Keeping You in the Know

Health Tips and Information


Research Your Medicare Options Before You Move

When you’re planning a move out of state, health insurance issues might not fall at the top of your to-do list. Many people assume that their Medicare insurance plan will transfer to their new state, or that a similar option will be readily available after the move. But due to differences in some Medicare plan offerings, these assumptions are not necessarily true. Here’s what you need to know about Medicare when you’re planning a move.

Moving qualifies you for a Special Enrollment Period. Moving is one of the special circumstances under which you are granted a Special Enrollment Period to change your plan(s).

Those enrolled in Original Medicare Parts A and B probably don’t need to make changes. Original Medicare is not based upon provider networks, so you can use your insurance anywhere that accepts Medicare. So if you’re enrolled in Original Medicare Parts A and B, you can always access medical care anywhere in the United States.

Those enrolled in Medicare Part C (Advantage) or Part D (prescription plans) should research their options. Part C and D plans are based upon provider networks, which can differ from one area to another. Your plan offerings might not be commensurate between states.

You might also prefer to research providers and facilities in your new area of residence, so that you gain an understanding of your care preferences. Then, speak to an insurance professional in that state to learn about your Medicare options. In some cases your current plan(s), or something very similar, might be available in the new state.

If the Advantage plans in your new area do not meet your needs, you can also return to Original Medicare.

Those with Medigap plans might require a change. Sometimes those who are enrolled in Original Medicare plus Medigap can keep their old plans and use them anywhere. However, a type of Medigap policy, called Medicare SELECT plans, are based on provider networks. That plan might include a guaranteed-issue right to enroll in a new plan when you move out of the provider network area.

Talk to your Medicare plan administrator before you move. When notifying a plan administrator prior to a move, the Special Enrollment Period begins the month before the month of the scheduled move, and continues for two months afterward. When you wait until after the move to notify your plan administrator, the Special Enrollment Period begins that month and continues for two months afterward.

Plan ahead to gain more time to weigh your options, and you can transition more smoothly into your new life. When selecting options such as Medicare Part C or Medigap plans, you will also be able to evaluate premium expenses to accommodate your changing budget.

Next Time You Need Healthcare, Try Telemedicine

Getting sick is bad enough, and most of us can identify with the additional pain endured throughout the process of making and attending an appointment with a doctor. Traditional appointments might require us to leave home or work, endure traffic entanglements, obtain childcare or take children with us, and spend significant time waiting. Often the wait is the most difficult part, and we know that sitting in a waiting room exposes us to numerous other illnesses. Telemedicine aims to address all of these obstacles and more.

Technically, telemedicine is nothing new. It’s been around since the 1950s, in its earliest form, when patients learned that office visits were not always necessary. Depending upon the type of care needed, we could always call to speak with our doctor or a nurse over the phone. In many cases a prescription could be issued or advice given, without the need for an in-person appointment. Now we can accomplish those goals, and more, via telemedicine appointments with the added convenience of video calls.

Today, the need for remote access to medical services is more pressing than ever. As we continue to battle the effects of the coronavirus pandemic, most of us would rather avoid crowded and potentially infected waiting rooms! So the next time you need routine medical care, consider the benefits of telemedicine:

  • No need to travel to a healthcare provider’s office
  • No worried about childcare or time away from work
  • Avoid traffic and other hassles
  • Avoid potential contagions in waiting rooms
  • Save time and money (telemedicine is priced lower than traditional office appointments)
  • Faster and more convenient care
  • Often reimbursed by Medicare and Medicaid/Medi-Cal

A telemedicine appointment proceeds very much like any other doctor appointment. After virtually checking you in, a nurse will ask you about symptoms and other concerns you’re having. Based on your answers to these questions, a doctor will probably join the call and review your medication or treatment options. In some cases additional tests will be ordered, and you might offered an appointment for lab work.

Obviously, telemedicine should never be used for emergency situations, and you should call 911 or go directly to an emergency room in the event of a life threatening situation. But for everything else, contact your primary care physician about the option of telemedicine appointments to see if this type of care is right for you.

What to Expect with Health Insurance Premiums in 2021

Each year, we prepare for the possibility of rising health insurance premiums in the following year. Premiums affect not only individual budgets, but also the bottom line for any business that offers a group healthcare plan. Since this is an issue that truly affects all of us, many of you might be wondering how the Covid-19 pandemic will impact health insurance premiums.

