Keeping You in the Know

Health Tips and Information


4 Ways to Pay for Nursing Home Care

It is a common belief that Medicare will cover absolutely everything you need, regarding healthcare expenses, during retirement. But that unfortunately is not true. While Medicare does pay for hospitilization, doctor appointments, and some medical supplies, the cost of a nursing home is usually outside of the scope of coverage. So most people who enter a nursing home must find some other way to pay for it. But how?

Out-of-pocket. Some individuals simply pay for nursing home care out of their own pocket. But with nursing homes costing a few thousand per month, the bill might exceed your monthly income. In some cases a retirement account could be quickly drained when nursing home care is required.

Medi-Cal (Medicaid). While Medicare does not generally cover nursing home care, Medi-Cal might. The government-sponsored program helps with medical expenses for people of lower income status, so even if you don’t qualify for Medi-Cal when you first move into the home, you might qualify later when your financial status changes.

It’s a good idea to make sure the nursing home you choose will accept Medi-Cal payments, in the event that you self-pay but suspect you might qualify for Medi-Cal later. Because states use different metrics to determine Medi-Cal eligibility for those who reside in nursing homes, it certainly can’t hurt to apply for help.

Long-term care insurance. If you were proactive enough to think ahead, a long-term care insurance policy offers the obvious solution to the long-term care dilemma. Purchasing a policy before you retire, and younger if possible, helps you to lock in lower premiums. Some long-term care insurance policies cover nursing homes only, while others might provide for in-home services, adult day care, and other options. Compare policies, and choose one that provides for the type of care you think you might prefer.

Life insurance. Some cash value life insurance policies carry a rider that allows you to withdraw funds for expenses such as nursing home care. Check with your life insurance broker about your own policy to see what might be available to you.

If you’re concerned about the potential cost of nursing home care, give us a call. We can help you explore your options so that you hopefully won’t have to worry about this expense now or in the future.


What You Need to Know About Transparency in Coverage

As both consumers and providers of healthcare plans are aware, the details of health insurance can trigger confusion for those enrolled in a policy. That’s why the federal government created Transparency in Coverage rules in 2020, with several deadlines for compliance on certain parts of the new law. One of those deadlines just passed on July 1.

Beginning on July 1, all healthcare plan providers must provide cost-sharing data to consumers. This information is designed to help consumers understand healthcare service pricing and their own out-of-pocket spending.

How can you find this information? Providers are required to provide this data via machine-readable files, published on a publicly-accessible website. The data includes pricing information for all covered items and services according to in-network negotiated rates, and also certain historical data on out-of-network rates that have been allowed. Not all historical data is required; if there are fewer than 20 out-of-network claims for a service by any particular provider, that information is not required to be included.

A third set of data will disclose prescription drug rates. However, the deadline for that part of the Transparency in Coverage law has been delayed due to a need for further instructions. Therefore, that information might not yet be available from all insurance carriers.

The information in all of these files should be updated monthly to reflect changing rates and new data.

What does “publicly available” mean? Consumers are not required to create a user account, provide a password, or submit any other type of credentials in order to access this information. The information must be published on a website where the general public can access it. Ask your health insurance provider and they will direct you to the the appropriate website.

Again, these files should be published by July 1, so that consumers can access information on cost-sharing from this point forward. If you have any questions about compliance with this new law, or need help interpreting the data, call your health insurance representative.


Take Note of New Limits for HRAs and HSAs

Enrolling in a high deductible health plan (HDHP), sometimes paired with a health savings account (HSA) or health reimbursement arrangement (HRA), can serve as an effective way to manage out-of-pocket healthcare spending while reaping some valuable tax benefits. But of course, as healthcare costs rise along with inflation, your budget is impacted. Without occasional adjustments to certain limits, the benefits of these plans could become irrelevant over time.

So for that reason, out of pocket maximums for HDHPs do change. And because of that, the IRS sometimes issues changes to annual contribution limits for HRAs and HSAs.

First, let’s take a look at the changes to HDHPs, coming next year:

  • The maximum out-of-pocket limit (excluding premiums) for self-only coverage will rise from $7,050 in 2022 to $7,500 in 2023
  • The maximum out-of-pocket limit (excluding premiums) for family coverage will rise from $14,100 in 2022 to $15,000 in 2023

Yes, this means your out-of-pocket ceiling for spending will be a bit higher next year. But accordingly, the IRS will allow for greater contributions to HRAs and HSAs.

