medicare plan or switch to another.

Ideally, the process should entail assessing your medical needs for the coming year, reviewing the details of your current plan to make sure it covers what you’ll need going forward, and considering whether there’s a better plan that will provide the right coverage at the right price. But unfortunately, that’s not how it usually works. In fact, a new survey sponsored by WellCare Health Plans, called the Cost of Complacency, shows that only about a third of seniors comparison shop for a Medicare plan at all.

Those harmed the most by not doing so are women: 26 percent more women than men ages 65 and older report feeling burdened by the cost of healthcare. It’s no wonder; there are several reasons for this. Women live longer than men—by an average of about 7 years. Longevity should be good news, but coupled with the fact that women typically have lower incomes and fewer financial assets—and have more chronic conditions requiring medical care than men—women often spend those extra years in a precarious financial situation.

Given these realities, it’s critical that older women have healthcare coverage that will meet their medical needs—not threaten their financial health. That’s not to say that figuring out what you need and which plan will best serve you is easy. As the WellCare survey found, 29 percent more women than men find the process of reviewing and comparing plans painful and frustrating. But the stakes are too high for women to not engage in the critical process of ensuring they are getting coverage that will protect both their health and their finances.

The reason it’s important to review and reassess your plan each year—even if you’ve been satisfied with your past coverage—is that it likely won’t be the same in 2018. Most plans change every year and some of those changes can be significant. Your health also changes (inevitably with greater costs as you age), so it’s especially important to consider how your current health conditions and whether the plan you’re currently on will provide adequate coverage if you are likely to need more diagnostic tests, different drug regimens, or more health care visits.

The basic rules of reviewing your plan include determining out-of-pocket costs, which consist of your premium, deductible, and cost-sharing charges, whether they may be copayments or co-insurance. You should also make sure that the pharmacies, health care providers, and hospitals you use are covered by the plan’s network or—if they aren’t—decide that you’re willing to switch to those that are.

For women on traditional Medicare (Part A & B), it’s also important to understand the gaps and limitations of that coverage. For instance, if you currently have or have had cancer in the past, you should be aware that there is a lifetime limit to the amount of diagnostic testing Medicare will cover. With treatments now enabling people to live with cancer for years as a chronic disease, you can quickly hit that maximum if there’s a need for expensive annual tests such as PET-CT scans. If you reach the Part B cap, you could be looking at exorbitant out-of-pocket costs.

With older women having higher rates of cognitive impairments, such as memory loss and dementia as they age, the Medicare limits on services associated with those conditions can have a particularly negative impact. While Medicare covers assessments for cognitive and neurological decline, it does not help with related ongoing services including daily care, care management, and home companions who can be incredibly costly, especially if needed for an extended period of time.

There are also significant coverage gaps in cataract treatments and no coverage at all for corrective eye exams, hearing exams, hearing aids, or common dental work.

About half of all women fill some of these gaps by enrolling in private plans, such as a supplemental Medigap insurance policy or a Medicare Advantage Plan that provides both Part B coverage as well as additional benefits.

So, there’s a lot to consider and yes, it can be overwhelming, which is why you shouldn’t do it alone. But, as the Cost of Complacency survey showed, most women do try to power through the process on their own, which could be why so many give up on doing it altogether. Instead, get together with a friend, your spouse, child, or grandchild and look to do the following: 

  • Review your current plan’s paperwork, including benefits and any limitations;
  • If you have them, review your medical receipts from the year to determine how much money you spent, and on what services;
  • Create a priority list for a Medicare plan, including not just “must haves,” but also “might needs”;
  • Use the Medicare Plan Finder tool on Medicare.gov to research plans based on your needs. Also, access community resources, such as senior centers, the State Health Insurance Assistance Program (SHIP), or the toll-free numbers provided by the plan providers to ask questions; and
  • Don’t try to review everything in one day. Do a little bit each day until the December 7 deadline.
You still have time to review, compare, and choose a plan that will serve your health needs for the coming year! It may be one of the most important things you can do to protect your health and your financial wellbeing.