Premium changes are based upon projected spending on healthcare services, and that’s exactly where this issue gets tricky. So far, we know of a few things that might impact future rates, such as…

Decreased demand for routine or elective services. With the demand for routine care and elective surgeries currently very low (due to either hospital policies, fear of contracting Covid-19, or a combination of both) insurers are paying out far less for these services. Typically we might expect lower payouts to result in lower premiums for all, except of course for one complicating factor…

Care for Covid-19 patients can be expensive. You might have seen the news reports about one Washington state man, who survived Covid-19 only to confront a hospital bill amounting to over one million dollars. Most Covid patients won’t incur bills quite that large, but hospital care does not come cheap. Insurers are also footing the bill for widespread Covid testing, in an attempt to identify positive patients and slow the spread.

Looking toward the future (and premium rates for 2021), we will keep an eye on a number of factors:

  • Will decreased routine care result in more illness, and therefore more demand for healthcare services?
  • Will treatment options for Covid-19 prove successful and affordable, increasing odds of survival and lowering hospital bills for those patients?
  • Or will those treatments be very expensive to manufacture and distribute?
  • Will a second (or third) wave of Covid-19 result in overloaded hospitals and higher medical bills?
  • As people lose or change jobs, how will this affect health insurance enrollment in both the group and individual marketplaces?

As you can see, these variables are hardly set in stone, and will likely shift over time. We will continue to track the trends with regard to Covid-19, healthcare spending, and likely impacts upon premiums. In the meantime, do contact us if you have questions or concerns, and we can help you to evaluate your health insurance options.


You May Be Getting a Discount on Your Health Insurance Premiums

During these times of uncertainty, many of us are worried about various factors of our lives, from whether schools will reopen in the fall to what will happen to our jobs. So we wanted to take a moment and give you some potential good news: Many health insurance providers are offering credits toward, or grace periods for paying your health insurance premiums.

For many of you, this news will take one worry off of your already full plates. It makes sense from the providers point of view, too. The numbers of elective procedures being performed right now are way down, and consumers are avoiding both emergency rooms and doctor’s offices due to the pandemic. Many of the larger health insurance providers are seeing a 30 percent drop in healthcare usage. Inpatient care is down 30 percent, outpatient care is down 25 percent, and physician services are down 35 percent.

Since claims have dropped precipitously, and knowing that many consumers are experiencing financial strain at this time, many health insurance providers are extending that savings to their members. Depending upon your insurance carrier, the following provisions might be available:

  • An extended grace period to pay your premiums due
  • A credit for previous months’ premiums
  • A discount on upcoming premium payments
  • Suspension of some out-of-pocket charges

You can discover what your particular insurance carrier is offering by calling them, or giving us a call. We’ll be happy to help you navigate these new rules during this time.

One final note of caution: Even though claims for medical services are down now, analysts have predicted a surge in health care (and of course, claims) in the near future. Those who are postponing necessary preventive care could be in greater danger of developing chronic health conditions. While it’s understandable to be worried, do contact your doctor to discuss alternate methods of receiving care (such as telehealth) or to decide which tests and procedures really cannot wait. Budgets are important, but your health is always top priority.



A Potential Coronavirus Tax Credit for Employers

As you continue to grapple with the effects of coronavirus upon our businesses and livelihoods, we hope to bring you encouraging news in the form of various aid packages from the government. One piece of good news is an employee retention provision within the CARES Act, that offers a tax credit to employers who continue paying the health insurance premiums of furloughed employees.

In the unfortunate event that you do need to lay off or furlough employees, you might not be able to continue paying their salaries. But if you do continue to make payments toward their healthcare plan premiums, in absence of any other wages, the IRS will allow you to treat that expense as qualified wages.

In order to qualify for this special treatment, the premiums must have been paid between March 12, 2020 and December 31, 2020 (if the pandemic lasts for longer than expected and the IRS extends this time period, we will be sure to notify you).

Some limitations do apply. The qualified health expenses paid for each employee cannot include amounts that the employee paid with after-tax contributions. If an employee participates in more than one healthcare plan offered by the same employer, the expenses for each plan are aggregated for that employee. The expenses are limited to $10,000 per employee for all calendar quarters of this year.

This is at least a piece of good news during an otherwise difficult time. If you are forced to take the unfortunate step of laying off employees, know that the government is putting provisions into place that should help you continue their small group healthcare plan. Now is no time for anyone to be without health insurance if we can all prevent it. And of course, employees with a valuable health insurance plan are loyal employees.