For those with an excepted-benefit health reimbursement arrangement (HRA), the annual contribution limit will rise from $1,800 in 2022 to $1,950 in 2023.

The annual contribution limits for health savings accounts (HSAs) will change as follows:

  • The contribution limit for those with self-only health insurance coverage will rise from $3,650 in 2022 to $3,850 in 2023
  • The contribution limit for those with family health insurance coverage will rise from $7,300 in 2022 to $7,750 in 2023
  • Catch-up contributions for those aged 50 and older will remain the same, at $1,000

Employers should update all of their communications with employees to reflect these new limits, before the start of next year. If you have any questions about these healthcare plans, or anything else concerning your healthcare insurance arrangements, call our office and we’ll be happy to assist you.

6 Great Reasons to Enroll in a Life Insurance Policy

Some of the benefits of life insurance appear obvious to most of us, but others might surprise you. There are many great reasons to purchase a life insurance policy, here are six of them…

Provide money for your dependents. This is the benefit most people associate with life insurance. When you die, your policy will pay a specific amount of money (called the death benefit) to your survivors. The most important reason to enroll in a life insurance policy is to provide for your loved ones in the event of your death. And remember, it’s not just wage earners who need a life insurance policy. Everyone has final expenses, such as burial or cremation.

Leave a legacy. You probably want more than subsistence for your loved ones. The lump sum of a death benefit can be used to cover taxes on your estate, pay for college tuition, set up trust funds for children, leave a gift to a favorite charity, and more. A life insurance policy allows you to leave behind something meaningful to the people you care about.

Tap into cash value. Some types of life insurance build cash value, that you can tap into via a loan against the policy. You can use this cash value for emergencies or even to help fund your retirement one day.

Access needed income if you get sick. Some life insurance policies include a clause, called a rider, that allows you to receive a portion of your death benefit if you become chronically or terminally ill. This rider can allow you to handle expenses and support your family during one of life’s toughest moments.

Lower your tax burden. Some loans against the value of a permanent life insurance policy can be taken as tax-free income. And the death benefits from both term and permanent life insurance policies provide your beneficiaries with a lump sum of untaxed income when you pass away.

Protect your business. In the event that one business partner dies or becomes disabled, the right life insurance policy can aid in business continuation by facilitating the transfer of ownership. This way you don’t have to worry about your business being interrupted, and your employees will be protected, too.

Give us a call to discuss these benefits of life insurance, and we can help match you to a policy that suits your individual needs.

Medicare Coverage for Mental Health Services: What You Need to Know

At some point in life, many of us experience a need for mental health services. And in a lot of cases, those circumstances come after retirement. Once the kids have left home, you’ve left your career, and your social life changes, feeling like depression and anxiety can surface. Many Medicare beneficiaries are uncertain of their treatment options, and might wonder about Medicare coverage for these services. Here’s what you need to know.

Medicare coverage includes preventive services for mental health. We all know that preventing a health condition is often easier, and wiser, than attempting to treat one after the fact. So along with other types of preventive services, Medicare offers screenings for mental health conditions:

  • A “Welcome to Medicare” visit within your first year of coverage, which includes an assessment for your depression risk
  • Annual depression screening via your primary care doctor
  • Alcohol misuse screening (one per year)
  • Annual wellness exams, during which you can talk to your doctor about mental health symptoms or concerns, or ask for a referral if necessary

Medicare coverage includes treatment for mental health conditions. If prevention fails, Medicare does offer coverage for a variety of mental health treatment options. The following services are offered on an outpatient basis:

  • Psychiatric testing and diagnoses
  • Therapy -both individual and group, depending upon your needs and preferences
  • Family therapy in some situations
  • Up to 4 sessions of alcohol abuse counseling

Medicare coverage does extend to inpatient services. In some circumstances, a patient might need more intensive mental health care. Medicare Part A does cover hospitalization, up to 190 days in your lifetime. Medicare Part B will cover services that you receive during your stay in the hospital.

Medicare coverage can help pay for certain medications. Yes, antidepressants and other medications used for mental health conditions can be covered by your Medicare plan. However, because Part D and Medicare Advantage formularies (lists of covered drugs) do differ from one plan to another, it is wise to check your list of covered drugs each year during the enrollment period. Taking this step will help you to maintain a plan that covers the prescriptions you need for your condition.

