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BENEFITS OF LIFE INSURANCE FOR SENIORS

Life insurance plays a major role in every stage of life, from childhood to retirement. It is better to enroll in some insurance plans before you retire. Early planning makes you secure in terms of finances. If you have an insurance policy, it provides financial protection and security for you and your family. As we grow older, it is quite obvious we are getting more prone to more dieses. It is better to have an insurance plan that covers all kinds of diseases. If you are concerned about finding an affordable insurance plan for seniors, you may consider health insurance plans in Harrisburg, Pa. 

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10 Essential Health Benefits Insurance Plans Must Cover Under the Affordable Care Act

One popular aspect of the Affordable Care Act is its requirement that all individual and small group health plans (for people who don’t have traditional job-based coverage) cover important health benefits like maternity, mental health, preventive, and pediatric dental care. Members of Congress and the Trump administration have frequently proposed measures that would eliminate or undermine these essential health benefits (EHBs), as they are known.

Essential health benefits ensure that health plans cover care that patients need

EHB requirements ensure that everyone in the individual and small group health insurance markets has access to comprehensive coverage that actually covers the services they need. These essential health benefits fall into 10 categories:

Ambulatory patient services (outpatient services)

Emergency services

Hospitalization

Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

Prescription drugs

Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services, including oral and vision care

The Affordable Care Act eliminated caps on how much coverage people got for these essential health benefits

The Affordable Care Act’s requirement that essential health benefits be covered without annual dollar caps provides patients with more health benefits and a lesser financial burden. While plans before the ACA stated that they covered many of these services, actual coverage was often uneven—patients often faced unexpected dollar limits on services that were technically covered by their plans, forcing them to pay the remainder of costs.

Additionally, this new definition of coverage enshrined in the ACA ensures that plans cover important services that are not currently covered by many plans:

People with mental health or substance abuse disorders will have the peace of mind of knowing that their plan must cover their needs and that their coverage for these mental health services must be as comprehensive as their coverage for medical and surgical services.

Women can rest assured knowing that they will have maternity coverage when they become pregnant.

People with developmental and intellectual disorders will benefit from habilitative services that help them learn, keep, or improve functional skills when most plans now will only cover services to regain skills.

Americans were waiting a long time for substantial coverage of services that are essential to their health. The ACA’s requirement that plans cover these essential health benefits offers a pathway to comprehensive health insurance for all Americans.

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Looking for a Guaranteed Income Stream for Life?

Are you headed toward retirement or even in retirement and concerned about outliving your savings? Perhaps an income annuity will fit your needs. An annuity is a financial instrument that can offer a guaranteed lifetime income that you can’t outlive.

I’ve spent many years helping my clients with annuities as part of their broader financial plan. So here’s a very high-level understanding of some options.

Fixed income annuities are offered with a number of payment options, allowing you to structure payouts according to your financial goals and objectives. Consider these four income streams:

Joint life: This option provides income for two people, as long as either person is alive. When one person passes away, payments continue to the survivor.

Period certain only: This allows you to target how long you need an income stream. If you were to pass away before the end of the certain period, the remaining payments would continue to the person you designate as your beneficiary, meaning the person you want to receive the money.

Life with a period certain: In this scenario, the annuity pays out income for your lifetime. If you were to pass away prior to the end of the certain period elected, your beneficiary receives the remaining payments.

Life only: This is the least-commonly selected payout. When you die, payments cease—no matter what. This can be risky, but the upside is this option provides the highest payouts.

My mother-in-law, now deceased, used a joint life immediate annuity to generate a lifetime income, using the proceeds from the sale of her home. Now my wife, as her beneficiary, is receiving an income stream for the balance of her life from this same annuity policy.

Do you want to know more about the catastrophic health insurance pa then please contact us and send your queries regarding this.

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Ways To Save On Medicare Costs

You may be able to get help paying for your health and prescription drug costs. Even if you are not sure you are eligible, it’s worth learning more about these ways to save on Medicare costs. Each state has different rules about eligibility and applying for Medicaid. Medicare has different savings programs that may help you pay for your Medicare premiums and other costs. Extra Help is a Medicare program that helps people with limited income or resources pay Medicare prescription drug costs, like premiums, deductibles, and coinsurance. If you want to know more about medicare then explore blue cross medicare advantage plans and get the best options to choose from.

