Medicare Part C – Medicare Advantage Plan

January 13, 2021 13:08 newlambertagency

Medicare part C is part of the 4 basic Medicare. Also known as Medicare Advantage Plan (like an HMO or PPO), Part C is an alternative way to get your Original Medicare coverage.

While Medicare Part C covers the same benefits as Medicare Part A including Inpatient care in a hospital, it also includes home health care.

There are 4 types of Medicare Advantage Plans:

  • Health Maintenance Organization plans (HMOs)
  • Preferred Provider Organization plans (PPOs)
  • Special Needs Plans (SNPs)
  • Private Fee-for-Service plans (PFFS)

Some plans under Medicare Part C require you to see in-network providers to qualify for coverage while others might let you see out-of-network providers with less coverage. It’s always better to choose in-network doctors if you decide to enroll in this plan.

The Benefits

With exception of hospice care, Part C includes your Part A and Part B benefits. Many Medicare Advantage plans offer additional coverage beyond Original Medicare. Some of those benefits might include:

  • Routine dental care
  • Routine vision services
  • Routine hearing services
  • Wellness programs called SilverSneakers
  • Prescription medications

Besides the aforementioned benefits, Part C also offers additional benefits today, such as over-the-counter medications, transportation to and from doctor appointments, and adult day-care services.

The Cost

Part C plans may have different costs – some plans charge a monthly premium before enrollment, while they can also have an annual deductible, which is an amount you pay out of pocket before your coverage starts.

There are also plans with $0 premiums and $0 deductibles.

Medical services may require you to pay a copay (a set amount you pay at every visit) or coinsurance (percentage of the total bill)

It is important to compare plans in your service area carefully since costs and coverage can be different from plan to plan. This step will ensure you get all the coverage you need at a cost that fits with your monthly budget.

Enrolling in Medicare Part C

Enrollment in a Medicare Part C plan can be done at different times of the year. First is the Initial Enrollment Period (IEP). This is the period when you first become eligible for Medicare. This enrollment period begins three months before the month you turn 65.

The second opportunity to enroll is during the Fall Open Enrollment Period (OEP), which runs from October 15 to December 7 each year. During the Fall OEP, you can switch from Original Medicare to a Medicare Advantage plan. You can also change from one Medicare Advantage plan to another.

The third time is from January 1 to March 31, during which, you can switch from one Medicare Advantage plan to another. However, you cannot change from Original Medicare to a Medicare Advantage plan during this enrollment period.

Obamacare – Pro, Cons, Benefits, and Penalties

January 5, 2021 17:41 newlambertagency

You must be familiar with Obamacare by now. But have you wondered how it works or is it beneficial?

If you have, then this blog post is for you. Let’s just dive into it.

What is Obamacare?

Obamacare is an alternative term for the Patient Protection and Affordable Care Act (ACA) of 2010. As the name implies, it was signed into law by then-President Barack Obama to make healthcare more affordable.

Earlier, insurance companies could exclude people with pre-existing conditions. As a result, the people with the greatest health expenses sometimes had to go without insurance or settle for a policy that did not cover a pre-existing condition.

Obamacare has made it possible for people with pre-existing conditions to afford preventive care which in turn has reduced hospital visits and slowed down the rise of health care costs.

How does it work?

When you enroll in a health insurance plan, you typically pay a monthly premium to keep that plan. Obamacare includes subsidies to help lower-income individuals cover the cost of their plans. These subsidies, also known as tax credits, are still in effect in 2021.

Obamacare also provided payments to insurance companies to keep their deductibles low. Although the Trump administration has cut those payments, the law requires companies to continue to keep the deductibles low.

Let’s look at some Obamacare pros and cons

Pros

Apart from affordable healthcare and coverage for pre-existing conditions, Obamacare has the following pros.