Make your health a priority: Enroll in Marketplace health insurance by the January 31 deadline – National Consumers League

There is considerable anxiety over the future of healthcare in the face of our new Administration. However, the most important thing that consumers can do right now to protect their health is to enroll in or change their Marketplace health insurance plan by the January 31, 2017 deadline.

Consumers can go to HealthCare.gov to find a plan that best fits their needs and budget.

Why is having health insurance important?

  • It protects you and your family from unexpected medical costs. No one plans to get sick or hurt, but health insurance gives you important financial protection, just in case.
  • Marketplace health insurance gives you access to essential health benefits (like emergency services, maternity and newborn care, and prescription drugs) and preventive health services (like vaccines and screening tests) at no cost to you.
  • Marketplace plans may be more affordable than you think. About 85 percent of Marketplace consumers qualify for tax credits to assist with costs. At HealthCare.gov, you can find out if you qualify for financial help with your premium costs.

Contact HealthCare.gov’s Marketplace Call Center toll-free at 1-800-318-2596 for assistance with enrolling. If you have more questions about health insurance, we encourage you to visit MyHealthPlan.Guide, a joint project of NCL and America’s Health Insurance Plans, which provides helpful tips about choosing and using your health insurance plan.

Don’t miss out on your chance to get covered–enroll by the January 31 deadline. Make your health a priority–you owe it to yourself!

Preventive care benefits: Your health plan’s best kept secret – National Consumers League

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To those who may question the necessity of health insurance, I have two words for you: Preventive care. Seven out of ten deaths among Americans each year are from chronic diseases, many of which are preventable. Preventive health services like physicals, immunizations and other screenings can help find health problems early, when the chances for treatment and cure are better, or even prevent health problems before they start. 

Preventive health services are covered under all health insurance plans with no additional out-of-pocket costs when provided by in-network providers. Your health insurance plan may cover even more services that cost you nothing – to find out more, be sure to contact your health plan.

Unfortunately, many consumers with health insurance don’t take advantage of these services – simply because they don’t know their insurance covers it.  That’s a problem we’re working hard to resolve.

Below we list some of the preventive care benefits available through your health plan: 

For adults:

Immunizations (Vaccines)

It is important for adults to stay up to date on their immunizations.  They can save your life and save your health.  Through your health plan, vaccines for diseases such as chicken pox, tetanus, diphtheria, and pertussis, hepatitis A & B, and the flu are all covered. 

Depression screenings

Too many people suffer from mental health conditions, such as depression, and the consequences can be devastating on individuals and families alike. Taking a depression screening is one of the most efficient and effective ways to determine whether you are experiencing symptoms of depression and get you on the path to treatment. Depression screenings are fully covered by your health plan. 

Cancer screenings

Nearly everyone has felt the impact of cancer – either themselves or a friend or loved one.  Screenings are one of the most powerful weapons against cancer. When many cancers are found early, chances of survival increase exponentially. Important preventive cancer screenings include cervical cancer screening, breast cancer mammography screening, and colorectal cancer screening. Lung cancer screening is also covered for adults aged 55-80 who are current smokers or have quit smoking in the last 15 years. 

For women:

Well-woman visits

Well-woman visits are key to women’s health and help identify health concerns before they become life-threatening. These visits usually include your annual physical examination, as well as any necessary screenings (such as pap tests, blood pressure and cholesterol screenings), evaluations, counseling, and immunizations based on your age and risk factors. 

Services for pregnant women or women who may become pregnant

In addition to the preventive services available to all women, there is also a list of services available for mothers-to-be. Breastfeeding support and counseling, gestational diabetes screenings, anemia screenings, and even folic acid supplements for women who may become pregnant are all covered under your health plan – at no additional cost to you. 

For children:

Autism screenings

The American Academy of Pediatrics recommends that children are screened for autism at their 18- and 24-month well-child visits. This type of screening can quickly identify children with developmental and behavioral challenges when early treatment may be most effective. 