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Steps to Prepare for Medicare

Medicare is a valuable source of health insurance for people 65 and older, and some key decisions are involved in making the transition from private health insurance. Choose your Medicare Plan and make sure that your prescription drugs are covered by the plan selected. Compare the two plan options to determine which best fits your medical circumstances. Select your Medicare Supplement Insurance (Medigap) policy. In addition to your insurance costs, make sure to include your out-of-pocket medical expenses as part of your retirement budget. Recognize that additional insurance is needed to provide custodial care. It is important to have medicare and you can enroll for medicare and explore best options for yourself with the help of  medicare providers in pennsylvania.

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Medicare Advantage Plan

A Medicare Advantage plan, sometimes called a Part C plan, is a health plan offered to provide Medicare Part A coverage (inpatient hospital visits, skilled nursing facility stays, home health care visits, hospice care) and Part B coverage (doctor visits, outpatient services, preventive care, some home health visits). It replaces Original Medicare (the federal government program that administers Parts A and B) and usually includes Part D prescription drug coverage, as well as other benefits. Individuals must have both Part A and Part B to enroll in a blue cross medicare advantage plan.

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How Much Do Medicare Supplement Rates Go Up

Medicare Supplement Rate Increases

How much do Medicare Supplement Rates go Up?  For most health insurers, once a policy has been issued, any rate changes are generally event-driven. Medicare Supplement policyholders should not be surprised when their rates go up, in fact, they should expect in every year.  If you just got another Medicare supplement rate increase, discuss your options with medicare providers in pennsylvania.  Keep reading to understand how Medicare supplement prices increase.

How Much Do Medicare Supplement Rates Go Up Each Year

Although Medicare controls the minimum coverage that each plan must contain, how much you pay for coverage depends on the company you select.  There are ways to limit your exposure and how much your Medicare supplement prices go up.

Choose a large A rated company, that has the financial strength to overcome any blips in the market

Choose a plan that is known for low rate increases, such as the Medicare supplement Plan G or Plan N, with the Medicare supplement Plan N having the lowest rate increase history.

Although not everyone selects their Medicare Supplement plan based on the premium, a large part of seniors do and therefore they will typically shop their policy during the annual open enrollment period.

Most policyholders change companies because of rates but there also many who do so because of service or the lack of it. In today’s economy, consumers do not have relationships with their vendors like they did back in the 50s, 60s, and even 70s.

Since most services like health insurance are purchased online, there is little to no loyalty established in the transaction or subsequent service requests.

Let’s face it, you don’t get a free toaster when you buy health insurance (remember those days?) and you’ll rarely get a birthday card. Instead, you’ll get a notice of an impending rate increase.

Why do My Medicare Supplement rates Go Up?

Your Medicare Supplement (Medigap) pricing will typically be based on one of three pricing methods.

This simply means that there are three pricing methods your company can use to establish your rates: Attained Age rates, Issue-Age rates, and Community rates.  The average Medicare supplement rate increase that we have seen is between 5 and 8%, yearly, depending on plan, state and age.

What’s even more confusing is that these three rating methods can look the same unless less you drill down into each pricing method over time.

Medicare Supplement Rating Methods

Attained Age Rating

When using the attained-age rating method, the insurance company sets your rate based your age when you originate your Medicare Supplement plan.

On each anniversary of your policy, your rate will begin to creep up because you are a year older. It may not be substantial at first but over time your rate increases may become alarming.

To make things even more difficult for your budget, your carrier can also increase rates based on claims experience, inflation, and a few other reasons.

Issue Age Rating

With issue-age rating method, the insurance company will rate your policy based on your age at the time of issue and your premiums will not increase based on your age.

The company can, however, increase your rates based on other factors like inflation, rising health care costs, and claims experience.

On its face, the issue-age rating method appears to be the most economical way of purchasing a Medicare Supplement plan, but only if you buy it when you are 65.

For example, Mr. Brown purchases an issue-age Medicare Supplement plan when he’s 65 and the rates are set at $150 per month. His close friend, Mr. Black wants to purchase the same plan in the same state but he is 70-years-old and his rate is $182.

Although both men in this example have locked in their rates because the company uses issue-age rating, they will likely experience rate increases over time due to the factors mentioned above.

Community Rating

If you choose a Medicare Supplement plan that is community rated, age is not considered for rating.