  1. Affordable – As already mentioned, Obamacare has made health insurance very affordable allowing more people to get covered. Also, under the ACA, you can’t be denied coverage because of a pre-existing health problem.
  2. There’s no pre-set limit – Earlier insurance companies used to set certain limits on the amount of money they would spend on an individual consumer. Insurance companies can no longer maintain a pre-set dollar limit on the coverage they provide their customers.
  3. More screenings are covered – The ACA covers many screenings and preventive services that usually have low copays or deductibles.
  4. Prescription drugs cost less – Obamacare aims to make prescription drugs more affordable. The number of prescription and generic drugs covered by the ACA is growing every year.

Cons

  1. Higher premiums – Since insurance companies now provide a wider range of benefits and cover people with pre-existing conditions. This has caused premiums to rise for a lot of people who already had health insurance.
  2. Penalty – The main goal of Obamacare is to have everyone under an insurance plan all year round, If you’re uninsured and don’t obtain an exemption, you must pay a modest fine
  3. Higher Taxes – To help pay for the ACA, several new taxes were proposed. This has caused people with higher incomes to pay more tax.
  4. Signing up can be tricky – The ACA website has had a lot of technical problems when it was first launched. This made it difficult for people to enroll and led to delays and lower-than-expected signups.

Obamacare witnesses change almost every year. Just keep a lookout for all the changes and make a sound decision regarding your health insurance coverage.

Critical Illness Insurance: What Is It and Who Needs It?

November 28, 2020 11:28 newlambertagency

If you have never experienced any critical illness, you’re one of the lucky ones. Their treatments are quite expensive and pose a burden on every common man’s finances.

But you need to be prepared for everything that life throws at you. In the event of a big health emergency such as cancer, heart attack, etc. Critical Illness Insurance could provide you with a much-needed financial shield.

People usually assume that they’re fully protected under their health insurance plan, but the exorbitant costs of treating life-threatening illnesses are usually more than any plan will cover.

That is why critical illness insurance exists to help meet the high costs associated with critical illnesses and provide the necessary financial security.

Read on to know everything about them, a Critical Illness Insurance 101 if you will.

What are Critical Illness Health plans?

Critical illness health plans are fixed benefit health insurance plans which cover a specified list of critical illnesses. Some common illnesses covered include cancer, stroke, heart attack, major organ transplants, liver failure, lung failure, multiple sclerosis, etc.

Critical illness insurance can pay for costs not covered by traditional insurance. So if the policyholder is diagnosed with any of the covered critical illnesses during the term of the plan, the sum insured is paid in lump sum irrespective of the actual medical costs incurred.

Not just that, the money can also be used for non-medical costs related to the illness, including transportation, child care, etc.

The coverage limits may vary and the policy pricing is impacted by several factors, including the cost and extent of coverage, age, health, and the sex of the insured, and the family medical history.

What is not covered?

There are exceptions to critical illness insurance coverage. These exclusions are as follows:

  • Illnesses or treatments occurring within 60 to 90 days of buying the policy
  • Pre-existing illnesses during the waiting period
  • Congenital defects, ailments, or diseases
  • Diseases occurring due to alcohol or drug abuse
  • HIV/AIDS infections
  • Illnesses due to war or war-like situations
  • Maternity related illnesses
  • Death due to critical illness during the survival period

Why are such plans necessary?

Illnesses like cancer, heart-related ailments, etc. are on the rise. With various external factors like pollution, health ignorance, and genetics, many individuals are getting afflicted with common critical illnesses and are requiring intensive treatments.

Even the treatments required for critical illnesses are very expensive. Individuals need a specially designed plan which pays for such expensive treatments where normal health insurance might prove to be insufficient.

This is where Critical illness insurance can prove to be extremely beneficial for people who are at a high risk of falling prey to severe illnesses.

Also, the premiums which are paid for a critical illness plan are allowed as a tax deduction under Section 80D. Thus, you can avail tax benefits too from a critical illness policy.

Bottom Line

Since medical bills are a common cause of bankruptcy in the United States, it’s crucial to be prepared and protect yourself against the unpredictable fate, especially if you have a family history of any of the illnesses mentioned above.

All About COBRA Health Insurance

November 25, 2020 17:50 newlambertagency

COBRA health insurance or Consolidated Omnibus Budget Reconciliation Act (COBRA) is an insurance program that gives workers and their families who lose their health benefits the right to choose to continue the health benefits.

