#medicare dental coverage

[lifeandinsurances]

Your Medicare Coverage Guide for 2023

[coverageguru]

Affordable Health Insurance

Health insurance is a type of insurance that helps cover the cost of medical expenses. It can be provided by an employer or purchased individually from an insurance company. Health insurance plans typically have different levels of coverage, ranging from basic to comprehensive, and they often come with different costs, such as premiums, deductibles, and co-pays.

Before signing up for a health insurance plan, it's important to understand your specific healthcare needs and budget. You should consider factors such as your age, health status, and any pre-existing conditions you may have. You should also research the various affordable health insurance plans available to you and compare their costs and benefits.

Some common types of health insurance plans include HMOs, PPOs, and EPOs. HMOs typically have lower out-of-pocket costs but limit you to a specific network of healthcare providers. PPOs offer more flexibility in choosing healthcare providers but may have higher out-of-pocket costs. EPOs are a hybrid of HMOs and PPOs, offering some of the benefits of both.

Ultimately, choosing the right health insurance plan for you and your family requires careful consideration and research. By understanding your healthcare needs and the different options available to you, you can make an informed decision that best meets your needs and budget.

[healthinsurancediva]

Long-Term Care Insurance: A Critical Component of Retirement Planning

As you approach retirement, it’s essential to consider all aspects of your future, including the potential need for long-term care. Long-term care insurance (LTCI) is a critical component of comprehensive retirement planning.

Why Include LTCI in Retirement Planning?

Retirement planning isn’t just about ensuring you have enough savings to cover your living expenses; it’s also about preparing for potential health care needs. With over 5 million seniors currently requiring long-term care and costs averaging $50,000 to over $90,000 annually, it’s clear that these expenses can significantly impact your retirement funds.

Protecting Your Retirement Savings

LTCI helps protect your retirement savings by covering the high costs of long-term care. Without insurance, you may have to dip into your savings or sell assets to cover these expenses, which can deplete your financial resources and jeopardize your financial security.

Ensuring Quality Care

Having LTCI ensures that you can afford quality care without compromise. Whether you need home care, assisted living, or nursing home services, LTCI provides the financial means to choose the best care options available. This not only protects your health but also your quality of life.

Relieving the Burden on Family

Without a plan in place, the responsibility of providing care often falls on family members. This can be a significant emotional and financial burden. LTCI alleviates this burden by covering the costs of professional care, allowing your family to focus on their own lives and well-being.

Planning for the Unexpected

Life is unpredictable, and health conditions can change rapidly. LTCI provides a safety net, ensuring that you’re prepared for unexpected health changes and the need for long-term care. This foresight allows you to face the future with confidence and peace of mind.

Conclusion

Long-term care insurance is a vital part of retirement planning, offering financial protection, ensuring quality care, and relieving the burden on family members. By including LTCI in your retirement strategy, you can secure your financial future and enjoy peace of mind. Luann Allen offers trusted expertise that can’t be matched. She stays on the cutting edge of our state’s long-term care options, costs, and regulations so you have the latest facts. Plan wisely and ensure a secure retirement with long-term care insurance.

[coredocuments01]

Understanding HRA Plan Documents and Group Coverage: A Comprehensive Guide

An HRA Plan Document is a legal document that outlines the terms and conditions of the Health Reimbursement Arrangement offered by an employer. It serves as a roadmap, detailing the rules and regulations governing the HRA and acts as a crucial communication tool between the employer and employees.

Why is it Essential?

Legal Compliance: HRA Plan Documents are required by law. The Employee Retirement Income Security Act (ERISA) mandates that employers provide written plan documents for all employee benefit plans, including HRAs. Failure to comply with ERISA regulations can lead to legal repercussions.

Clarity and Transparency: A well-drafted HRA Plan Document ensures that employees understand the benefits, coverage limits, and reimbursement procedures. This transparency fosters trust and helps in managing expectations.

Flexibility and Customization: Employers have the flexibility to design HRAs that align with their budget and employee needs. The HRA Plan Document serves as the tool to document these specific plan details, such as eligible expenses, rollover provisions, and coverage periods.

Employee Education: The document serves as an educational resource for employees, helping them navigate the complexities of the HRA. It can include FAQs, examples, and scenarios to clarify any uncertainties.

Group Coverage HRA Plan Documents

What Sets Group Coverage HRAs Apart?

Group Coverage HRA Plan Document are a specific type of HRA designed to provide a group of employees with a common set of benefits. The HRA Plan Document for a GCHRA takes into account the collective needs of the group, providing a unified approach to healthcare benefits.

Key Components of Group Coverage HRA Plan Documents:

Eligibility Criteria: Clearly define the criteria for employees to participate in the GCHRA. This may include factors such as employment status, hours worked, or other specific conditions.

Contribution Structure: Specify the employer's contribution structure, including the maximum allowable contribution per employee, reimbursement rates, and any tiered contribution levels.