With the community rating method, the insurance company charges the same premium for everyone who has the same type of Medigap plan and the rates will not increase as you age.

Although the insurer will charge the same premium for a 65-year-old and a 75-year-old, this does not mean that a policyholder has their rates locked in forever.

The insurance company may increase rates over time because of inflation or to keep up with health care costs.

What are My Options if Medigap Rates become to expensive?

Certainly, policyholders understand that Medicare Supplement rates are likely to increase over time. We do not live in a vacuum.

The good news is when your rates are getting out of hand and making it difficult to keep up with increased premiums, you can simply go shopping!

Remember, since the government requires all Medicare Supplement plans to have the same benefits from one company to the next, you’ll find it easy to compare rates of the plan you like against all the insurance carriers that offer it.

Plan G from Aetna is the same as Plan G from Humana or UnitedHealthCare; the only thing that differentiates one company from another is pricing and service.

It’s important, however, to only go shopping during certain enrollment periods. You can’t start calling around because you’ve received a rate increase and you’re angry with your insurance company.

When Can I Change My Medicare Supplement Company or Plan?

When you can change your Medicare Supplement provider depends primarily on your health status or what state you are in.

If you are a Medicare Supplement plan that you purchased during your open enrollment, your insurer did not take your health status into consideration because you had a guaranteed issue right.

If you are disappointed with rate increases or claim service and decide to shop around for a better deal or better service, the insurance company will use medical underwriting which means that if your health status is poor, the company could charge you higher rates or even deny you coverage if your health underwriting results are unsatisfactory.

Fortunately, there are some occasions when the guarantee issue rule can still apply. You can still have guaranteed issue rights outside your Open Enrollment Period under any of the following circumstances:

Instead of buying a Medigap Plan, you have a Medicare Advantage Plan (Part C) and the insurance company is leaving your service area.

You have a Medicare Advantage Plan but the company is leaving Medicare or discontinuing your plan.

You decide to move to an area where your Medicare Advantage Plan does not offer service.

You lose your Medigap coverage because the insurance company is filing for bankruptcy.

You want to change your Medicare Supplement company because your current company has misled you or is not complying with Medicare rules and regulations.

Learn about Options from a Professional

Trying to navigate Medicare on your own can be confusing and stressful. There just seems to be no way to make complicated health insurance rules and regulations easy for consumers to understand.

Seniors who are looking to purchase a new Medicare Supplement (Medigap) plan or Medicare Advantage or want to replace the one they have should speak with a Medicare Professional who will advocate for them.

Independent insurance brokers The Medicare Solutions Team have experienced and reputable insurance professionals available to help you shop with all of the highly rated carriers and help you find a solution that will best meet your needs and budget.

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Switching from Medicare Advantage Plan to Medigap

Switching from Medicare Advantage back to Original Medicare can be a bit tricky due to election periods and underwriting.

The last thing you want is to leave your Medicare Advantage plan and then find out you can’t qualify for Medigap. It’s smart to work with a broker to process the change in the right order and use the right election periods. A broker can also help you determine whether you are eligible for other viable coverage first.

Many people try out Medicare Advantage plans because they offer lower premiums than Medigap. Medicare beneficiaries are also lured by promised of minor extra benefits like vision exams and eyeglasses or gym memberships.

So then why would someone enrolled in a Medicare Advantage plan want to switch back to Original Medicare? There are a number of reasons that we frequently see here at our agency.

Reasons for Switching from Medicare Advantage to Medigap

Probably the most common is that an important doctor drops from the network. Advantage plans generally have networks of doctors that members must use. Doctors can come and go from the networks as their contracts come up for renewal. If a trusted doctor leaves the network, that beneficiary may want to return to Original Medicare so that he can continue to see that doctor.

Other reasons might include frustration with having to get referrals to see a specialist. Medicare Advantage plans may require prior authorizations for things like surgeries or diagnostic tests. All of these things are common in Medicare Advantage plans but people can find it burdensome. Sometimes beneficiaries decide the savings they are receiving on their premium just isn’t worth the freedom of access that they have given up.

Whatever the reason, Medicare beneficiaries should take careful steps when considering a change from Medicare Advantage back to Original Medicare. Here are some basic “rules” for doing so:

Switching from Medicare Advantage Requires a Valid Election Period

Medicare Advantage plan membership is generally for an entire calendar year.  Leaving the plan requires that you have an approved election period to do so.

