Archive for Month: October 2018
2019 Medicare Part B Changes
2019 MEDICARE PREMIUMS AND COPAY/DEDUCTIBLES
2019 PART B PREMIUM
The Medicare Part B standard monthly premium will be $135.50 in 2019, compared to $134 in 2018.
Note: The income-related Part B premiums for 2019 will vary depending on the extent to which an individual beneficiary’s income exceeds $85,000 (or a married couple’s income exceeds $170,000).
Income level- File Individual
Income Level- File Joint
2019 Part B Premium
|Less than or equal to $85,000||Less than or equal to 170,000||$135.50|
|Greater than $85,000 and less than or equal to $107,000||Greater than $170,000 and less than or equal to $214,000||$189.60|
|Greater than $107,000 and less than or equal to $133,500||Greater than $214,000 and less than or equal to $267,000||$270.90|
|Greater than $133,500 and
less than or equal to $160,000
|Greater than $267,000 and
less than or equal to $320,000
|Greater than $160,000 and less than $500,000||Greater than $320,000 and less than $750,000||$433.40|
|Greater than or equal to $500,000||Greater than or equal to $750,000||$460.50|
As always, 2019 Medicare supplement benefits match the federal program’s deductible and coinsurance increases, a distinct advantage in today’s ever-changing environment.
|2019 Medicare Supplement Copay/Deductibles|
|Feature||2018 Benefits||2019 Benefits|
|Part A Inpatient Hospital Deductible||$1,340||$1,364|
▪ 61-90 days
▪ 91-150 days (lifetime reserve)
|Skilled Nursing Facility Care Coinsurance
▪ 21-100 days
|Part B Physician’s Services and Supplies Deductible||$183||$185|
Most Affordable Health Insurance in Maryland
The IHC Group has some of the most affordable health insurance in Maryland. When circumstances leave you temporarily uninsured, the Connect Value short-term medical insurance plan helps protect you during coverage gaps. Value Connect is an affordable way for Maryland residents to avoid going without health insurance.
Read below for more information about this exciting product.
Office Visit Copay – $50
The copay applies to the first covered office visit during the policy period. After the copay, the balance of the doctor office visit charge is covered at 100 percent. Additional covered expenses incurred during the office visit, including expenses for laboratory and diagnostic tests will be subject to plan deductible and coinsurance.
Looking for more robust coverage, learn about United Healthcare of Maryland.
Maximum benefit $1,000,000
View an online health insurance quote.
All benefits, except office visits applied to the copay, are subject to the selected plan deductible and coinsurance. Covered expenses are limited by the usual and reasonable charge as well as any benefit-specific maximum. If a benefit-specific maximum does not apply to the
covered expense, benefits are limited by the coverage period maximum. Benefits may vary by state.
Deductible – $1,000 | $2,500 | $5,000
The selected deductible must be paid by the covered person before coinsurance benefits begin. Family deductible maximum: Three times the individual deductible amount.
Coinsurance percentage and out-of-pocket costs
After the deductible has been met, you pay the selected percentage of covered expenses until the out-of-pocket amount has been reached.
The Connect Value plan covers the remaining percentage of covered expenses up to the maximum benefit. The out-of-pocket amount is specific to expenses applied to coinsurance; it does not include the deductible.
Utilize a network provider and Save
With your Connect Value short-term medical plan, you have the freedom to choose any provider. In certain markets, you also have access to discounted medical services through national preferred provider organizations (PPOs). These network providers have agreed to
negotiated prices for their services and supplies. While you have the flexibility to choose any healthcare provider, the discounts available through network providers for covered services may help to lower your out-of-pocket costs. At the time of service, simply present your identification card, which will include the network information needed for the provider to correctly process covered billed charges.
Why short term medical insurance?
When you are temporarily between major medical policies or waiting for coverage to begin, short-term plans provide benefits to help pay for unexpected healthcare. Covered expenses may include emergency room treatment, hospital stays, surgery, intensive care and more.