The plan you have matters.  Advantage Plans and Supplement Plans will differ in the way you access mental health benefits.  If you have any Advantage Plan, contact your broker or insurance company for details on how to access care. If you have Original Medicare, you can see any provider that will accept it.

If you have any other questions about Medicare coverage for mental health services, please contact one of our helpful representatives. We can help you compare and shop for Medicare plans that best suit your needs.


Understand Your Rights With Regard to Mental Health Care

Gone are the days in which mental health care was not treated with the same level of importance as care for physical health issues. These days, both the Affordable Care Act and California law set forth minimum standards for health care plans and providers, so that those needing treatment can seek and receive the services they require.

But as with anything else, knowing your rights is the key to accessing them. So here is what you need to know about mental health care and the law.

Under the ACA, mental health services are deemed “essential”, meaning any plan that seeks to be ACA-compliant must provide a certain level of care in this area of health. Services that must be provided under the plan include:

  • Treatments such as counseling and psychotherapy
  • Inpatient mental and behavioral health services
  • Substance abuse treatment

These mental health services are subject to the same standards as medical and surgical care in how care is managed and how deductibles and co-pays are applied.

Additionally, California law supplements ACA requirements by specifying a number of specific conditions for which care must be provided:

  • Major depressive disorders
  • Autism or pervasive developmental disorder
  • Bipolar disorder
  • Panic disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Obsessive-compulsive disorder
  • Anorexia nervosa
  • Bulimia nervosa
  • Serious emotional disturbances in children under age 18

California healthcare plans must cover inpatient and outpatient treatment, as directed by the overseeing doctor, and prescription drugs when needed.

Your health insurance plan, however, could stipulate how you access mental health services, so contact your insurance company or broker to learn how to access this benefit.

Finally, if you seek an initial consultation for mental health care, California law requires that the provider or facility provide you with a return appointment within 10 days. The same deadline applies to referrals for mental health care from your primary care provider.

We are fortunate that the law does take mental health seriously, and that we can all obtain care when we need it. Just as with any other healthcare need, seek services promptly when you need them to protect your health. And if you’re ever in doubt as to how your healthcare plan works, or what type of treatment it covers, contact your plan provider’s customer service team.

3 Benefits of an Independent Insurance Broker

When you’re shopping for an insurance plan, you face an important choice right away. Should you consult with an independent insurance broker, or what’s called a “captive agent”? Here’s the difference: An independent insurance broker contracts with many different providers, whereas a captive agent works for just one insurance company.

If you choose to work with an independent insurance broker, you will reap several valuable benefits…

Access to a wide range of insurance providers and plans. This can be especially important with regard to health insurance and particularly Medicare plans. You want a plan that truly suits your healthcare needs, while fitting into your budget with regard to things like copayments, premiums, and deductibles. Because health insurance and Medicare plans can vary so widely from one another, the ability to shop amongst numerous insurance carriers can only provide you with better options.

Customer support. Independent insurance brokers enjoy additional training, education, and support resources, the benefits of which are passed on to you. Your independent agent will reach out to you regularly with helpful blogs and/or email newsletters to keep you informed of your options. And it always helps to consult with a friendly face right in your own hometown, rather than an anonymous stranger over a nationwide 1-800 number.

Flexibility. Because independent insurance brokers are self-employed and make their own schedules, they are often available at more flexible hours and locations. This can be of great help to the busy professional who needs personal assistance that fits into their lifestyle.

As you’re shopping for a health insurance plan, Medicare plan, or any other type of insurance, keep these points in mind. Give us a call, and we will demonstrate the benefits of working with an independent insurance broker so that you can judge the difference for yourself.


Why an HSA Could be a Good Choice for You

For those with high-deductible healthcare plans, low monthly premiums can also mean high out-of-pocket expenses. These plans are often thought to be the right choice for those who are unlikely to experience significant health problems, or employers who cannot afford to provide a more expensive, low-deductible plan. But when health problems do strike, they can wipe out an individual’s financial resources. A health savings account (HSA) is the answer to that problem.