For more information on this tax credit, give us a call. We can explain more about the CARES Act and how it relates to your healthcare plan.


A Special Enrollment Period for Some California Workers

As of January 1, California law requires all of us to enroll in a healthcare plan or pay a penalty at tax time. So what happens to those workers who had the opportunity to enroll in a small group healthcare plan, but declined for some reason?

Luckily, the law does provide for a Special Enrollment Period for those workers, if they change their minds (for any reason) and want to enroll after all.

Why would someone change their mind? There are a myriad of reasons, but some small business workers decline their group healthcare plan because they are covered under a spouse’s plan.  This decision might be considered if the spouse loses their job, or a divorce occurs.

In other situations, a worker might enroll in Medi-Cal instead, but later lose that coverage. In that case, a 60-day enrollment period will apply.

These are just some of many reasons that an individual might decline healthcare coverage through a small business group plan, but later change their mind.

You don’t need to experience a qualifying life event. This Special Enrollment Period applies to anyone who previously denied coverage under a small group plan, for any reason.

Coverage and premiums will be equivalent to other members of the plan. Benefits must be equal to those offered to earlier enrollees. Late enrollees cannot be charged higher premiums, either.

Pre-existing conditions cannot disqualify anyone from coverage. Under the Affordable Care Act, healthcare coverage cannot be denied to anyone due to a pre-existing condition, assuming they are otherwise eligible for the plan. A general health questionnaire is sometimes used during the enrollment process, but enrollees cannot be required to undergo a physical or submit a full health history. Premiums cannot be based upon health conditions, either.

If you’ve formerly denied healthcare coverage under a small group plan, but have since changed your mind, get in touch with us for more information. Different plans impose different timelines for this Special Enrollment Period, so do act quickly so that coverage can begin soon.




Open Enrollment Deadline Has Been Extended

We’ve all experienced enormous changes in a short period of time, due to the coronavirus situation. With many Californians facing economic changes and possible loss of health insurance, Covered California has extended the Open Enrollment period for health insurance. Now, you have until June 30 to enroll in a healthcare plan or make changes to your existing plan.

Who is eligible? Anyone who is eligible to enroll through Covered California can take advantage of this extended enrollment period. Those who do not qualify for a employer-provided health insurance plan can create an account through Covered California and begin to shop for plans.

What about premium subsidies? It might relieve you to hear that yes, healthcare plans offered through Covered California qualify for a subsidy to help with the cost of your premiums.

Individuals who earn less than $17,237 annually can qualify for Medi-Cal.You can submit an application to Medi-Cal at any time.

Those earning between $17,237 and $49,960 qualify for subsidies through Covered California to cover part or most of their premiums, but you must submit your application by June 30.

Those income limits change for households of more than one person. You will need to create an account and input your personal information in order to receive an estimate of your subsidy amount.

Has the coronavirus outbreak prompted any changes to healthcare plans? Yes! For one thing, those enrolled in Medi-Cal or a Covered California plan should be able to obtain testing for coronavirus free of any charges such as a copayment.

Also, Medi-Cal and many Covered California plans are beginning to offer telehealth appointments, so that you can schedule a virtual appointment with a physician in the event that you don’t want to leave the house. This option provides a terrific way to access quality healthcare without unnecessarily exposing yourself to viruses that can lurk in waiting rooms.

Hopefully, the extended deadline will help more Californians to obtain healthcare when we all need it most. Give us a call if you have any questions about health insurance plans, and we will be happy to assist you in making this important decision.

Coronavirus Job Loss: How to Get Health Insurance When Unemployed

We hope you’re all doing well and staying healthy at this difficult time. Having said that, we know that unemployment – or the risk of imminent unemployment – concerns a lot of you. While both the state and federal governments are taking steps to provide stimulus payments and unemployment benefits at this time, you might be wondering what to do about health insurance coverage.

Federal law does require employers to allow you to remain enrolled in your group healthcare plan when you’re laid off. The COBRA law allows you to continue in the same plan, if you wish, but you have to pay the entire cost of the premiums (including your former employer’s share). That might work for a few people, particularly those whose spouses are still employed and can cover the cost of the premiums, but for many unemployed people the cost of the entire premium simply is not feasible.

So, what else can you do about healthcare coverage if you’ve recently become unemployed?