Vision screenings

Good vision is essential to a child’s development, success, and overall well-being. Their vision should be checked when they are first born, while they are a baby, and through their preschool and school years. If problems with a child’s vision are not detected early, their vision may become limited in ways that cannot be rectified later in life. And it can also affect school performance and learning.  But with early detection, it is usually possible to treat vision problems effectively. Thankfully, vision screenings for all children are covered through your health plan. 

Be on the lookout for new resources from the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) to help consumers get the most out of their health insurance benefits.

What you need to know about your health insurance benefits – National Consumers League

stethoscope_heart_92.jpgIt’s no secret that choosing a health insurance plan isn’t as easy as ordering at a restaurant. Even after purchasing a plan, actually understanding what exactly you’ve purchased is yet another stressful task. Health insurance can confuse even the savviest consumers. Read on for a few tips every consumer should know when it comes to health insurance benefits.


Your health plan most likely offers essential health benefits.

All plans purchased through the Affordable Care Act (ACA) marketplace and the majority of health plans provided by employers are required to provide a core group of medical services called essential health benefits. These services include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care 
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

To find the full list of services your plan covers and how much those services cost, check your Summary of Benefits and Coverage (SBC). You can request a copy of this document through your insurance company or access it via your online account through your insurance provider’s website.

Staying in network will save you money.

Visits to health care providers or facilities within your plan’s network are generally much cheaper than visits to out-of-network providers or facilities. The type of insurance policy you have plays a role in who participates in your plan’s network and how much you will pay if you choose to visit an out-of-network provider not covered by your plan. For example, HMO (Health Maintenance Organization) plans require you to select one primary care physician who will coordinate all of your health care services. With this plan, out-of-network providers are typically not covered at all, expect for true medical emergencies.

On the other hand, PPO (Preferred Provider Organization) plans allow you to visit any provider or specialist, in-network or out-of-network, and without a referral. Though your PPO plan may cover your out-of-network visit, you will pay more out-of-pocket for those services. Regardless of the type of plan you enroll in, be mindful of the providers in your network, as it can have a huge effect on your out-of-pocket costs.

All qualified health plans have cost-sharing limits.

All qualified health plans have an out-of-pocket maximum, which is the most you have to pay personally for covered services over the course of a year. All the money you pay for your deductible, coinsurance, and copays (but not premiums) goes toward your out-of-pocket maximum. Once you reach this limit, your insurance plan pays 100 percent for all covered medical services. Understanding how all potential out-of-pocket costs work together can be a little complicated, so here’s an example:

  • Suppose you are in a serious accident and have acquired $30,000 in medical expenses. Your health insurance plan offers a $2,000 deductible, 20 percent coinsurance, and a $5,000 out-of-pocket maximum for the year.
  • You would first be responsible for paying your deductible ($2,000).
  • After paying your deductible, you are responsible for your 20 percent coinsurance on the remaining $28,000 until you reach your out-of-pocket maximum.
  • Since 20 percent of $28,000 is $5,600, you would only be responsible for paying an additional $3,000 since your out-of-pocket maximum is $5,000. Your insurance plan would then pay 100 percent for all covered medical services thereafter.   

Be on the lookout for new resources from the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) to help consumers choose and get the most out of their health insurance benefits.

Five commonly asked consumer health insurance questions – National Consumers League

doctor_patient_crop.jpgWith the Affordable Care Act (ACA) becoming law in 2010, more Americans now have access to health care coverage than ever before. However, many consumers are still puzzled about how to select a plan, what services are covered, or why they need health insurance altogether. If health insurance talk leaves you disillusioned or just plain confused, don’t give up. Below, we answer five of the most commonly asked consumer questions about health insurance. 

Why do I need health insurance?

It is in your best interest to have some form of health insurance. Why, you ask?