Created in 1985, COBRA allows individuals who experience a job loss or other qualifying event the option to continue their current health insurance coverage for a limited amount of time.

It is generally provided by employers outside the federal government with more than 20 employees.

How do you qualify for COBRA health insurance?

You can avail COBRA benefits only in certain situations that are called ‘qualifying events’.

You’re eligible for COBRA if,

  1. You were employed and covered under an employer’s group health plan.
  2. You were laid off, fired, retired, or quit, or had your work hours cut to the point that your employer is no longer required to cover you under a group health plan.

As a dependent,

  1. If you are a dependent of someone who qualifies for COBRA based on the above, you may be eligible, too.
  2. If you are a spouse who divorces or files for legal separation from the employee, you may qualify.
  3. A spouse of an employee who dies may also get COBRA coverage.

How does it work?

As already mentioned, COBRA insurance extends your health plan coverage when an employer’s plan ends.

Your insurance carrier is required to include COBRA rights information in your plan documents when you initially enroll. Your employer, your insurance carrier, or both will give you information on COBRA coverage.

After your insurance benefits end due to any of the reasons mentioned earlier, you will have 60 days to decide whether you want to continue your health coverage under COBRA. If you don’t approve it, your health coverage will end on the day that your employer’s plan coverage ended.

If you elect to continue coverage under COBRA, it will start the day after your employer’s plan coverage ends. The COBRA continuation coverage will offer the same benefits you had under your employer’s group plan. This means that you can see the same providers and follow all existing plan details.

COBRA coverage may last for 18 or 36 months depending on the type of qualifying event that made you eligible in the first place.

The coverage may be terminated if you don’t pay your premiums or other fees for coverage. It can also be terminated if you get a new job that offers health insurance coverage.

COBRA can be extremely beneficial for you as it covers the same benefits your employer’s health plan covered you for. However, it does not cover supplemental coverage, such as disability, life insurance, hospital care insurance, or other types of voluntary coverage

HSA vs. FSA: Differences and How To Choose

November 21, 2020 11:50 newlambertagency

There’s no denying that healthcare can be costly. Even if you have insurance through your employer, you might consider taking advantage of one of the federal government programs that encourage saving for medical expenses not covered by insurance.

The most common type of accounts offered to employees is the Health Savings Account (HSA) and the Flexible Spending Account (FSA). The most significant difference between flexible spending accounts (FSA) and health savings accounts (HSA) is that an individual controls an HSA and allows contributions to roll over, while FSAs are less flexible and are owned by an employer.

Apart from this, there are several key differences between HSAs and FSAs.

Both HSAs and FSAs allow people with health insurance to set aside money for any healthcare costs referred to as “qualified medical expenses”. This includes deductibles, copayments and coinsurance, and monthly prescription costs.

You usually receive a debit card that you can use to pay for qualifying expenses. And both types of accounts have tax benefits as well.

Let’s discuss HSA vs. FSA – the difference

Although FSAs and HSAs both allow people to use pre-tax income for eligible medical expenses, there are considerable differences between HSAs and FSAs. Those differences include the qualifications, contributions limits, rules for rollovers and changing contribution amounts, and withdrawal penalties.

Qualification: The qualification for FSA must be set up by the employer while HAS is available only to people who have a high-deductible health plan, or HDHP.

Annual Contribution limits: The limit for FSA is up to $2,650/individual and up to $5,300/household. While for HSA, it’s up to $3,450/individual and up to $6,900/household.

Account Ownership: FSA is owned by the employer and lost with a job change, unless eligible for continuation through COBRA; while HSA is owned by individuals and carries over with employment changes.

Rollover Rules: In FSA, employees can roll over $500 into next year’s FSA, but it’s decided by the employer. In HSA, unused funds roll over every year.

Penalties for Withdrawing Funds: You may have to submit expenses to be reimbursed by FSA and depending on the employer, you may not have access to funds for nonmedical expenses. While in HSA, savings can be taken out of the account tax-free after age 65 and if used before 65, for nonmedical expenses, it is subject to a 20% penalty and must be declared on the income tax form.