The easiest election period to use is the Annual Election Period which runs from October 15th – December 7th.  During this period, members of Advantage plans can move from their current plan to a different Advantage plan. They can also choose to return to Original Medicare. Enrolling in a new Part D drug plan will  disenroll the member from their current plan and return them back to traditional Medicare.

Check out our post on preparing for the Medicare Annual election period each year.

And as of last year, beneficiaries can also use the Open Enrollment Period (OEP) that allows beneficiaries who are enrolled in a Medicare Advantage Plan to make a one-time change.

The Medicare OEP is for beneficiaries to:

Switch from one Medicare Advantage plan to another Medicare Advantage plan OR

Disenroll from a Medicare Advantage plan and return to Original Medicare, with or without a Part D drug plan

Outside of these two election periods, there are various special election periods which can qualify a person to make a change. Examples would include:

A move out of the current plan’s service area or qualification.

If someone newly qualifies for the Low Income Subsidy for prescription drugs.

Speak to your agent about whether you have a valid election period to make a mid-year change. There are literally pages of approved special election periods, and your agent can help you determine if you qualify for one.

Approval for Medigap is Not Guaranteed

Leaving a Medicare Advantage plan simply moves you back to Original Medicare. Having only Original Medicare puts you at considerable risk for catastrophic medical spending if you have a serious illness.   Medicare has no cap on your out of pocket expenses. For example, someone with cancer will pay 20% for their chemotherapy with no cap to that spending.

For this reason, most people returning to Medicare want to also apply for a Medigap plan to supplement their Medicare.  However, unless you are being involuntarily disenrolled from your Medicare Advantage plan, you don’t automatically qualify for Medigap.

A Medigap plan application includes a section of health questions. You must be able to answer NO to all of these questions in order to be approved for coverage in most states. A medical underwriter will review your application. A serious illness such as congestive heart failure or COPD will disqualify you from almost every insurance carrier offering Medicare supplements.

So before you leave your current coverage, make sure you are certain you can be approved for Medigap coverage. You don’t want to be left with no supplemental coverage.

Plan Your Effective Dates

Leaving your Medicare Advantage plan usually means you will need new coverage for the first of the month following that disenrollment. However, if you use the Annual Election Period to change, then your effective date for any new insurance will need to be January 1st.

Leaving Medicare Advantage usually means you’ll lose the built-in Part D drug plan.  You’ll want to have done all your research about which standalone drug plan will be most suitable for you when you return to Original Medicare. Drug formularies are different on each plan. It also takes time to set up things like mail order delivery on a new plan. Be sure to plan when to get a final fill of your medications on your current plan before you roll off that coverage.

Working with an insurance broker who specializes in Blue Cross Medicare Advantage plans can greatly simplify this process. Our agency handles scores of Medicare Advantage plan switches every year. Our team knows all the proper election periods to use. More importantly we can help you plan each step so that you don’t overlook anything important.

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How to Screw Up Your Medicare

You’ve finally got your Medicare all set up and you breathe a sigh of relief. Then whammo – a slew of claims denials flood your mailbox. Post-enrollment Medicare mistakes sometimes happen, and in this post, I’m going to show you how to avoid them.

First, let’s look at an example:

A long-time client sent me an email about $1,500 in unexpected charges. He had changed drug plans during the Annual Election Period to a new plan that would save him about $500 annually next year on his prescription drugs. (He did not change his Medigap plan)

Even though the annual election period does not affect Medigap plans, it’s not unusual for all the annual Part D plan changes to confuse people. Somehow he started using his new Part D drug plan card when attempting to purchase replacement parts for his CPAP machine.

All the bills were denied of course because Part D doesn’t cover durable medical equipment. That falls under Part B and would have been covered entirely by Medicare and his supplement if he had presented the right insurance card.

Fortunately he knew to call us when he received a denial and an unexpected bill. Our Client Service Team quickly stepped in to help him straighten it out and get the bills to the right place. But these are the kinds of things that constantly happen to Medicare beneficiaries. Many who don’t have an insurance agent on their policies are left to fix these Medicare mistakes on their own.

Post-Enrollment Medicare Mistakes to Avoid

Here’s a few of the most common Medicare mistakes we’ve seen over the years so that you can avoid them.

