Author Archives: Dianne Savastano

Health Insurance in 2021

While working with clients who are newly enrolled in Medicare or accessing health insurance via the Open Market and/or from employers, we identified common themes in the advice we offer. I share those themes below, in the hope that it will get your new plan year off to a smooth start!

Paying Premiums

This may seem like common sense, but please be sure to pay your premiums! Just as every insurance product is different, so are the processes by which premiums can be paid.

For some, a monthly paper bill is received and must be paid by a certain date. For others, coupon books are sent, and it’s up to you to remember. For still others, some form of electronic payment is possible*.

[*If you sign up for a form of automatic payment — it will take time for bank deductions to begin. During this time, you may be required to continue making payments, so be sure to understand and follow the insurance company’s requirements.]

Whatever the specifics, make sure to create a plan for payment and follow it. See below for more detail on how payment works…

Medicare

Unfortunately, there are several entities involved, each of which requires separate payment:

Medicare Part B premiums and Medicare IRMAAs (Income Related monthly Adjustment Amounts) for Part B and Part D

  • Premiums can be deducted from your Social Security benefit, if you are receiving one.
  • Premiums can be paid after receiving a paper bill. (These can be very confusing initially, as they are processed by different systems and do not arrive together.)
  • Premiums can be paid via your “My Medicare” portal.
  • Premiums can be deducted automatically from a checking or bank account via Medicare Easy Pay.

Regardless of which method you use, we highly recommend that everyone on Medicare enroll in a “My Medicare” account for viewing bills online and making quick electronic payments.

Medicare Part D Prescription Drug Plans or Medicare Advantage Plans

  • Premiums can be deducted from your Social Security benefit, if you are receiving one.
  • Premiums can be paid after receiving a paper bill or coupon book.
  • Premiums can be deducted automatically from a checking or bank account, or set up as a recurring payment from a credit card. (Note that electronic payment requires enrolling in the Part D plan’s member portal, which can be valuable in any case for reviewing claims and medication costs.)

Medicare Medigap/Supplement Plans

  • Premiums cannot be deducted from your Social Security benefit.
  • Premiums can be paid after receiving a paper bill or coupon book.
  • Premiums can be deducted automatically from a checking or bank account, or set up as a recurring payment from a credit card. (Note that electronic payment requires enrolling in the Medicare Medigap/Supplement plan’s member portal, which can be valuable in any case for reviewing claims and benefits.)

Open Market Plans

On most plans, you are not given much of a grace period before you may be disenrolled from the plan for non-payment. Reinstatement can be tedious, sometimes even impossible, which could leave you without insurance until January 1 of next year!

As we have mentioned in (many!) previous newsletters, setting up a member portal on your plan’s website is valuable for payment, for reviewing claims and benefits, and for asking questions.

Employer-Sponsored Health Insurance Plans

Typically, your contributions to premiums are made via payroll deduction. Even so, be sure the amounts deducted are accurate and reflect the choices you made during Open Enrollment season.

Coordination of Benefits

Medicare

If you are newly enrolled in Medicare and all of its associated products, you should contact the Medicare Coordination of Benefits (855-798-2627) the week Medicare and the associated products become effective/primary for you. You want to make certain the Medicare system shows Medicare as your primary insurance and your Medicare Supplement as secondary.

Follow the prompts and provide the information requested. The system will then provide a response — the response you want to hear is “Medicare is primary” for Part A and Part B. If you hear anything else, follow the directions to get to a live person and explain that Medicare should be primary as of a specific date.

If you do not take this extra step, in addition to notifying your healthcare providers that Medicare has become primary for you, bills could be inadvertently sent to your previous insurer, be denied, and cause administrative hassles that you will need to troubleshoot later on.

If You Made a Change to Your Health Insurance

Three things:

First, be sure that your previous insurance company is notified that your plan was discontinued as of midnight the day before your new coverage begins.

Second, be sure you receive your new plan’s identification card and share it with your healthcare providers and pharmacy, so they know to bill the appropriate health insurance company.

Third, remember to put copies of your new insurance cards in your Grab-n-Go Kit!

Understanding Benefit Levels

Every January, we receive lots of calls from clients who are surprised by how large the out-of-pocket costs are for their prescription refills. Most often, it’s because the deductible — which resets to zero on January 1 — has not yet been met. Many generic medications are not subject to a deductible, but for those that are, the out-of-pocket costs can be significant.

Make sure as well to pay special attention to plans that require staying within a network of providers and/or require prior authorization, have quantity limits, or employ step-therapy protocols for prescription drugs. Understanding how these requirements work can prevent confusion and aggravation as you begin to use your plan.

In Summary

I understand, it’s a lot to manage. But as we write often, it’s important to stay informed and be proactive about your health insurance benefits. Doing so will ensure that your year is off to a strong start, providing you with the coverage you need and with limited surprises!

Recommended Reading / Watching

Every Sunday morning, my phone displays a report of my screen time for the previous week. I am often astonished at how high the number is!

Yes, I read three newspapers online, which certainly adds to the total. But the truth is, I also spend countless minutes doing mindless things such as scrolling on Facebook and Twitter.