Conclusion:

A well-crafted HRA Plan Document, especially for Group Coverage HRAs, is essential for the successful implementation and administration of healthcare benefits. Employers should invest time and resources in creating comprehensive and compliant documents to provide a clear roadmap for both the organization and its employees. In doing so, they can navigate the complexities of healthcare benefits, foster transparency, and build a foundation of trust and satisfaction among their workforce.

[smarthealthtrackers]

[mososimos]

Listen to the podcast by Amber Darst – OSI’s Solutions Manager, Amber Darst discusses about Medicare coverage for dental procedures. Outsource Strategies International (OSI) is a reliable dental billing company in USA. We provide a comprehensive suite of dental billing services including comprehensive dental eligibility verifications, authorizations, coding and more.  https://bit.ly/3uXaFke

[boreal-sea]

"In a move last month that received little fanfare, the Biden administration finalized a rule that would give states the option of adding adult dental insurance coverage as part of their Affordable Care Act plans. In another attempt to bolster dental coverage, Sen. Bernie Sanders, I-Vt. on Friday introduced the Comprehensive Dental Care Reform Act of 2024, a bill that would expand dental coverage through Medicare, Medicaid and the Veterans Administration and increase the number of dentists, dental hygienists and dental therapists nationwide." -USA Today

VOTE

[justinspoliticalcorner]

Jessica Glenza at The Guardian:

A bill introduced by the US senator Bernie Sanders would dramatically expand access to oral healthcare by adding dental benefits to Medicare and enhance them in Medicaid, public health insurance programs that together cover 115 million older and lower-income Americans.

Despite Americans’ reputation for the flashy “Hollywood smile”, millions struggle to access basic dental care. One in five US seniors have lost all their natural teeth, almost half of adults have some kind of gum disease and painful cavities are one of the most common reasons children miss school. “Any objective look at the reality facing the American people recognizes there is a crisis in dental care in America,” Sanders told the Guardian in an exclusive interview. “Imagine that in the richest country in the world.” Nearly 69 million adults and almost 7 million children lack dental insurance. For those who have insurance, costs are often opaque and high. Multi-thousand-dollar bills are so common that the nation’s largest professional organization for dentists, the American Dental Association (ADA), signed an exclusive partnership with a medical credit card company. In 2019, more than 2 million Americans went to the emergency room for tooth pain, a 62% increase since 2014, and a crisis of affordability pushed an estimated 490,000 Americans to travel to other countries such as Mexico for lower-cost dental care.

“The issue of dental care is something we have been working on for years,” said Sanders. “It is an issue I think tens of millions of Americans are deeply concerned about, but it really hasn’t quite gotten the media attention it deserves.” Sanders said he had seen how poor dental health can affect every aspect of a person’s life – he described constituents who cover their mouths when they laugh or have been turned down for jobs because of missing teeth. Sanders said he recognized the importance of the issue by attending town halls in his home state of Vermont, “and learning how hard it is to get dental care, how expensive it is and [how] dental insurance [is] totally inadequate”. “Having bad teeth or poor teeth is a badge of poverty,” said Sanders. “It becomes a personal issue, a psychological issue, an economic issue as well.”

Sanders’ bill expands dental coverage by adding comprehensive benefits to Medicare; incentivizing states to improve dental benefits through Medicaid; and providing dental benefits to veterans through the Veterans Administration. Additionally, the bill would attempt to tackle some states’ dentist shortage by creating student loan forgiveness programs for dentists who practice in underserved areas, and increasing funding to non-traditional places to see dentists, including at community health centers and schools. Expanding dental coverage is exceedingly popular – recent polls show 92% of voters support the proposal, including an overwhelming majority of Republicans. Sanders said his proposal was good policy and “very good politics”.

Senator Bernie Sanders (I-VT) has proposed a bill called the Comprehensive Dental Reform Act that would dramatically increase coverage for dental care for Medicaid and Medicare patients.

[gwydionmisha]

Personal: For Profit Healthcare and Me

So remember how Peacehealth drove all the independent offices in four specialties out of business, thus forcing everyone to use their clinic, then closed those clinics to force everyone to go to their central clinic two counties to the south? And remember how both the Doctors who were running that clinic made a deal to operate out of a clinic a regional medical conglomerate was opening near the hospital? so instead of me spending all day on a sixty mile each way trek for my treatment I was using the last three months of skeleton crew treatment at old clinic which ended the last Thursday in September? Remember how they said we could all follow our doctors there?

Yeah, about that.

I've been dutifully calling ever two weeks to see if they were letting people schedule appointments yet. They sent out a letter saying they were open. I stayed up Tuesday to get in sorted. it was a whole drama because the automated maze to get to the scheduler was as much of a hassle as Peacehealth's and prone to dropping calls, forcing one to start from scratch each time. so that was frustrating and tine consuming.

Apparently they have no access to our health records, so it was a start from scratch situation. Me, mentally: Shit! This is going to be HOURS. Only it wasn't for all the wrong reasons. They take Medicare, but not Medicare Advantage. So if I want it covered I have to lose most of my benefits including having Medicaid pay my big Medicare copay. O.o. Or I can pay for expensive treatments myself as uninsured.