What is an HSA? A health savings account works like a savings account, but the money in it will be strictly used for covering out-of-pocket healthcare expenses. They can be paired with low-premium, high-deductible healthcare plans, to help employees save up to meet their deductibles and other costs.

An HSA provides certain tax advantages. An HSA is funded via automatic contributions from the employee’s paycheck, on a pre-tax basis. This means that the funds used to cover their out-of-pocket healthcare expenses are not taxed, and the employee’s overall income tax liability is lowered by the amount of their HSA contributions for the year. This can provide a significan tax benefit to workers while helping them to budget for large medical expenses.

HSA funds roll over from one year to the next. If funds within the HSA are not used in a particular year, there is no risk of losing the money. It simply rolls over to the next year. In fact, because the HSA stays with the employee and rolls over each year, they can even take it with them into retirement. At that point the money can be used to cover Medicare premiums or out-of-pocket healthcare expenses like prescription medications, making HSAs another way to prepare for the future.

What is the HSA contribution limit? In 2022, individuals can save $3,650 and those with family healthcare plans can save $7,300 in their HSA.

What if my employer does not offer an HSA? You can still open a health savings account through any bank that offers one. Then, you can fully deduct your contributions on your tax return each year.

To learn more about HSAs and how they can help you and/or your employees, give us a call and we’ll help you evaluate the possibilities.

Medicare Coverage for Dental and Vision Care

As you plan for retirement, you might expect that Medicare will cover all of your necessary medical service. Unfortunately, that isn’t the case. Depending upon the type of Medicare plan you choose, you will probably end up paying out of pocket for at least some of your healthcare. That is especially true with regard to dental and vision care, especially if you enroll in Original Medicare (Medicare Parts A and B).

Here’s what you need to know: Original Medicare does not cover dental and vision care, except in certain (and very limited) emergency situations. Generally speaking, you will have to pay your dentist and eye care professional yourself. On the other hand, some Medicare Advantage plans do offer coverage for these services.

Medicare Advantage plans are contracted through private insurance companies, who can put together their own package of coverage. Advantage plans cover everything offered through Original Medicare, but often with the addition of other types of services such as dental and vision care. However, each Advantage plan is different, and you will usually pay a monthly premium for these plans (unless you choose a $0 premium plan, which is sometimes possible).

Vision care offered through Medicare Advantage plans will generally include preventive screenings, routine eye exams, and corrective lenses.

Dental care offered through Medicare Advantage will often include the following, although plans might differ:

  • Routine dental exams
  • Dental X-rays
  • Routine teeth cleanings
  • Fillings
  • Tooth extractions
  • Root canals
  • Gum disease treatment
  • Dentures
  • Dental implants
  • Bridges
  • Crowns

To learn more about which Medicare Advantage plans offer coverage for dental and vision care, and what that coverage looks like, call one of our insurance professionals. We can help you assess your budget, evaluate different plans, and choose one that suits your needs and budget.

Warning: Income Changes Can Impact Health Insurance Subsidies

If you receive a subsidy to help pay for your health insurance premiums, you probably already know that these subsidies are calculated based upon your household size and income. But what you might not know is that errors regarding those calculations can lead to an unpleasant surprise later.

Each year, your subsidy is calculated based upon your anticipated income for the year. Those subsidies are then paid directly to your health insurance provider, as Advanced Premium Tax Credits (APTC) each month. But if your income exceeds expectations for the year, and your the APTC paid is larger than it should have been, then you will owe the difference when this discrepancy is discovered. This generally happens when you file your income tax return, which reflects your true income for the year. If you received a raise during the year, your spouse’s employment situation changed, or if you worked a lot of overtime, you could earn more than the original estimate of your annual income.

Certain limitations do apply to the repayment demand, according to IRS rules, so you might not owe the full balance. However, this is a situation that you definitely do not want to risk! No one wants to discover that they unexpectedly owe hundreds or even thousands of dollars.

Luckily, there is a simple way to avoid this unpleasant situation. Simply keep track of your income throughout the year, and update the system if it looks like your earnings will exceed the original calculation of your expected income. Log into to update your earnings record, so that your subsidy can be recalculated to reflect your true income.

If you have more questions about health insurance subsidies or how they are calculated, give us a call so that we can assist you. The system can be confusing at times, but with professional assistance you can maintain health insurance coverage while avoiding overpayments and subsequent repayment demands.


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