After watching this documentary and reading this article (admittedly, both on a screen), I was frightened on many levels, especially knowing how much more time my grandchildren spend on their phones during the pandemic. I think you will find these eye-opening too.

Be the Leader of Your Own Healthcare

It may sound like an overstatement, but it’s true: The work of Kouzes and Posner and the Leadership Challenge has provided me with a framework that guides not only my work within Healthassist, but also the way I conduct my life.

Here are the five practices of exemplary leadership which they have developed:

  1. Model the way
  2. Inspire a shared vision
  3. Challenge the process
  4. Enable others to act
  5. Encourage the heart

This month, I focus on two of these practices — challenge the process and model the way — both of which come into play as you access care for yourself or a loved one.

Since the start of the pandemic, exerting leadership of our own healthcare has become even more important; the number of administrative obstacles seems to grow with each passing day! Challenging the process, politely and persistently, along with modeling behavior you expect in others, is required.

When Hospitalized

A piece of advice I have often shared in the past about inpatient hospitalizations is that you or your loved one should never be left alone. During the COVID-19 pandemic, I had to change course and advise about the best ways to manage from afar.

Use the phone to talk first, before emailing or texting.

The relationships I encouraged between you and the care team that were best facilitated in person, now must be developed over the phone. Although I fully appreciate the use of Patient Portals for outpatient communication, these do not work as well inpatient.

So, you must rely on the phone first, working towards the use of Facetime/Zoom for meetings in which you can see each other. Granted, since more than half of communication occurs non-verbally, a traditional phone call is not ideal. But it’s a start. Here are some suggestions:

  • Upon admission, call to introduce yourself to the nursing staff and ask for the best time of day, during each shift, to call for an update.
  • Identify the physician in charge; appreciate that this may change according to an outlined schedule. Request a daily telephone meeting after patient rounds are finished, during which they will have reviewed the events of the previous day and developed a plan for the current day.
  • Upon initiation of the relationship, let them know that within your family, you have been designated as the single point of contact with the healthcare team, so that they only have to talk with one person. Assure them that as the leader of the family team, you will distribute information readily among the others.
  • Make it as easy as possible for the physician to contact you. Ask if it is best for you to call them or for them to call you, and at what time. Be sure to be available as promised; ask that they communicate if they will be delayed. Cell phones and texting can be very helpful in managing all of this.

When Accessing Care from a Physician in the Community

Here is where Patient Portals can be invaluable for proactive communication, so be sure that you are enrolled and familiar with the tool, and that you always check it in advance of appointments.

Here is what is happening on the portals:

  • Scheduling and confirmation of appointments
  • Online check-in, 24-48 hours before the appointment that may also coincide with a telephone check-in with the medical assistant working with your physician
  • Verification of medications, dosages and how often you take them
  • Gathering of data that is to be shared with the physician, such as sequential blood pressure readings or medical records from external healthcare systems
  • Verification of insurance information and payment of co-pays
  • Sharing of a written agenda (most important!) in advance of the visit, including visit objective(s), items for discussion, specific questions, action items and next steps, a summary

When Having Diagnostic Testing

Whether something simple, like routine bloodwork, or something complicated, such as an overnight sleep study or a colonoscopy, allprocedures have changed since COVID-19 arrived.

This requires that you be proactive and remain politely persistent, in order to successfully complete the procedure and obtain the results necessary for making decisions with your provider.

Calling in advance and asking for specific details about the administrative procedures in place to protect both you and the staff will go a long way towards getting diagnostic tests done as scheduled. If you do not abide by the protocols, procedures will be cancelled, contributing to delays in care.

In Summary

This has been quite a year! All of us, especially those that provide the quality healthcare we need, have felt the impact. At Healthassist, we have had to pivot in the way we deliver our services.

And yet, the core of our message has not changed: As healthcare consumers, we have a responsibility to be the leaders of our own healthcare; to develop good quality relationships with our healthcare providers; and to do all of this respectfully, with diligence, and by demonstrating how much we appreciate each other.

Recommended Reading: #itdidnthavetobethisway

#justdontgetit and #itdidnthavetobethisway

If you have read this newsletter over the past few months, you know I espouse the mantra of #justdontgetit as a point of emphasis about not contracting COVID-19 in the first place. Also, I often find myself angrily stating #itdidnthavetobethisway!

And so, it’s no coincidence that I was fascinated by a recent Politico article describing the power of anger and grievances:

“It turns out that your brain on grievances looks a lot like your brain on drugs. And that is a problem not just for the outgoing president, but for the rest of us.”


The work of these two journalists has been critical to my education during this pandemic:

Donald G. McNeil Jr

Laurie Garrett

Open Enrollment Season is Here!

By Camille Barron

Between the pandemic and the election, we are all more concerned about our health insurance than ever before. The Supreme Court recently heard oral arguments in a lawsuit that seeks to overturn the Affordable Care Act (“Obamacare”).

In addition, with millions of people having lost their jobs due to layoffs or shutdowns — and the associated employee benefits that come with those jobs — more people than ever are seeking insurance for themselves and their families in the Health Insurance Marketplace®. If this includes you, today’s newsletter reviews some of the most important factors to consider when choosing a policy for the coming year.