I was upset, but I remembered superstar medical social worker lady personally calling around town to talk dentists into taking medicare dental coverage for me thus opening up my small city so that medicare patients can now get root canals and crowns instead of learning to live without chewing.

So I still thought it was salvageable. Problem is she's gone and the woman replacing her is a busy supervisor who likes to call me two hours into my sleep cycle without warning and then gets angry at me for not being charming. Previous lady asked when was best to call and would schedule calls in advance for a time when I was able to be awake and functional. it is a lot easier for me to be charming when I wasn't just ripped out of REM sleep and am now being interrogated about something.

New lady is a supervisor and super busy with supervisor things and is made of no and is snippy. I can not make her understand that not only is a 120 mile round trip over mountain passes dealing with the traffic mess along the highway in the major metropolitan area where I once got caught in a four hour traffic jam and couldn't get off to pee, is an entire exhausting day for me and that plus a treatment would not only mean i could do anything useful that day, but the next day to. She can't grasp how much pain is involved in long car trips or how much treatments take out of me. She keeps hard selling me on this and then calling me resistant and recalcitrant like I'm the one being unreasonable for considering this basically insurmountable at my level of disability.

She did not fight the in town clinic for me. She did not try to argue them around.

Her, repeating a suggestion she has made over and over since the closing announcement: You should just get your GP to do it.

Me, explaining for at least the third time because we have this conversation every time we talk: I asked my GP last spring like you asked. They can't do it. It can't be administered by a GP. They'd need to hire a specialist and build new facilities for compounding and for special storage of medication.

Her: Well just ask you GP to give you a different treatment.

Me: There are no other treatments. I have medications to manage symptoms. These treatments are the cure. There is only one cure.

Her: You are being recalcitrant!

Me: There is literally only one cure. No new ones have been invented since last February. The cure is working. I'm getting better. i will get worse again with only symptom management.

But she kept arguing with me because I was being stubborn about facts being facts. My GP can't pull an entire brand new treatment regimen out of her ass. She would not let it go or let me go and I was exhausted because it was hours past when I would normally be asleep at this point and also what was the point of her hard selling me on demanding the imaginary alternative treatment or the 120 mile trip. I ended up giving and and saying something like, "I have to go now," which I know is rude, but we spent this entire conversation with her neither listing not understanding and basically acting like I was the asshole here.

So I'm fucked and I'm frustrated and angry. I was literally at the point where I was going to get better really quickly if I kept doing treatments, but if we stop now I'll be back to square one with it all to do again if another clinic opens.

And it's all like this because Obama and Biden didn't have the balls to stick to their universal free healthy care guns and decided to adopt the capitalist give away Republican health plan in pursuit of bipartisan buy in they did not get, which anyone paying attention told them they could not get, which Mitch McConnell vowed they'd never get as part of the project to make Obama a one term president at all costs. They burned all their political capital on a bullshit give away to insurance companies when they could have taken the same or less of a hit just giving up a developed country level health care system. No fucked up website needed for sign ups. No red tape or copays or catch 22 shit like I'm dealing with now.

[kp777]

By Jake Johnson

Common Dreams

Oct. 4, 2023

"Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare," says a new report from Physicians for a National Health Program.

A report published Wednesday estimates that privately run, government-funded Medicare Advantage plans are overcharging U.S. taxpayers by up to $140 billion per year, a sum that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare's prescription drug program.

Physicians for a National Health Program (PNHP), an advocacy group that supports transitioning to a single-payer health insurance system, found that Medicare Advantage (MA) overbills the federal government by at least $88 billion per year, based on 2022 spending.

That lower-end estimate accounts for common MA practices such as upcoding, whereby diagnoses are piled onto a patient's risk assessment to make them appear sicker than they actually are, resulting in a larger payment from the federal government.

But when accounting for induced utilization—"the idea that people with supplemental coverage are likely to use more health care because their insurance pays for more of their cost"—PNHP estimated that the annual overbilling total could be as high as $140 billion.

"This is unconscionable, unsustainable, and in our current healthcare system, unremarkable," says the new report. "Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare, siphoning money from vulnerable patients while delaying and denying necessary and often lifesaving treatment."

Even if the more conservative figure is accurate, PNHP noted, the excess funding that MA plans are receiving each year would be more than enough to expand traditional Medicare to cover dental, hearing, and vision. Traditional Medicare does not currently cover those benefits, which often leads patients to seek out supplemental coverage—or switch to an MA plan.

The Congressional Budget Office has estimated that adding dental, vision, and hearing to Medicare and Medicaid would cost just under $84 billion in the most costly year of the expansion.

"While there is obvious reason to fix these issues in MA and to expand traditional Medicare for the sake of all beneficiaries," the new report states, "the deep structural problems with our healthcare system will only be fixed when we achieve improved Medicare for All."