Underwritten by Independence American Insurance Company, (IAIC), a member of The IHC Group. For more information about IAIC and The IHC Group, visit www.ihcgroup.com. This product is not considered to be Minimum Essential Coverage as defined by the Patient Protection and Affordable Care Act (ACA). This product is administered by The Loomis Company.
Connect Value offers short-term medical coverage with an affordable premium
Connect Value’s low premium is achieved through carefully selected benefit limitations. Coverage is available in most states for 30 to 90 days. Short-term medical insurance is not a substitute for a major medical plan that meets the minimum essential coverage levels as defined by the Patient Protection and Affordable Care Act, also known as ACA. It can, however, offer financial protection in the event of an unexpected injury or illness while you are waiting for coverage to begin under an ACA compliant plan.
Waiting for an ACA plan
Many plans on the Health Insurance Exchange offer only one effective date, the first of the month. Depending on when you submit your application, you may have to wait up to 45 days for your coverage to begin.
Often, an employer-sponsored plan includes a waiting period before health insurance benefits begin.
Missed Open Enrollment
If you have missed the opportunity to secure coverage during the open enrollment period, you may be ineligible to buy a major medical policy until the next open enrollment period, unless you have a qualifying event.
Can I Apply?
Connect Value is available to the primary applicant from age 18 to 64, his or her spouse age 18 to 64 and dependent children under the age of 26. A child-only plan is available for children age 2 up to age 18.
Covered Services Include Treatment for services and supplies for:
• Inpatient hospital room, board and general nursing care up to the amount billed for a semi-private room or 90 percent of the private room billed amount, not to exceed $10,000 per day
• Inpatient intensive care or specialized care unit up to three times the amount billed for a semi-private room or three times 90 percent the private room billed amount, not to exceed $12,500 per day
• Inpatient doctor visits not to exceed $500 per confinement
• Inpatient prescription drugs administered while hospital confined
• Emergency room up to $500 per day
• Office visits not paid through a copay will be subject to deductible and coinsurance, not to exceed a maximum benefit of $1,000 per covered person
• Outpatient hospital surgery or ambulatory surgical center charges not to exceed $1,000 per day
• Surgeon services in the hospital or ambulatory surgical center not to exceed $2,500 per surgery
• Anesthesiologist services not to exceed the maximum benefit of 20 percent of the surgeon’s benefit
• Assistant surgeon services not to exceed 20 percent of the primary surgeon’s covered charges
• Surgeon’s assistant services not to exceed 15 percent of the primary surgeon’s covered charges
• Ground ambulance services not to exceed $250 per occurrence
• Air ambulance services not to exceed $250 per occurrence
• Organ, tissue, or bone marrow transplants not to exceed $150,000 per coverage period
• Acquired Immune Deficiency Syndrome (AIDS) not to exceed $10,000 per coverage period
• Outpatient hospital surgery or ambulatory surgical center not to exceed the maximum benefit of $1,000 per day
Pre-certification is required prior to each inpatient confinement for injury or illness, including chemotherapy or radiation treatment at least seven days prior to receiving treatment. Emergency admissions must be pre-certified within 48 hours following the admission, or
as soon as reasonably possible. Failure to complete pre-certification will result in a benefit reduction of 50 percent which would have otherwise been paid. Pre-certification is not a guarantee of benefits and may vary by state.
Pre-existing Condition Limitation
Connect Value will not provide benefits for any loss caused by or resulting from a pre-existing condition. A pre-existing condition is any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within five years* immediately preceding the covered person’s effective date of coverage; or symptoms within the five years immediately prior to the coverage that would cause a reasonable person to seek diagnosis, care or treatment.
*In the following states, the pre-existing condition time period is 6 months: GA, ID, KY, MA, MI, NH, NJ, NM, NY, ND, WA, WY.
Coverage ends on the earliest of the date: the premium is not paid when due; you enter full-time active duty in the armed forces; or Independence American Insurance Company determines intentional fraud or material misrepresentation has been made in filing a claim for benefits. A dependent’s coverage ends on the earliest of the date: your coverage terminates; the dependent becomes eligible for Medicare; or the dependent ceases to be eligible.