  • To protect your health
    While you may seem perfectly healthy now, sudden injuries or illnesses can occur in an instant. Without health insurance, you could be faced with thousands of dollars in medical costs, which could pose a significant financial burden well into the future. With health insurance, you also have access to preventive services such as physicals, immunizations, and other screenings that can help prevent diseases and identify problems earlier when they are easier to treat.
  • It’s required by law  
    Under the ACA, individuals are required to have health insurance (unless you qualify for an exemption). If you choose not to enroll, you will have to pay a tax penalty. 

How do I know what type of insurance plan is right for me and my family?

When shopping for a health insurance plan, here are some things to take into consideration:

  • Premiums: Each health insurance plan has a monthly premium that you must pay to maintain your coverage.  
  • Coverage/access to providers: Every plan has a different set of services, prescription drugs, and doctors that it agrees to cover. Every plan also uses a specific network of hospitals and health care providers to facilitate your care. Before choosing a plan, check that the services and prescription drugs you need are covered, and ensure that your current providers are within your plan’s network to avoid incurring additional costs down the line. 
  • Out-of-pocket costs: Out-of-pocket costs are health care expenses  you must pay yourself and that are not reimbursed by your insurance plan.

 Copayment, deductibles, coinsurance … What’s the difference?

  • A copayment or “copay” is a fixed amount ($10, for example) that you pay each time you visit a health care provider or fill a prescription.
  • A deductible is the amount you are responsible for paying for covered medical services before your health insurance plan starts to pay for covered medical expenses.
  • Coinsurance is usually a percentage of a total bill that you are responsible for paying after you’ve paid your deductible (for example, you pay 20 percent and your plan pays 80 percent). 

What is a health savings account, and what can I use those funds for?                                                                         

Health savings accounts (HSA) allow you to deposit pre-tax funds to pay for qualified medical expenses. They are typically combined with qualifying high-deductible health plans (HDHP). While HSA funds cannot be used to pay for monthly premiums, HSA-eligible HDHPs are attractive to many consumers because the premiums are generally lower. HSA funds can be used as needed to pay for prescription drug costs and fees such as copays, deductibles, and coinsurance. Learn more about health savings accounts here.

If my insurance company denies coverage for a service, is there anything I can do? 

If your insurance company does not authorize payment for a medical service, you have the right to appeal that decision. Before sending an appeal, carefully review your health coverage and the correspondence from your insurance company. Have copies of your medical records, letters from your providers, and any other pertinent information that supports your appeal. If your plan still denies payment of your claim after your initial appeal, you may opt for an external review conducted by an independent third party.

To answer questions like these, the National Consumers League (NCL) and America’s Health Insurance Plans (AHIP) are teaming up to provide consumers with even more helpful information about how to choose and use health insurance benefits.

 

 

King v. Burwell ruling will keep consumers insured (and healthy!)

Health_Care_Law.jpgThe King v. Burwell ruling in favor of the Affordable Care Act (ACA) has allowed for approximately eight million consumers to keep their insurance coverage. In the King case, petitioners challenged the clause of the Affordable Care Act that stated subsidies are available to people who use an exchange “established by the State” to purchase insurance. 

Consumers living in the 34 states without state marketplaces are able to benefit from the subsidies because the Internal Revenue Service allowed people to receive assistance if they purchased a plan on the federally-run marketplace. The plaintiffs argued that subsidies by law are only given to people living in states with their own health insurance marketplaces. The ruling allows consumers in states where the marketplace is run by the federal government to keep their subsidy and insurance.

The National Consumers League (NCL) applauds the Supreme Court for upholding the ACA subsidies for consumers using the federal marketplace. The Supreme Court decision helps prevent a rise in premiums for all consumers using the health care exchange. The subsidies are a key provision of the law and they are an important part of keeping consumers insured and healthy. This decision provides hope that the ACA will face fewer political and legal obstacles in the future and can continue to provide health insurance to consumers. Despite the naysayers, the numbers speak volumes. Since the ACA’s enactment, more than 16 million Americans have been able to afford quality health insurance they did not have before.

If you do not already have health insurance, you can enroll in person, over the phone, by mail, online at Healthcare.gov, or on your state exchange’s site during the open enrollment period.