Bolstered by taxpayer subsidies, Medicare Advantage has seen explosive growth since its creation in 2003 even as it has come under fire for fraud, denying necessary care, and other abuses. Today, nearly 32 million people are enrolled in MA plans—more than half of all eligible Medicare beneficiaries.

Earlier this year, the Biden administration took steps to crack down on MA overbilling, prompting howls of protest and a furious lobbying campaign by the industry's major players, including UnitedHealth Group and Humana. Relenting to industry pressure, the Biden administration ultimately agreed to phase in its rule changes over a three-year period.

Leading MA providers have also faced backlash from lawmakers for handing their top executives massive pay packages while cutting corners on patient care and fighting reforms aimed at rooting out overbilling.

As PNHP's new report explains, MA plans are paid by the federal government as if "their enrollees have the same health needs and require the same levels of spending as their traditional Medicare counterparts," even though people who enroll in MA plans tend to be healthier—and thus have less expensive medical needs.

"There are several factors that potentially contribute to this phenomenon," PNHP's report notes. "Patients who are sicker and thus have more complicated care needs may be turned off by limited networks, the use of prior authorizations, and other care denial strategies in MA plans. By contrast, healthier patients may feel less concerned about restrictions on care and more attracted to common features of MA plans like $0 premiums and additional benefits (e.g. dental and vision coverage, gym memberships, etc.). Insurers can also use strategies such as targeted advertising to reach the patients most favorable to their profit margins."

A KFF investigation published last month found that television ads for Medicare Advantage "comprised more than 85% of all airings for the open enrollment period for 2023."

"TV ads for Medicare Advantage often showed images of a government-issued Medicare card or urged viewers to call a 'Medicare' hotline other than the official 1-800-Medicare hotline," KFF noted, a practice that has previously drawn scrutiny from the U.S. Senate and federal regulators.

PNHP's report comes days after Cigna, a major MA provider, agreed to pay $172 million to settle allegations that it submitted false patient diagnosis data to the federal government in an attempt to receive a larger payment.

Dr. Ed Weisbart, PNHP's national board secretary, toldThe Lever on Wednesday that such overpayments are "going directly into the profit lines of the Medicare Advantage companies without any additional health value."

"If seniors understood that the $165 coming out of their monthly Social Security checks was going essentially dollar for dollar into profiteering of Medicare Advantage, they would and should be angry about that," said Weisbart. "We think that we pay premiums to fund Medicare. The only reason we have to do that is because we're letting Medicare Advantage take that money from us."

[lizardbytheriver]

Good luck, Jamaal Bowman. AIPAC has poured millions of dollars into getting Bowman ousted. We should stand in solidarity with Jamaal Bowman. We should support Jamaal Bowman. If he retains his seat in the House of Representatives, that will send a powerful message that AIPAC can no longer just buy our politicians and control our political parties. Jamaal Bowman has been a supporter of a Permanent Ceasefire in Gaza. Jamaal Bowman has been vocal about supporting and humanizing Palestinian Civilians. He is an ally to Palestine. He advocates for the demilitarization of the police, for Medicare for All (including free dental, vision, hearing, reproductive, and mental health coverage), for the abolishment of ICE, for the cancellation of ALL student loan debt, and for making public colleges tuition-free. Support Jamaal Bowman. He is a great leader and a great politician. We believe in you, Jamaal Bowman.

[rainofaugustsith]

About that Medicare for All slogan

So I've been seeing 'Medicare for All' slogans again, and while I fully believe in universal health care I think they need to revise that slogan. Right now I also see a lot of people sneering because older Americans aren't glomming onto that slogan. 

They really should, IMHO, be making that slogan "EXPANDED or REFORMED Medicare for all" to get people on board. Because as it is, it can be really costly, and many seniors and disabled people are not able to afford healthcare even with it. Those thinking it's a panacea as it is, without reform? Well, let's have a peek and see.  

1. Background: Medicare is a program mostly for seniors and disabled people receiving SSDI. 

There are two basic ways to get Medicare: be over a certain age (right now 67) and receive Social Security Retirement. OR, be younger than 67, disabled and receive Social Security Disability Insurance (SSDI). Disabled people who receive only SSI are not eligible for Medicare. 

Original Medicare functions like a PPO. For those outside the States, you can go to any doctor that accepts Medicare and there are little to no prior authorizations required. This makes it easier for people to obtain quality care because they can go anywhere, more or less, and aren't trapped in a narrow provider network. 

BUT: 

2. Medicare is fucking confusing. 

There's Part A (hospital), Part B (outpatient), Part D (drug coverage), Part C (Advantage plans) and several other moving parts, each with their own fee schedules and rules. 

3. Medicare isn't free. 

Part A is free for most, but if you don't qualify for that, it can cost up to $506/month. 

Part A also has a deductible of $1600 every single inpatient hospital stay. For those outside the USA, the deductible is the amount you have to pay out of pocket before the insurance will pay anything at all. 