If your need for temporary health insurance continues, most states allow you to apply for another short-term medical plan. Your application is subject to eligibility, underwriting requirements and state availability of the coverage. The next coverage period is not a
continuation of the previous period; it is a new plan with a new deductible, coinsurance and pre-existing condition limitation.
The Policy does not provide any benefits for the following expenses:
• Treatment of pre-existing conditions, as defined in the pre-existing conditions limitation provision, shown in the Policy
• Incurred prior to the effective date of a covered person’s coverage or incurred after the expiration date, regardless of
when the condition originated, except in accordance with the extension of benefits provision
• Treatment, services & supplies for:
• complications resulting from treatment, drugs, supplies, devices, procedures or conditions which are not covered
under the Policy;
• experimental or investigational services or treatment or unproven services or treatment;
• Amounts in excess of the usual, reasonable and customary charges made for covered services or supplies or you or your
covered dependent are not required to pay, or which would not have been billed, if no insurance existed;
• Paid under another insurance plan, including Medicare, government institutions, workers’ compensation or automobile insurance
• Expenses incurred by a covered person while on active duty in the armed forces. Upon written notice to us of entry into such active duty, the unused premium will be returned to you on a pro-rated basis
• Treatment, services and supplies resulting from:
• war (declared or undeclared);
• the commission of engaging in an illegal occupation;
• normal pregnancy or childbirth, except for complications of pregnancy;
• a newborn child not yet discharged from the hospital, unless the charges are medically necessary to treat premature birth, congenital injury or sickness, or sickness or injury sustained during or after birth;
• voluntary termination of normal pregnancy, normal childbirth or elective cesarean section;
• any drug, including birth control pills, implants, injections, supply, treatment device or procedure that prevents conception or childbirth, including sterilization or reversal of sterilization; sex transformation (unless required by law), penile implants, sex dysfunction or inadequacies and/or diagnosis and treatment of infertility, including but not limited to any attempt to induce fertilization by any method, invitro fertilization, artificial insemination or similar procedures, whether the covered person is a donor, recipient or surrogate.
• Physical exams or prophylactic treatment, including surgery or diagnostic testing, except as specifically covered
• Mental illness or substance use, including alcoholism or drug addiction or loss due to intoxication of any kind unless
mandated by law
• Tobacco use cessation
• Suicide or attempted suicide or intentionally self-inflicted Injury, while sane or insane
• Dental treatment or care or orthodontia or other treatment involving the teeth or supporting structures, except as specifically covered and the treatment by any method for jaw joint problems including temporomandibular joint dysfunction (TMJ), TMJ pain syndromes, craniomandibular disorders, myofascial pain dysfunction or other conditions of the joint linking the jaw bone and skull and the complex of muscles, nerves and other tissues related to the joint
• Eye care, hearing, including hearing aids and testing
• Cosmetic or reconstructive procedures that are not medically necessary, breast reduction or augmentation or complications arising from these procedures
• Outpatient prescriptions, drugs to treat hair loss
• Feet unless due to accidental bodily injury or disease
• Weight loss programs or diets, obesity treatment or weight reduction including all forms of intestinal and gastric bypass
surgery, including the reversal of such surgery
• Transportation expenses, except as specifically covered
• Rest or recuperation cures or care in an extended care facility, convalescent nursing home, a facility providing rehabilitative treatment, skilled nursing facility, or home for the aged, whether or not part of a hospital
• Providing a covered person with (1) training in the requirements of daily living; (2) instruction in scholastic skills such as reading and writing; (3) preparation for an occupation; (4) treatment of learning disabilities, developmental delays or dyslexia; or (5) development beyond a point where function has been demonstrably restored
• Personal comfort or convenience, including homemaker services or supportive services focusing on activities of daily life that do not require the skills of qualified technical or professional personnel, including bathing, dressing, feeding, routine skin care, bladder care and administration of oral medications or eye drops;