Failing to Pay Your Part B Premiums

Many people today work well past age 65, and most of these people delay their Social Security income benefits because they still have working income. Since Medicare can’t deduct your Part B premiums from your Social Security check in that situation, they send a quarterly invoice to you instead.

With the mountain of mail that Medicare beneficiaries get every day from insurance companies, it can be very easy to overlook a bill from Social Security.  Unfortunately the result is catastrophic.

When Social Security revokes your Part B for non-payment, they notify your Medigap carrier, who promptly cancels your Medigap plan. Now you are left with no coverage for outpatient services, which includes doctor visits, lab-work, medical equipment, surgeries, chemotherapy, dialysis and many other expensive services.

What’s worse is that you then must wait until the next General Enrollment Period (GEP) to enroll. The GEP runs from January 1st – March 31st each year. Though you can enroll during this period, your coverage won’t start until the following July.

Let’s think about this. If you failed to pay your bill in April, you would wait 8 months to reapply in January. Then that new Part B coverage wouldn’t start for yet another 7 months. That would be 15 months without coverage for anything except your Part A hospital related services.

A serious illness or injury during this uncovered time could result in thousands of dollars of unpaid medical expenses. We want to avoid that at all costs.

Not Notifying Medicare That You’ve Left Employer Coverage

In a perfect world, your former employer would accurately notify Medicare that you are no longer working there. Then Medicare would know that it is now your primary insurance, and it would begin to pay as primary.

This works like it should about 95% of the time. However, every year there are a handful of situations where the employer fails to properly notify Medicare that you have left your job. Your doctor bills Medicare based on your presenting your Medicare card at the time of service. Medicare will promptly deny all of those claims because they believe the bills should have gone to your employer insurance first.

On occasion, we’ve even seen instances where the next year the employer again notifies Medicare that they are still covering you. This results in a whole new round of denied claims.

Presenting your Provider with the Wrong ID Card – Part 1

This one has several versions of easy Medicare mistakes. If you have chosen Medicare as your primary coverage then you will present your Original Medicare card (and Medigap card) to your provider at the time of service

If you enrolled in a Blue Cross Medicare Advantage plan though, that plan pays INSTEAD OF Medicare.  People don’t realize this and they give their doctor their Medicare card by mistake.  What does Medicare do? Deny all of the claims because those bills should have gone to your Medicare Advantage Company.

I’ve also seen this one where a Medicare beneficiary is rushed to the hospital. His or her spouse digs through their wallet and pulls out the Medicare card for the hospital. The hospital sends all the bills to Medicare because they assume the spouse is presenting the correct coverage.

It’s particularly awful because treatment in the hospital can be billed from a variety of places – radiology, anesthesiology, physical therapy, the hospital itself. Each of those bills then have to be corrected separately which can take you several hours by phone to straighten out.

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How to Use Your Health Insurance

Health insurance helps pay for your health care. It can help cover services ranging from routine doctor visits to major medical costs from a serious illness or injury. It also covers many preventive services to keep you healthy. You pay a monthly bill called a premium to buy your health insurance and you may have to pay a portion of the cost of your care each time you receive medical services. Each insurance company has different rules for using health care benefits. You should look at your plan’s benefits and limitations when you first sign up for business health insurance.

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Understanding The Difference Between Medicaid and CHIP

Both Medicaid and the Children's Health Insurance Program (CHIP) provide healthcare coverage for low-income children. Both programs are jointly funded by federal and state governments. Both are run by the states. There are still some inherent differences between the two programs you need to understand. Medicaid offers care to the poorest families while CHIP extends coverage to a larger number of children. CHIP programs provide benchmark care that includes hospital care, laboratory studies, x-rays, and well-child examinations, including immunizations. Care through the Medicaid program may be more extensive, but the CHIP Program also offers a broad depth of coverage.

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The Future of CHIP

What is CHIP?, or the State Children’s Health Insurance Program . The latest proposed temporary appropriations bill (“continuing resolution”) from Congress has added a six-year extension of the program. This continuing resolution (CR) passed the House in a vote of 230 to 197. The Administration, however, expressed its disapproval of CHIP as part of this effort to keep the government open. As the legislative and executive branches sort out their differences, CED urges Congress to extend CHIP and to make needed follow-on reforms.