First, some basics…

Health Insurance Costs Are a Three-Legged Stool

When most people think of the costs of insurance, they think about premiums. These are the fixed costs that must be paid to keep insurance in force. While premiums are important, they are just one aspect of insurance costs. Deductibles and other out-of-pocket costs matter too. When you evaluate a health insurance policy, you’ll want to consider all three.

#1. Premiums

Despite the chaos caused by the pandemic, premiums for next year have remained relatively stable. Whether they shift beyond that remains to be seen.

#2. Deductibles

Next year’s offerings feature higher deductibles to help minimize steep premium increases. (As a general rule, policies with higher deductibles charge lower premiums, and vice versa.)

In some cases, carriers have eliminated low deductibles altogether. Others have expanded both low and high deductible options, so it’s really a mixed bag.

Higher deductibles are one way to save on insurance premiums, particularly if paired with a Health Savings Account (HSA).

#3. Out-of-Pocket Costs

In addition to premiums and deductibles, other costs include copays and coinsurance – those fees you pay as you utilize medical services. As you’d expect, the lower the premiums, the higher these out-of-pocket costs tend to be.

PPO plans (explained further below) have different costs for in-network versus out-of-network services. In-network costs are lower than out-of-network and typically are flat dollar amounts called “copays.” Out-of-network costs are often percentages of the fees for medical services; these are known as “coinsurance.”

Beyond these essential three legs of the stool, there are additional factors which will have an impact on cost:

Utilization

The degree to which you use the healthcare system matters. If you are in good health, with few doctor visits beyond the basics (e.g., annual physicals, yearly screenings, occasional visits for miscellaneous issues), your expected utilization would be low compared to those with significant medical conditions.

As a result, your overall health and expected frequency and type of care are important factors in determining which combination of benefits and associated costs are best for you.

Maximum Out-of-Pocket Limit

Of course, none of us knows before the fact what our actual healthcare costs will be. That is why most insurance policies set an annual limit on the amount you would have to spend on total, out-of-pocket costs. This is a safety net against a worst-case scenario; it protects you from the devastating financial impact of serious medical treatments and prescriptions.

Beyond choosing the most cost-effective option that matches your expected utilization, make sure you also have some funds available to cover unanticipated medical expenses up to your maximum out-of-pocket limit.

HMO or PPO?

HMOs (Health Maintenance Organizations) are a good option if you are willing to see providers that belong to your plan’s network. Visits outside that network are not covered and referrals to specialists are required.

PPOs (Preferred Provider Organizations) allow you to see both in-network and out-of-network providers. Out-of-network visits have higher costs, but many people like the flexibility of choosing where they seek care.

Whichever you choose, the key is to determine if your providers are in-network. Even if you are making no changes from this year’s coverage, check to make sure your providers are still in-network, as it is not uncommon for medical practices to reevaluate their network participation year to year. You can do this on the plan’s web site or by calling the insurance company in question.

Discontinued Plans

Mergers, acquisitions, or consolidated products are common in the insurance industry. When these happen, the insurance companies reassign policyholders from their original plan to one of its new plan offerings.

At that point, costs and coverage will be similar — but not identical — to the plan you are losing. Make sure to evaluate the proposed new plan as if it were any other policy under consideration! Don’t assume that the newly assigned plan’s costs and coverages will be the same as those of the policy you are losing.

Employer-Sponsored Coverage and COBRA

All the factors discussed above apply in choosing an employer-sponsored plan.

If your employment is terminated, in most cases, you will be eligible for COBRA benefits. Typically, this allows you to choose from one of several options that will cover you for the next 18 months.

Keep in mind, however, that with a COBRA plan, there is no employer subsidy. You’ll have to pay the full premium, plus an additional 2% for administrative fees.

Additionally, if you are over the age of 65 when terminated, there are intricacies between Medicare and COBRA that must be understood.

Affordable Care: Public vs Private Exchanges

The ACA exchanges/marketplace, including the federal healthcare.gov website and those established by some states, remain a source of affordable health insurance. Once you register, you’ll find out if you:

  • Qualify to save money when you enroll in a medical insurance plan
  • Qualify for Medicaid
  • Qualify for the Children’s Health Insurance Program (CHIP)

Most ACA exchange policies are HMOs, covering in-network providers only.

If you qualify, you must enroll via the exchange. If you do not qualify, you can still enroll via the exchange, but you may want to consider other options.

To find out if you are eligible for a subsidy, visit healthcare.gov or your state’s health exchange.

Finally, keep in mind that the choice of insurance plans in these public exchanges is somewhat limited compared to the open market/private exchanges in which private insurance companies provide coverage directly to consumers. Information about these plans is generally available on the private insurer’s website. Because additional options beyond HMOs may be available, be sure to compare and contrast with options available on the public exchange.

In Summary

Open Enrollment comes just once a year. It’s your opportunity to evaluate your circumstances and make changes (or not) best suited to your personal preferences.

As we always say at Healthassist, an informed healthcare consumer is a more satisfied one!