• Supplies provided by a member of your immediate family
• Sleeping disorders
• Expenses incurred in the treatment of injury or sickness resulting from participation in skydiving, scuba diving, hang or ultralight gliding, riding an all-terrain vehicle such as a dirt bike, snowmobile or go-cart, racing with a motorcycle, boat or any form of aircraft, any participation in sports for pay or profit, or participation in rodeo contests
• Bone stimulator, common household items
• Participating in interscholastic, intercollegiate or organized competitive sports
• Medical care, treatment, service or supplies received outside of the United States, Canada or its possessions
• Spinal manipulation or adjustment
• Private duty nursing services
• The repair or maintenance of a wheelchair, hospital-type bed or similar durable medical equipment
• Marital counseling or social counseling
• Expenses for replacement of artificial limbs or eyes, removal of breast implants
• Treatment, services or supplies not defined or specifically covered under the Policy
About The IHC Group
Independence Holding Company (NYSE: IHC), formed in 1980, is a holding company that is principally engaged in underwriting, administering and/or distributing group and individual specialty benefit products, including disability, supplemental health, pet, and group life insurance through its subsidiaries (Independence Holding Company and its subsidiaries collectively referred to as “The IHC Group”). The IHC Group consists of three insurance companies (Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company), and IHC Specialty Benefits, Inc., a technology-driven full-service marketing and distribution company that focuses on small employer and individual consumer products through general agents, telebrokerage, call centers, advisors, private label arrangements, independent agents, and through the following brands: www.HealtheDeals.com; Health eDeals Advisors; Aspira A Mas; www.PetPartners.com; and www.PetPlace.com.
Medicare Part B
Medicare Part A and Medicare Part B are required if you want to apply for a Medicare Supplement policy. When you have both Medicare Parts A and B it is commonly known as Original or Traditional Medicare. For Americans over the age of 65, Medicare Part A and Part B form the core of their healthcare. Medicare is one of the best healthcare systems in the world.
What does Medicare Part B Cover?
Medicare Part A is the first part of Medicare. It is free and is mostly in-patient Hospital Coverage. Medicare Part B is the second part; it helps cover outpatient treatments. The services fall into two categories, (1) Medically necessary services, such as treatments required to diagnose and treat accepted medical conditions. (2) Preventative services to help prevent illnesses, like flu shots, or to detect conditions at an early stage like prostate cancer screenings or mammograms.
- Outpatient Care
- Home Health Care
- Preventive Services
- Durable Medical Equipment (DME)
- Flu Shots
- Mental Health
- Ambulatory service
However, Medicare Part B is not designed for long term care, dental issues, routine foot care, hearing devices, or eye exams to name a few.
Who is Eligible for Medicare Part B?
- Some Disabled individuals
- People with Renal Disease
- 65 or older
What is the Cost of Medicare Part B?
Although Medicare is administered by the government, it comes at a small price. Most Americans pay a monthly cost of $104.90. However, some people who are Medicaid eligible may get it for free. And some higher income individuals will pay higher rates for their Part B. Once you enroll in Medicare, a review of your last two years tax returns will be used to determine the cost of your Part B.
Medicare Part B Deductible and Co-Insurance
Medicare Part B has a deductible and co-insurance. Each person must meet the $185 per year deductible. This is a calendar year deductible. After deductible Medicare Covers 80% in most cases, leaving the patient with 20% of the cost.
Medicare Part B Preventive Care
The government and healthcare community want to make sure certain medical items are covered. Preventive care helps both medical insurance and the government save money. Medicare Part B recipients can receive the following each year for free:
- Cardiovascular disease screenings
- Diabetes screenings
- Colo-rectal Cancer Screenings
- HIV Screenings
- Bone Density
- Prostate Cancer Screenings
- Cervical Cancer Screenings
Part B Enrollment
Enrollment in Part B is easy. Often times it will automatically process or you could visit Medicare.gov to enroll online. It is very common today that a person’s Part A and Part B both automatically begin on the 1st day of one’s 65th birth month. So if a person turns 65 on June 7th, their Part A and Part B would begin June 1st. If you have questions about Part B enrollment and want to learn more about Medicare it is best to let us provide you with a Medicare Overview.