CHIP Background

In 1997, shortly after the failure of the more sweeping Health Security Act, Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT) put forward a bipartisan effort to provide all low-income American children with health insurance. Within Section 4901 of the Balanced Budget Act of 1997, Congress officially established CHIP, the State Children’s Health Insurance Program.

According to the text, the federal government provides “funds to States to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children.” Today, CHIP resembles Medicaid in its implementation and maintenance; like Medicaid, the programs are funded largely by the federal government, but are run by individual states according to those requirements established by the Center for Medicare and Medicaid Services (CMS).

CHIP has been successful overall and, throughout much of its tenure, has maintained bipartisan support—for example in its last renewal in 2015 the re authorization was passed in the Senate 92 to 8 and in the House 392 to 37.  As of 2016, there have been nearly 9 million children enrolled in CHIP since its inaugural year. And, CHIP has decreased the percentage of uninsured children from 13.9 percent in 1997 to 4.5 percent in 2015.

2017/2018 Controversy

In late 2017, House Republicans passed a bill that would continue CHIP funding but simultaneously charge higher premiums to wealthier Medicare beneficiaries, cut money from the ACA’s public health fund, and shorten the grace period for ACA enrolls who do not make premium payments.

Finally, to avoid a government shutdown, Congressional Republicans looked to use CHIP as collateral, hoping that a six-year extension to the program would be enough to garner the necessary Democratic votes to keep the US government operational for another month. Instead, with less than 48 hours to go before a possible shutdown, the administration voiced its opposition to merging CHIP to a short-term spending bill. With many opponents in the Senate and just a few hours to go, the future of CHIP and the CR looks bleak.

Recommendations

As CHIP is threatened by Congressional inactivity, partisanship, and the dispute between the President and Congress, American lawmakers must consider solutions for the program that could ensure its long-term health and solvency.

Organizations like the Medicaid and CHIP payment and Access Commission, Georgetown University Health Policy Institute’s Center for Children and Families, and the Committee on Child Health Financing have contemplated the issues and drafted solutions for CHIP. CED’s recommendations (below) echo and build on the pre-existing literature.

1. Extend the CHIP program funding through 2022.

Though CHIP is not perfect, we believe that the program should be reauthorized for at least another six years. With a long-term extension, states could budget appropriately for the program, and the federal government would have ample time to make necessary improvements. This extension is necessary whether in a short-term spending bill or a separate piece of legislation.

2. Congress should provide that children with family incomes below 150 percent of the poverty level should not be subject to CHIP premiums.

For the sake of consistency and parity, Congress should require of the states that children of families with incomes below 150 percent of the federal poverty line are exempt from premium payments. Current CHIP law allows for states to impose a combined total of premiums and cost sharing of at most 5 percent of family income. As of January 2016, 26 states require premiums and 25 required cost sharing—with some states demanding both.

While premiums and cost sharing allow for more flexibility to the state and can help states offset the cost of coverage, they serve as barriers to the CHIP program and to insurance generally for the children of families most in need. The Congressional Budget Office (CBO) estimates that this would increase federal spending by less than $50 million per year.

3. Congress should eliminate waiting periods for CHIP.

Currently, some state CHIP programs stipulate that a child must be without private health insurance for a certain amount of time before enrolling in the state-funded CHIP. Though the period may not exceed 90 days and there are several federal exemptions, 15 states, per the most recent data from just over a year ago, still enforce a waiting period.

The waiting periods were intended to deter crowd-out of private coverage, but the data have been inconclusive regarding its effectiveness due to competing data sources. Ultimately, waiting periods likely do more harm than good, as they disrupt care for children—making them oscillate between CHIP, no insurance, and other coverage—and create vastly different CHIP experiences depending on the child’s home state.  The elimination of waiting periods would cost the federal government between $50 million and $250 million in FY 2019.

4. Congress should permanently extend the authority for states to use Express Lane Eligibility (ELE) for children in CHIP.

Streamlining the CHIP process would benefit those requesting coverage and lead to administrative/regulatory savings. CHIP provides an opportunity to use Express Lane Eligibility, in which states can streamline the application processes. ELE would allow states to rely on findings from programs that have similar eligibility requirements and can use those findings to determine CHIP eligibility.