First, know this: If you’ve lost your health insurance due to job loss, you qualify for a Special Enrollment Period. This means that you can enroll in a new healthcare plan outside of the usual Open Enrollment period (which normally happens in the fall).

If you elect to pursue coverage through Covered California, you might be eligible for a subsidy to help cover the cost of your premiums. Keep in mind that if you’ve applied in the past and didn’t receive a subsidy, that is likely to change now since your income has changed.

Also, those with lower incomes might be able to obtain free health insurance through Medi-Cal.

The next round of coronavirus relief legislation is set to proceed through Congress in coming weeks. Several lawmakers have called for 100 percent COBRA coverage, or otherwise addressing the shortage of healthcare coverage in light of widespread unemployment. It is possible one of those provisions might work out for you. However, if you would prefer to proceed with obtaining coverage now – and that is likely the wise thing to do – then give us a call and we’ll be happy to help you compare health insurance plans.

What To Do if You Are Sick

If you’re reading this, chances are good that you’re snug inside your home while we all ride out the pandemic situation. But even if you’ve practiced regular hand washing and social distancing techniques, it is still possible to get sick. Some people will still experience regular colds, allergy symptoms, the flu, or other illnesses during this time. And yes, Covid-19 is a possibility for anyone. Here’s what to do if you get sick.

Don’t proceed to the emergency room, unless you are truly experiencing a life threatening emergency. For one thing, you don’t want to expose yourself to all of the illnesses in the waiting room. Second, if you do have Covid-19, you wouldn’t want to expose everyone else to the illness. And most importantly, hospital staff are severely overworked right now. They need to focus on the most critically ill patients, and for most of us, minor illness is not an emergency.

If you think you might have Covid-19 and your symptoms are severe, proceeding to the emergency room is certainly what you want to do. But do call ahead first, so that they can review their procedure with you. You might be asked to use a separate entrance or take other precautions to avoid exposing others to the potential illness.

Call your doctor. We can’t stress this enough. Before going anywhere for medical attention (except in emergency) calling ahead is proper procedure now. Your doctor can assess your symptoms over the phone, decide if you need to be tested for Covid-19, and direct you on how to complete that lab work.

Otherwise, it might be possible to receive a prescription over the phone, or to schedule an appointment when necessary.

Don’t panic. Remember that for most people, Covid-19 is not a deadly illness. If you are over the age of 60, are immune compromised, or have health conditions that predispose you to complications (such as asthma, heart disease, high blood pressure or diabetes) then you certainly want to be extra careful. These are the people who need to seek more urgent care. Everyone else should still call their doctor and discuss their options, but there is no need to panic.

If you test positive for Covid-19, or if you experience mild symptoms but do not qualify for testing, follow self-quarantine procedures precisely in order to protect others from infection. This guide from the CDC shares more of this information in detail.



No Out-of-Pocket Fees for Coronavirus Testing

If you’re concerned about the novel coronavirus outbreak currently sweeping the globe, perhaps we can offer at least one bit of good news: Health insurance companies in California, New York, Vermont, and Maryland have waived all out-of-pocket fees associated with coronavirus testing.

This means that if you show symptoms of the virus, and head to your physician or hospital for the test, you won’t be required to pay your normal per-visit fee.

It is possible other states will soon follow suit. President Trump just signed a spending package worth $8.3 billion, aimed at reducing the spread of the outbreak and addressing patient needs. This funding will go toward testing as well, although at current time the requirements for receiving a test remain unclear.

Currently, more than 500 cases of the novel coronavirus have been diagnosed in the United States, with our own death toll standing at 22. Worldwide, the virus has infected more than 114,000 and killed more than 4,000.

Between two and fourteen days after exposure, patients with coronavirus notice the following symptoms:

  • Fever
  • Cough
  • Shortness of breath
  • Difficulty breathing/wheezing

The illness is typically more severe in those with known health complications, including asthma, other breathing disorders, or suppressed immune systems. The elderly tend to experience more trouble with the illness as well. Yet, regardless of your state of health, testing is important in order to detect and quarantine patients so that we can reduce spread of the virus to the most vulnerable populations.

If you suspect you might have contracted the novel coronavirus – and remember, odds for that are still extremely low unless you have a known exposure risk – remember to call your physician or the emergency room before heading their way. Health officials have ordered certain preparations be made ahead of potential patient exams, so that the spread of the virus can be contained. Follow their instructions when arriving for your exam and test.


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