If someone is in the hospital for a while, they start paying copayments that begin at $400/day, starting on the 61st day. If they need to be in skilled nursing facilities for surgery/injury recovery, copayments of $200/day kick in after the 20th day.

Part B (outpatient) has a premium which, as of 2023, is $164.90 per month, as well as a once-yearly deductible of $226. 

Medicare is an 80/20 scheme, which means they cover 80% of the bill and you get the rest. That might not sound too bad until you look at what medical care in the USA costs. A simple MRI might be billed at $3000. 20% of that is yours. Still sound reasonably priced? 4. Medicare doesn't cover everything. 

Dental, optical and many other things are notoriously not covered by Medicare. That's why you will find people on Medicare buying separate coverage for these things - which means they're paying additional premiums every month. 

5. We haven't even gotten to prescriptions yet. 

So prescription coverage for Medicare is under Part D. You have to choose a prescription drug plan to administer your benefits and they are all different. Some might cost you nothing. Some might cost you a lot every month, so if you're keeping count, that's your fourth monthly premium after Part B, vision and dental. Some change their formulary every year. Those commercials about Medicare open enrollment? That's the period in the fall when people on Medicare have to sift through the formularies and see if their PDP is going to cover their meds next year. Some people do qualify for Extra Help from Medicare which covers the premiums and brings down the coinsurance for meds, but not everyone. 

Oh, and the meds are tiered. Tier 1 are the most basic/common meds that will cost you nothing or very little. Tier 4 are meds that are barely covered, perhaps 30%. 

Wait, there's more! There's a 'donut hole' or coverage cap built into plans. Essentially, when your med costs reach $4660 for the year, the coverage gap begins. Right now you pay no more than 25% of the drug costs, but it used to be a complete gap. This continues until you reach $7400 in drug costs, at which time you enter the 'catastrophic' tier where meds usually cost a lot less. And it resets annually. 

Think this is a hard cap to reach? Remember, common meds for things like cardiac conditions and headaches can cost $1000 each per month. Take a few of them and you're up to that $4460 real quick. 

This is why you may have read or heard stories about seniors taking bus trips to Canada to buy meds. It's honestly cheaper sometimes to take a trip across the border than navigate this shit. 

6. This is why a lot of people get pressed into an HMO. 

In order to navigate a lot of the above, a lot of people get pressed into optional Medicare Advantage plans, technically Part C. These are mostly HMOs run by major insurance companies. They offer the promise of consolidating benefits, eliminating the copays and drug coverage web - at the cost of pressing you back into an HMO with referrals and prior authorizations, as well as their limited network.  OR people get a 'Medigap' supplement that covers the costs that Medicare doesn't, while allowing them to remain with original (PPO style) Medicare. Those typically cost more than the Part C plans.

7. Some people do get help, but it may be hard to navigate. 

Some people have secondary insurance they can keep through a job or spouse. That might have premiums attached to it.  Some states have Medicare Savings Programs to help people pay the costs. But not all.

Some people earn little enough for SSDI or retirement that they also qualify for Medicaid as a secondary insurance. Medicaid generally picks up that which Medicare doesn't - such as that 20% coinsurance and the deductible. Medi-Medis are often pressured into joining HMOs as well, which really don't benefit them. 

Medicare also has some programs like Extra Help and such, which they can help you apply for. But this is a lot for people to navigate.  So- this is why Medicare for All might not thrill people the way you think it might. REFORMED Medicare for All on the other hand might make the same people jump right on board.

[healthinsurancediva]

Simplifying Accidental and Critical Illness Insurance in St. Augustine with Luann Allen

Introduction

Accidents and critical illnesses can occur unexpectedly, leading to financial instability. In St. Augustine, securing proper insurance coverage is crucial. Luann Allen offers personalized guidance to help you navigate this complex landscape and ensure you are adequately protected.

The High Cost of Being Unprepared

Not having the right insurance can result in:

Loss of Income: Accidents or illnesses can lead to a significant loss of income, jeopardizing your financial stability. Medical Expenses: Uncovered medical bills can quickly deplete your savings. Time Wasted: Hours spent researching insurance options often leave you confused and without adequate coverage.

A Better Way to Prepare

The Simpler Supplemental Insurance Solution

Luann Allen’s approach to insurance offers a clearer, simpler path:

Clear Guidance: Luann demystifies the complexities of insurance, providing clear and understandable advice. Time Efficiency: Her hands-on approach saves you countless hours of research. Reliable Support: As your knowledgeable ally, Luann ensures you get the proper coverage tailored to your specific needs. Schedule a Complimentary Consultation with Luann

Begin your journey to secure insurance by scheduling a consultation with Luann Allen. During this session, Luann will:

Evaluate Your Needs: Assess your current insurance status and identify any gaps. Recommend Plans: Suggest insurance plans that fit your needs and budget. Assist with Enrollment: Guide you through the enrollment process. Strategize Premiums: Help you manage your premiums effectively. Provide Year-Round Support: Offer continuous guidance throughout the year.