Some Express Lane agencies include Head Start, the National School Lunch Program, and Supplemental Nutrition Assistance Program. We already have evidence of ELE’s success: Louisiana saved an estimated $12.9 million in the first year of implementation. CED would support such administrative efficiency. CBO estimates that this recommendation would result in net federal spending of approximately $100 million a year.

Conclusion

The future of CHIP is threatened.  Congress should guarantee that children of all circumstances have health insurance for the next six years. From there, perhaps Members of Congress can begin a productive dialogue on ways to improve the program and guarantee its viability for years to come.

The improvements we cite above do cost money when the budget is already unsustainable. Clearly, these costs, and much more, must be saved from elsewhere in the budget. We add only that the health of the nation’s children should rank high among our collective priorities.

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Using your new Medicaid or CHIP coverage

If you’re enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), here are some things to know about coverage and care.

Using your coverage

For most questions, contact your state Medicaid or CHIP agency.

If you’re enrolled in a health plan through Medicaid or CHIP, contact the member services phone number on your eligibility letter or the back of your enrollment card. This information should also be on the websites of your health plan or Medicaid or CHIP agency.

Talk to your doctor or pharmacist. They may be able to answer questions about what services are covered.

Using emergency services: In an emergency, you should get care from the closest hospital that can help you. The law requires providers offering emergency services to examine you to determine if your medical condition is life threatening and provide medical care until your life is no longer in danger.

When to contact your state Medicaid or CHIP agency

Issues to take to your state Medicaid or CHIP agency include:

You didn’t get an enrollment card and aren’t sure you’re covered

You can’t find a doctor who accepts Medicaid or CHIP, or you can’t get an appointment

You want to know if a service or product is covered

You have a life change that may affect if you’re eligible for Medicaid or CHIP — like getting a job that increases your income, your dependent reaching an age where they no longer qualify, or getting married or divorced.

FILLING PRESCRIPTIONS IF YOU DON’T HAVE A CARD: If you need to fill a prescription and haven’t received your enrollment card yet, check if your pharmacy accepts Medicaid, CHIP, or your health plan. If they do, take your eligibility letter and prescription to the pharmacy. They’ll try to fill it using the information in the letter.

If they don’t have enough information, most pharmacies can give you enough medicine for 3 days. Call your Medicaid or CHIP agency or health plan for help getting the rest of your medicine.

If your pharmacy doesn’t accept Medicaid, CHIP, or group Insurance plan, call the number in your eligibility letter to find a pharmacy you can use. You can usually find this information on the state Medicaid or CHIP agency website too.

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What benefits are included in a small group health insurance plan?

Purchasing group health insurance for your small business is a great way to cover multiple employees. If your business has fewer than 50 full-time employees, you aren’t legally required to provide health insurance. However, there are some nifty benefits to getting small group insurance:

Current employees can get covered while new hires can be enrolled along the way.

Your employees may be able to access a larger network of doctors on a group plan than they would on an individual plan.

Both the company and your employees can receive tax benefits, making it a more cost-effective option.

Other good things to know about group coverage

Schedule of benefits

Your schedule of benefits is a document that will give you the rundown on what’s covered by your insurance plan and which out-of-pocket expenses you’ll be responsible for, so you should definitely read it carefully and ask questions when deciding on a new plan. Things like preventative check-ups, generic prescription drugs and pediatric dental and vision may be included for free, while ancillary services like adult dental and vision may be available at an additional cost.

One plan doesn’t have to fit all of your employees

You’ve got a staff made up of great folks, but they might be of different age groups with varying health needs. The best way to guarantee that you are offering plans that work for all your employees is to provide a range of plan options.  Check with your broker or insurance carrier to find out which plan options you can make available for your employees.

Some plans allow employees to mix plan metal tiers or networks, allowing for even more options.  For example, with Oscar for Business in New York and New Jersey, you can offer up to three plans for each employee class.

HRAs, FSAs & HSAs

Another helpful option with group insurance is setting up a savings account for health care expenses using pre-taxed income to pay for medical costs. There are 3 major account types for qualified medical expenses:

HRA (Health reimbursement arrangement): The employer sets aside a certain amount of pre-tax money each year for an employee to use on medical expenses like deductibles or coinsurance that aren’t covered by a health insurance plan. Only an employer can put money into an HRA.

FSA (Flexible spending account): The employer owns the account, but the employee makes their own pre-tax contributions and decide which qualified medical expenses to pay with it.