Medicare Part A
Medicare Part A usually begins when turning age 65. Medicare Part A coverage is typically free if you or a spouse paid Medicare taxes during your working career. The majority of Americans are automatically enrolled in Medicare Part A when they are 65 years old. To receive Part A you must be already eligible to receive retirement benefits, either through Social Security or the Railroad Retirement Board. However, you do don’t have to be actively collecting Social Security benefits as many people wait to file. Disabled Americans who are under age 65 and receive Social Security or Railroad Retirement disability benefits are often eligible for Part A after 24 months, and those diagnosed with End-Stage Renal Disease can obtain Medicare Part A.
Key Points of Medicare Part A
- Americans may receive their Medicare Card three months before their 65th birthday
- If you receive Social Security checks and turn 65, you are enrolled in Medicare Part A automatically
- Most Part A beneficiaries will pay zero premium if they contributed 40 or more quarters of work
- Medicare Part A becomes effective the 1st day of the month of the beneficiaries 65th birthday
What does Medicare Part A Cover?
Medicare Part A is mostly associated with inpatient hospital care. Here is what you pay:
- $1,364 annual hospital deductible
- Days 61-90: $341 per a day
- Days 91 and later (while using 60 lifetime reserve days): $682 per a day
Important: After lifetime reserve days are used Medicare pays nothing, the beneficiary is responsible for all hospital charges.
Keep in mind the above information only lists costs for Medicare Part A. You would also have Medicare Part B costs.
Blood covered under Medicare Part A
Part A annually covers the first three pints of blood at no cost to the beneficiary. The Medicare beneficiary is responsible for paying for all additional pints of blood per calendar year.
What Else does Part A Cover?
Medicare Part A covers expenses that are incurred during a stay in the hospital as well as brief Home Health services for some situations, and sometimes brief Hospice care and Skilled Nursing Facility care, and occasionally Nursing Home care, provided you are not merely in need of assistance with daily living. Mental health care is also a covered service when admitted to a hospital as an in-patient.
Medicare Part A does not cover cosmetic surgery, acupuncture, eye exams for the purpose of prescribing glasses, most dental work, dentures, standard foot care, custodial care or hearing aids and the exams required for fitting them.
Need Help Understanding Medicare Part A?
The easiest way to get help with understanding Medicare Part A is to fill out a request online to speak with us. It only takes ten or fifteen minutes to do a brief overview to Medicare Parts A and B. In the event that more information is needed, we could help direct you to your local Social Security office for an in person appointment.
While Medicare may seem confusing, we strongly urge you to contact us sooner than later. We find many Americans spend a great deal of time looking at the wrong Medicare products or over complicating how Medicare works. Sometimes a nice conversation with a knowledgeable person, can greatly ease the tensions that come with learning something knew and transitioning to Medicare.
What if I want Medicare with No Co-pays or Deductibles?
Medicare with no cost sharing is no problem. About 25% of all Medicare recipients have Part A and Part B. They add a Medicare Supplement to cover their deductibles and co-pays, and Part D, a prescription drug plan. Our office can easily help with this process. As always, our services are no cost to you.
Aetna Dental Insurance with Added Vision and Hearing
Aetna Dental, Vision, and Hearing offers valuable protection by including three types of coverage in one policy. Aetna is trying to help your family smile bigger and brighter, protect healthy vision to see clearer, and hear the world just that much better.
- Guaranteed Acceptance – No Health Questions
- Guaranteed Renewable – as long as you pay your premiums on time
- Issue ages 0-89
- For individuals or families
- Choose $1,000 or $1,500 max benefit per policy year that covers dental, vision, and hearing per person
- Plan deductible is $100 per policy year per a person
- Freedom to choose any provider or get even better pricing by using Aetna in-network providers
- Benefits paid directly to insured or to the provider
- 30-day free look – return your policy for any reason within 30 days for a full refund of all premiums paid
When does my Aetna Coverage Begin?
- Dental Coverage
- Day 1 for cleanings, x-rays, exams, filings
- After 1 year for endodontics, root canals, periodontal surgery, bridges, crowns, and dentures
- Vision Coverage
- After 6 months
- Hearing Coverage
- After 12 months