Secure your financial and health future with Luann’s expert assistance in St. Augustine. Don’t let uncertainty jeopardize your well-being. Let Luann simplify your accident and critical illness insurance.

[coredocuments01]

How Does The Individual Coverage HRA Works?

While health benefits have historically been one-size-fits-all, today's employees need personalisation and flexibility, which is what will win them over in a competitive job market. How, therefore, do you provide health advantages that are specifically suited to the requirements of your varied workforce, which includes employees of all ages, health FSA plan, and financial means?

By providing Individual Coverage HRA, you may provide qualified workers with a tax-free healthcare allowance that they can use each month to pay for the personalised insurance that is most advantageous to them. If you want to know how ICHRA works, read the blog.

This is a list of the procedure's four steps:

First, create your benefit.

The ICHRA benefit is first tailored to meet the requirements of the employee by the employer. The amount of tax-free money users want to effective reward each month in the form of a set allowance, the expenses you want to be covered by reimbursement, and whether or not you want to provide multiple advantages to workers in various groups are all decisions you must make when establishing your ICHRA.

Workers purchase healthcare

Employees can opt in to your benefit and use their allowance as soon as it is set up, if they so desire. Workers who want to participate in the ICHRA will use their own funds to pay for any individual health insurance they choose as well as any additional eligible medical expenditure.

Everything mentioned in IRS Publication 502 is eligible as an out-of-pocket expense, however you can restrict some of these costs based on your preferences.

Workers provide documentation of their spending.

The employee will next present proof of the expenditures they have spent and are requesting for reimbursement after making their purchases.

Examine and pay back expenditures.

After reviewing the expenditure, the employer will either accept or deny the request. Our specialists will evaluate your workers' submissions if you're any consultant to give an Individual Coverage HRA to help you be certain it's acceptable. You shall compensate your employee for any eligible expenses up to the amount of accumulated leave.

[lunod]

Why did they discontinue your drug plan? Are you still on Medicare?

Turning this into a Medicare Explanation Thing since a lot of people don't know, feel free to save this if you/someone you know is waiting on SSI/SSDI case or thinking about it. Medicare comes in 5 separate parts because why not make disabled people jump through a bunch of complex unnecessary stuff.

Part A is hospital, covering specifically hospital bills not regular outpatient appointments. Part B is medical insurance which is your primary Dr and everything outpatient. When you get on disability they will give you Part A and/or Part B. If you have both they call it Original Medicare. Original Medicare also only covers 80% of the cost of everything, you have to pay 20% out of pocket and they don't have a limit meaning there's not a point where you stop paying the 20%. Oh and Original Medicare doesn't cover vision, dental, or hearing.

Part D is prescription drug coverage. They usually do not immediately put you on this because it costs extra, but also if you fail to sign up for it and then sign up several months after getting Medicare you will be penalized with an extra cost for the rest of the time that you have Medicare (yay!). Part D is not directly through the govt, it's private insurances like United Healthcare that are contracted with the govt. If you only have Original Medicare, none of your meds are covered and you have to pay full price.

Part C is also called Medicare Advantage, it is optional where you get Part A, B, and D all bundled together but you do this through private insurers like UHC and BCBS. Some of them do not charge a premium but some of them do, which is important because you would be paying for Original Medicare and then also potentially paying another premium for Part C. There is also the downside that Medicare is accepted by a LOT of places, but if you do Medicare Advantage you have to go through drs that that insurer covers. That may/may not be an issue depending on where you live. Upside is it may cost less (because they often have limits on how much you pay before they cover 100%) or cover more things than Medicare.

Last one is Medigap which is a separate plan (that you also pay for and get penalized if you don't sign up in time) that helps pay for your deductible. The Original Medicare deductible is $200-something for 2023 meaning you have to pay that amount before Medicare even bothers covering 80%.

So for my specific circumstance, I still have Original Medicare and there's no issue with my govt disability payments either. I was auto-enrolled for Part D because I qualified for Extra Help (basically I am Extra Poor), but for some reason UHC gave me drug insurance for a state I don't live in. I called to correct it and they told me it was fine and they would just switch me to the correct state, except the contractor actually just cancelled the plan entirely without telling me that's what they were doing and also without signing me up for a new plan. Which I found out when I went to pick up from the pharmacy. If I did not qualify for Extra Help, which has Special Enrollment Periods, I would have had to go 4 months without drug insurance until Open Enrollment in October...I just lucked out so instead of waiting til Oct I only have to wait til next month.

[ms-cellanies]

Sign Bernie Sanders Petition for Medicare For All

I am posting below the email I received from Bernie Sanders.

---------------------------------------------------------------------------------

I understand that there is a lot that is going on in this world today. We’re worried about climate change, the terrible war in Ukraine, inflation and the fact that wages are not keeping up with prices. We’re worried about massive income and wealth inequality and the increased concentration of ownership that we see in our country. We’re worried about whether this country is going to remain a democracy. Among many other things.