HSA (Health savings account): A long-term savings account an individual sets up to pay for healthcare spending - like a retirement account for medical expenses. While employers can offer HSAs, they are also available to people buying their own individual coverage. (Note: At this time, HSAs are not available through Oscar for Business accounts.)

Long story short, there are actually a lot of benefits

Enrolling your business in a small group health insurance plan means benefits for your company as well as your employees. The first step to making it happen is talking to your broker or health insurance advisor to find out the cost of enrolling your eligible employees.  You could have more flexibility, possible access to a larger network of doctors, and it may save you money on taxes. Most importantly, you’ll have a healthier, happier team.

Do you know there is also another program popularly known as CHIP(Children health insurance program). Chip health insurance pa serves uninsured youngsters up to age 19 in families with pay too high to even consider evening consider evening think about qualifying them for Medicaid. You can get many options under the Children health insurance program.

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Helping Employees in a Mental Health Emergency

Think about all the plans and protocols you have in place for the safety and well-being of your workforce. You probably have a fire escape plan. A natural disaster plan. And (though you might not want to think about it) an active shooter plan.

But what happens if an employee has a mental health emergency, as some 5.5 million people (or more) do each year? When crisis strikes, every minute matters — both for the safety of the employee in need and for the safety of others. That’s why it’s important to plan ahead for mental health emergencies, just as you would for any other medical event that could take place in the office.

When you prepare for the worst to happen on your watch, you ensure that employees feel supported and have the tools to connect with immediate resources and providers who can help. Skipping out on this area of planning may overlook a critical component of workplace wellness — with potentially serious, and even devastating, consequences.

4 Elements of Mental Health Crisis Planning

According to the National Alliance on Mental Illness (NAMI), a mental health crisis can mean a range of things, from breaking the law to unintentional (or intentional) self-injury or harm to others. But because no two situations are exactly alike, it can be helpful to develop a crisis plan broad enough not to be pigeonholed into one circumstance but specific enough to offer concrete and actionable support during emergencies, whether those emergencies happen at work or at home.

As for what goes into it, consider these four elements:

Mental health training. Your staff may be trained in first aid or CPR, but what about recognizing mental health issues? That’s the question behind Mental Health First Aid, a collaboration between the National Council for Behavioral Health and the Missouri Department of Mental Health. An eight-hour training course, the curriculum helps employees spot and address telltale signs of a crisis with evidence-based interventions. Find a class near you.

EAP engagement. Despite the mental health benefits that employee assistance plans (EAPs) can provide, a mere 7% of workers use them. If your benefits package includes an EAP, let employees know the full scope of those benefits with literature in the break room, reminders in the employee newsletter, flyers in bathroom stalls — wherever and whenever you can to make sure they’re familiar with the benefit when they need it.

Signs and symptoms. Sometimes, the signs may be hard to detect during a crisis. An employee might have a panic attack in the bathroom, for example, but not tell anyone. However, there are usually clues leading up to a mental health emergency, such as poor work from a usually high performer, increased absences, late arrivals or abnormal behavior, among other signs and symptoms.

Phone and text hotlines. Keep the National Suicide Prevention Lifeline available at all times for employees: 1-800-273-TALK. For those who would prefer to text rather than speak to a person over the phone, NAMI also offers a crisis text line: Text NAMI to 741-741. Both options provide free 24/7 crisis support.

Plan With Prevention in Mind

Emergency response planning should be just one part of a comprehensive effort to support mental health in the workplace. A key component of that effort is early detection — and early intervention.

That’s because giving employees the resources they need early can make all the difference to their well-being. The company’s bottom line could benefit as well: Employees with unresolved depression, for example, experience a 35% decrease in productivity.

Cultivating a supportive environment that prioritizes mental health is a big part of that — including minimizing stressful work conditions and building in schedule flexibility, mental health days and telemedicine mental health benefits when possible.

Above all, the best thing you can do is to help de-stigmatize mental health in the workplace. Employees who have a heart attack wouldn’t feel embarrassed to return to work after their ordeal. Why should a panic attack be any different? Target openness and acceptance of mental health issues, and create a culture where they’re embraced, rather than hushed or feared.

That way, whether it’s an emergency or just another day, all employees can feel supported at all times — as they should be. Your Chip eligibility pa is based on your household size and income and determined by the government and you can apply any time of year.

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