By looking at the above HSA vs. FSA comparison, you can choose the one that best suits you.

Overall, the higher limits and contribution rollover of the health savings account make it a better choice if you can qualify. HSAs are more flexible than FSAs, allowing you to save for potential medical expenses and accumulate money over time.

Buying Private Health Insurance

November 18, 2020 09:13 newlambertagency

If your workplace or employer doesn’t offer you health insurance, then the obvious choice is to buy private health insurance.

If you’re planning to insure yourself, you need to keep in mind that you’ll have to pay the full cost of the premiums. Thus it is natural to be concerned about how the cost of life insurance will affect you financially.

Fortunately, there are different options and prices available to you based on the level of coverage you need.

Since your employer is not providing you with the insurance benefits, the process of buying private health insurance seems more complicated than simply selecting a company plan and having the premium payments come straight out of your paycheck every month.

Here are some tips that could help you:

How Buying Private Health Insurance Works

You can get insurance by enrolling in a group health insurance plan through your employers. Medicare and Medicaid also provide health care coverage to many Americans.

Medicare is a federal health insurance program for people who are 65 or older while Medicaid is a public assistance healthcare program for low-income Americans regardless of their age.

However, you cannot buy private insurance directly from the state or federal government. If you are not eligible for Medicare or Medicaid and if your company does not offer an employer-sponsored plan, then you have the option of purchasing insurance policies from private insurance companies or through the Health Insurance Marketplace.

But how would you know that you need private health insurance?

Here are some scenarios when you might need them:

If you’re unemployed

If you’re currently unemployed or have lost your job, then obviously you have no insurance support from anyone. But you may be eligible to maintain coverage through your employer’s health insurance plan with the help of a program called the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows eligible employees and their dependents the option to continue health insurance coverage when an employee loses their job or experiences a reduction of work hours

Self-employed

If you’re self-employed, you need to buy your health insurance naturally. However, you can be insured through your spouse’s plan. But if you’re not married, then you must consider buying private health insurance on your own.

If you’re 26 or older

It’s true that under the provisions of the Affordable Care Act (ACA), young people can be covered as dependents by their parents’ health insurance policy until they turn 26 years old.  But after that, you must seek out your insurance policy.

If you retire

When you retire, you will likely no longer be eligible for employer-sponsored health insurance. If you are under 65 and not disabled, you will need to purchase individual private health insurance until you turn 65 and can apply for Medicare.

If you find yourself in one of the above situations and lack health insurance coverage, it’s important to enroll in an individual plan as soon as possible. So, do your research or consult an agent who can help you choose the best plan that benefits you and your family.

Medicare Part A and Part B – What’s the Difference?

November 11, 2020 16:21 newlambertagency

If you’ve been covered by employer-sponsored health insurance most of your life, you probably never had a reason to distinguish between the different parts of your coverage.

When you qualify for Medicare, you’re first enrolled in Medicare part A and Part B. Their enrollment and eligibility are generally the same but have differences in costs and coverage.

Medicare Part A covers hospital expenses, skilled nursing facilities, hospice, and home health care services, while Medicare Part B covers outpatient medical care such as doctor visits, x-rays, bloodwork, and routine preventative care.

The two parts together form Original Medicare.

Let’s discuss more about them in brief.

What is Medicare Part A?

Sometimes referred to as “hospital insurance”, Part A covers hospital stays and inpatient treatment. For treatment to be covered by Medicare Part A, it must be deemed medically necessary. This means a doctor has agreed that the treatment is required to prevent or treat a condition or illness.

You typically pay a deductible and coinsurance and/or copayments. As for premium, if you have worked for at least 10 years i.e. 40 quarters while paying taxes, then you don’t pay a premium for Part A.  If you have worked for less than 30 quarters, you generally pay $458 per month in 2020.

What is Medicare Part B?