But, despite all of that, there is an issue that is always on peoples’ minds because, by definition, it touches every single one of us. And that is health care, and the reality that today we have a dysfunctional and collapsing health care system.

While it is not discussed much in the corporate media or in the halls of Congress, we have the most inefficient, bureaucratic and expensive health care system in the world.

That’s not just what I believe. That’s what the American people know to be true because of their lived experience with that system.

I would hope that all Americans take a hard look at a poll that was published this week by the Associated Press-NORC Center for Public Affairs Research. And this is some of what the poll disclosed:

At a time when I hear some of my colleagues tell us that we have the best health care system in the world, just 12 percent of the American people believe that health care in general is handled very well or extremely well in the United States. 12 percent.

At a time when we pay the highest prices in the world for prescription drugs, only six percent of the American people believe that prescription drug costs in the United States are being handled very well or extremely well. Six percent.

At a time when COVID has exacerbated the crisis, only five percent of the American people believe that the mental health care system in the United States is being handled well or extremely well. Five percent.

And when so many older Americans have died unnecessarily in nursing homes, and when so many cannot even find nursing home beds, just six percent of Americans believe that the quality of care at nursing homes in the United States is very good or exceptional. Six percent.

The American people increasingly understand, as I do, that health care is a human right, not a privilege, and that we must end the international embarrassment of the United States being the only major country on earth that does not guarantee health care to all of its citizens.

Again, that is not just Bernie Sanders talking. That is what the overwhelming majority of the American people believe.

According to this AP poll:

66 percent of the American people believe it is the federal government’s responsibility to make sure all Americans have health insurance coverage. 66 percent.

Over 86 percent of the American people understand that it is absurd that millions of seniors lack dental care, hearing aids and vision care and they believe that Medicare should be expanded to cover these basic health care needs. 86 percent.

At a time when our long-term health care system is in shambles, 81 percent of the American people believe that Medicare should cover the outrageous cost of long-term health care for senior citizens and people with disabilities. 81 percent.

Frankly, It is hard for me to imagine how anyone could defend a system in which over 70 million people today are either uninsured or underinsured. As we speak, there are millions of people who would like to go to a doctor but cannot afford to go to a doctor because they cannot afford the outrageous cost of a doctor’s visit or a stay in a hospital.

I am tired of talking to doctors who tell me about the patients who died because they were uninsured or underinsured, and walked into the doctor’s office when it was too late. And we are talking about some 68,000 Americans who die every year because they are uninsured or under-insured. This is America. This is truly beyond comprehension.

I am tired of seeing working-class families and small businesses pay far more for health care than they can afford which forces more than 500,000 Americans to declare bankruptcy each year because of medically related expenses. Families should not be driven into financial ruin because someone became seriously ill. How insane is that?

I am tired of hearing from Americans who lost loved ones because they could not afford the unbelievably high cost of prescription drugs, or hearing from constituents who are forced to cut their pills in half due to the cost. Today, almost 1 out of 4 patients cannot afford the prescription drugs their doctors prescribe.

You want to hear about an irrational system. People get sick. They go to the doctor. They get diagnosed and medicine is prescribed. But, in America, they can’t afford to buy the medicine their doctors prescribe. So, as their health deteriorates, they end up in an emergency room or a hospital at great expense to the system, not to mention personal suffering. Sometimes they die. Does that make sense to anyone?

I am tired of talking with people who are struggling with mental illness but cannot afford the care they desperately need. Last year, a record-breaking 100,000 people died of drug overdoses and I will tell you that in my Senate office we get desperate calls from family members looking for affordable mental health counseling and, far too often, that help is not there.

It’s not there because the function of the American health care system is not to provide quality care to all. It is to maximize profits for the insurance companies and the pharmaceutical industry.

Unbelievably, despite spending far more per capita on health care than any other nation, we don’t have enough doctors. We don’t have enough nurses. We don’t have enough dentists. We don’t have enough medical providers in general. We have more than enough people who bill us, and more than enough debt collectors who hound us to pay for a bill we cannot afford. But we just don’t have enough people to provide the health care that we desperately need. And, by the way, that crisis is only going to become worse as our society continues to age.

At a time of declining life expectancy, in the wealthiest country on earth, your health and your longevity should not be dependent on the amount of money that you have. It is an absolute outrage that the number of years you live in this country is dependent upon your income. Today, the top one percent of Americans live 15 years longer than the poorest people in our society and study after study has shown that working class people live shorter lives than the wealthy.

Health care is a human right that all Americans, regardless of income, are entitled to and all Americans deserve the best health care that our country can provide.

As Chairman of the Budget Committee, it is not acceptable to me that we end up spending over twice as much per capita as virtually any other major country on health care, while our life expectancy and other health care outcomes lag behind most other countries.

Unbelievably, according to the Center for Medicare and Medicaid Services (CMS), we are now spending $12,530 per capita on health care. This is an outrageous and unsustainable sum of money.

In comparison, the United Kingdom spends just $5,387 per capita on health care while France spends $5,468, Canada spends $5,905, and Germany spends $7,382 while providing universal care to everyone.

The question that we should be asking is how does it happen that we spend so much money for health care, but get so little in return.

Let’s be clear. The current debate over health care in the United States really has nothing to do with health care. Frankly, it is hard to defend this dysfunctional system.

This debate has everything to do with the unquenchable greed of the health care industry and their desire to maintain a system which fails the average American, but which makes the industry huge profits every single year.

While ordinary Americans struggled to pay for health care during the pandemic, the six largest health insurance companies in our country made over $60 billion in profits last year, led by the UnitedHealth Group, which made $24 billion in 2021.

While millions of Americans cannot afford soaring health care costs, the top executives in the insurance industry receive huge amounts of compensation.

In 2020, the CEOs of 178 major health care companies collectively made $3.2 billion in total compensation – up 31 percent from 2019 – all in the midst of the pandemic.

According to Axios, in 2020, the CEO of Cigna, David Cordani, took home $79 million; the CEO of Centene, Michael Neidorff, made $59 million; and the CEO of UnitedHealth Group, Dave Wichmann, received $42 million in total compensation.

In terms of the pharmaceutical industry, last year Pfizer, Johnson & Johnson and AbbVie – three giant pharmaceutical companies – increased their profits by over 90 percent to $54 billion.

Meanwhile, the CEO of Moderna got a $926 million golden parachute after his company received $2.5 billion in taxpayer dollars from the Trump Administration to develop its COVID vaccine.

And, while over 330,000 Americans died during the pandemic because they could not afford to go to a doctor on time, the CEO of Regeneron Pharmaceuticals made over $450 million in total compensation last year.

The current system is failing the American people. And the American people want change, real change.

In March, I was proud to introduce Medicare for All legislation with 15 Senate co-sponsors. Companion legislation in the House now has 122 co-sponsors.

This legislation would improve and expand Medicare to cover, over a 4-year period, health care for every man, woman and child in this country.

That comprehensive health care coverage would end out-of-pocket expenses and, unlike the current system, it would provide full freedom of choice regarding health care providers.

No more insurance premiums, deductibles or co-payments. No more “networks” which deny you your choice of doctors.

And when I talk about Medicare for All being comprehensive, it would cover dental care, vision, hearing aids, prescription drugs and home and community-based care. In other words, it would do precisely what the American people want us to do.

Would a Medicare-for-all health care system be expensive? Yes. But, while providing comprehensive health care for all, it would be significantly LESS expensive than our current dysfunctional system because it would eliminate an enormous amount of the bureaucracy, profiteering, administrative costs and misplaced priorities inherent in our current for-profit system.

Remember: We currently pay twice as much for health care as do the people of virtually any other country – all of which provide universal health care. So, yes, we can provide quality of care for all at a much lower cost per person.

Under Medicare for All, there would no longer be armies of people billing us, telling us what is covered and what is not covered and hounding us to pay our hospital bills. This not only saves substantial sums of money but will make life a lot easier for the American people who would never again have to fight their way through the nightmare of insurance company bureaucracy.

In fact, the Congressional Budget Office estimated that Medicare for All would save Americans $650 billion a year.

Now, trust me. I know the 30-second ads from the insurance and drug companies have told us that if Medicare for All becomes law, your taxes will go up. But what they won’t tell you is that under Medicare for All, you will no longer be paying premiums, deductibles and co-payments to private health insurance companies and there will be no more out of pocket costs.

And what they certainly won’t tell you is that Medicare for All will save the average family thousands of dollars a year. In fact, a study by RAND found that moving to a Medicare-for-All system would save a family with an income of less than $185,000 about $3,000 a year, on average.

Now, if Medicare for All was so great, you might ask, why hasn’t it been enacted by now? Why hasn’t the United States joined every major country on earth in guaranteeing health care for all?

Well, the answer is pretty simple. Follow the money. Since 1998, in our corrupt political system, the private health care sector has spent more than $10.6 billion on lobbying and over the last 30 years it has spent more than $1.7 billion on campaign contributions to maintain the status quo. And, by the way, they are “bi-partisan.” Their contributions go to many members of both the Democratic and Republican parties.

But, you know what I believe?

Maybe, just maybe, now is the time for Congress to stand with the American people and take on the powerful special interests that dominate health care in the United States. Now is the time to improve and extend Medicare to everyone. Now is the time to make health care in the United States a human right, available to every man woman and child.

In a rigged economy and a corrupt political system our struggle is not easy. But we are gaining momentum as more and more people understand the cruelty and dysfunctionality of the American health care system.

Let’s go forward together.

Add your name if you agree:

Sign my petition if you believe it is time to create a Medicare for All, single-payer system that grants health care as a right for all, and not a privilege for the wealthy few.

Thank you for reading, and thank you for adding your name to show that our movement is united on this issue.

In solidarity,

Bernie