Medicare Part B is known as “medical insurance” because it covers doctor visits and medical care outside the hospital. Like with Medicare Part A, treatment must be determined as medically necessary or preventative to be covered by Medicare Part B. While Medicare Part A is required for some people on disability or those receiving other forms of government aid, Medicare Part B is not mandatory for these people.

Under Part B, in most cases you will pay 20% of the Medicare-approved amount for each item or service and a deductible may also apply. The premium for Part B may be higher if your income is above a certain amount.

Can you get both Part A and Part B coverage at the same time?

It’s possible to get Part A and Part B coverage at the same time when you’re an inpatient in a hospital. For instance, while Part A generally covers medically necessary surgery and certain hospital costs, Medicare Part B may cover doctor visits while you’re an inpatient. 

Are There Alternatives to Medicare Parts A and B?

Yes. If you are still working, you could stay on your employer’s insurance plan. However, be aware that you may pay a penalty if you later enroll in Medicare outside of your enrollment period.

If you want Medicare benefits but need more flexibility than Parts A and B, you could opt for Medicare Part C, also known as Medicare Advantage.

Traditional Indemnity Health Insurance Plans

October 30, 2020 03:50 newlambertagency

Health insurance has come a long way over the past few decades, witnessing drastic changes. But with the right type of plan, you can still control your healthcare choices in the best possible way.

Also referred to as fee-for-service plans, a Traditional Indemnity plan is a healthcare plan that allows you to choose the doctor, healthcare professional, hospital, or service provider of your choice and gives you the greatest amount of flexibility and freedom in a health insurance plan.

Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.

Following are the types of Indemnity Health Insurance plans:

  • Hospital and surgery insurance coverage
  • Major medical insurance coverage
  • Comprehensive coverage—a combination of hospital and major medical plans

 

How does it work?

Under an Indemnity plan, you may see whatever doctors or specialists you like, with no referrals required. However, an Indemnity plan may also require that you pay upfront for services and then submit a claim to the insurance company for reimbursement.

You’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the “usual, customary, and reasonable (UCR) rate” for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service.

However, indemnity plans are not always for reimbursement. It does work like traditional insurance in some cases, where a member simply offers their card for the provider to process all their claims. The premiums are generally half of major medical and the deductible only applies to in-patient services, while the out-patient services are payable with no deductible or co-insurance.

Pros & Cons

As already mentioned, one of the biggest advantages you get from choosing a Traditional Indemnity plan is flexibility. You have the freedom to choose your preferred health care facility and provider without any restrictions.

While one of the downsides to this is that you may have to pay more for your health insurance coverage than if you choose a PPO Plan or an HMO Plan. Also, some preventive care services such as wellness check-ups and other routine care may not be covered by an Indemnity Health Insurance plan.

An Indemnity plan may be right for you if:

  • You don’t want to designate primary care physicians or get referrals to get specialists
  • You want to freely visit any physician you choose

 

Of course, such a type of plan is not right for everyone. Hence it is important to do the needful research and sit down with your family insurance agent to discuss the benefits of each type of health insurance plan, so you can make a decision that will give you and your family the best value on a health insurance policy.

Pros and Cons of Health Share Plans

October 21, 2020 10:43 newlambertagency

With health insurance premiums continuing to rise every year, more and more consumers are questioning whether it’s even worthwhile to have health insurance at all. This is why the subject of healthcare sharing programs as a viable alternative has become very common.

However, there’s still some uncertainty and confusion among people about those plans – what are the risks involved? How do they work? etc.

We have listed down some pros and cons of health share plans so that you make a safe and sound decision. Read on.

What is a Healthcare Sharing Program?

Also known as health share plans, they are faith-based programs that facilitate voluntary sharing among members for eligible medical expenses. The members of this plan send in monthly payments or premiums which are distributed to or on behalf of other members with medical expenses (i.e., benefits payments) in accordance with program guidelines.

These plans are built upon the principle of people with similar beliefs and values that come together to share each other’s burdens.

Let’s talk pros now:

They’re cheaper

The cost has always been an issue with traditional insurance plans. And if you too are worried that you might not be able to cover the cost of your insurance, then you should consider health share plans. The price of healthcare sharing programs is comparatively less than health insurance.

You can join anytime

People tend to miss out on plans because they miss the enrollment dates. But that’s not the case with health share plans. They don’t have any set enrollment dates and you can join anytime you want.

You chose the care provider

You have the freedom to choose your care providers. This means that to some extent, you have control over your health care and treatment. More natural options, such as chiropractors and midwives, are also available, and you can hand-pick them, too.

Apart from the above, they also offer efficient customer service and spiritual support as well.

Let’s talk cons now:

They aren’t DOI regulated

Health insurances are regulated by the Department of Insurance and follow a strict set of rules. But that’s not the case with healthcare sharing plans. And they’re not required to keep reserve or pay for claims promptly.

Pre-existing conditions are often not covered

Some pre-existing conditions (as well as chronic ones) are often not covered by health share plans. This means that it’s important to sign up for a plan on time if you wish to make the most out of it. It’s necessary to add that if you wish to have your pregnancy covered, you will usually be asked to join a plan a set amount of time before getting pregnant or giving birth.

The check takes time to clear

Since they’re not regulated, the checks from such plans often take time to clear – 2 to 3 weeks. Although it could be annoying, it is easy to budget for.

Also, Healthshare ministries are faith-based organizations, which means that they ask their members to follow their religious regulations.

Conclusion

Remember, everybody’s situation is unique, so what might be a great solution for one family might be an inadequate one for the other. Take your expenses and needs into consideration and look up different ministries before deciding if health share plans are a good way to go for you.

ACA Health Insurance Plans vs. Healthcare Sharing Ministries

September 16, 2020 12:17 newlambertagency

The individuals who had previously been uninsurable due to poor health or pre-existing conditions received a gift in the name of the Patient Protection and Affordable Care Act in 2010. It brought with it a new era of healthcare for many Americans.

The law proposed a new structure of subsidies intended to help make healthcare more affordable, which presented an opportunity for many to get comprehensive health insurance coverage via their state health insurance portal or its federal counterpart.

The introduction of the ACA health insurance plans eliminated lifetime caps on coverage, meaning you could never get kicked off your plan for getting sick or “run out” of coverage and gave several Americans a chance to finally buy healthcare regardless of their health, employment situation, or income.

While ACA health plans kept made and kept several families happy, another healthcare solution has been gaining popularity over the years – healthcare sharing plans or healthcare sharing ministries. While they aren’t considered “health insurance,” healthcare sharing ministries can be used to reduce the out-of-pocket cost by families who want to share their healthcare expenses with other like-minded families.

Individuals and families who choose healthcare sharing ministries pay a monthly “sharing amount” (read premium) and depending on the program they choose, they can enjoy many of the same perks of traditional health insurance – like discounts on healthcare, limited out-of-pocket limits, and predictable monthly payments.

ACA Plans vs. Healthcare Sharing Ministries: What you should know

Like choosing any insurance, it’s important to weigh the pros and cons before you sign up. We have laid out the pros and cons of both the plans for you to help you make a decision.

Benefits: ACA plans

As already mentioned the most attractive feature of ACA health insurance plans is that there are no lifetime limits or caps. You can buy coverage regardless of your health and subsidies available for those who earn less than 400% of FPL.

Drawbacks: ACA plans

ACA plans are quite expensive and the plans may run on narrow networks. Also, the availability of plans depends on your state of residence.

Benefits: Healthcare sharing ministries

The most appealing feature of healthcare sharing plans is its cost. They’re less expensive and are more cost-efficient than ACA plans. The annual costs and deductibles are low and Families can share their costs with other like-minded families. Also, with this plan, you can avoid the penalty for not having health insurance.

Drawbacks: Healthcare sharing ministries

You need good health to qualify for this plan. It has a lifetime or annual caps on coverage and you cannot use a health savings account.

At the end of the day, the best way to find the right plan for yourself or your family is to look at your unique situation and determine which plan might offer better protection without costing too much or sacrificing your quality of care. After all, it’s your life!