The first of these Medicare Advantage plans is the Chronic Condition SPN (Chronic Condition Special Needs Plan, abbreviated C-SPN and pronounced C-snip for short). You may have one or more severe or disabling chronic conditions to include cancer, chronic heart failure, dementia, diabetes mellitus, end-state liver disease, neurologic disorders or end stage kidney disease that requires dialysis.

The second SNP is called the Institutional SNP (shortened to I-SNP) where you reside in an institution like a nursing home or require nursing care at home.

The third SNP is the plans for people that are dual-eligible for both Medicare and Medicaid. and commonly called D-SNP plans.

These Medicare SNPs are approved by Medicare and run by private companies. You will see the providers who belong to the plan or use in- network hospitals to get covered services. These plans offer specifically tailored services for a particular medical condition plus other services like emergency care or care at an urgent care facility.

Please give us a call at (845) 723-5055 if you have any questions about these plans.

October 15, 2023 to December 7, 2023: You can change your Medicare health or drug coverage for 2024 if you wish to. This period is called Medicare’s annual open enrollment. If you switch to a new plan, always make sure that your current doctors, hospitals and drugs are covered in your new plan. You can join, switch or drop a Medicare Advantage plan or drug plan.

January 1, 2024: This is the effective date of plan coverage if you switched to a new Medicare plan. It is also the starting date of your current plan’s changes for 2024.

January 1 to March 31, 2024: If you are in a Medicare Advantage plan, you can change to a new Medicare Advantage plan or return to Original Medicare coverage (Parts A and B) and join a separate Medicare drug plan. The new effective date of coverage will begin on the first day of the month after the plan gets requested. This period is called the General Enrollment Period. You can also use this period of time if you missed your initial enrollment period at age 65 or do not qualify for a Special Enrollment Period.

Please call (845) 723-5055 if you have any questions about this information.

The big premium increase will be felt by single woman applying for long term care insurance with middle aged men generally enjoying a decline in premium for the first time.  The reason for this premium change is to recognize the big difference in claims submitted by men and women. Women account for two-thirds of the $6.6 billion in claims paid by insurers in 2013.   Women have longer life expectancy than men.

Carriers have not obtained state insurance approval for this new premium structure in all fifty states.  For example, John Hancock is still using old unisex (blended) premiums for both men and women in New York today.  They have awaiting approval from the NYS Department of Financial Services for approval to offer the new male/female premiums.

The best age bracket for long term care planning is between age 50-59 or even younger if you are a business owner. Call Bob Quinlan at (845) 534-4360 or him at BobQ@QuinlanCare.com if you have any questions or would like start a discussion on long term care planning.

These ten benefits are:

1.  Outpatient Care – most health insurance plans have covered this type of care.  This type of care typically starts with a visit to doctor’s office, a clinic or same – day surgical center. Home care and hospice care services are also covered.

2.  Emergency Room Services – also covered by many health plans in the past.  Some plans have charged higher out of pocket expenses if the hospital has been out of the patient’s network.

3. Hospitalization – major expenses for inpatient (overnight) care can occur during a stay in a hospital.

4. Preventive, wellness visits and chronic disease treatment – includes screening for blood pressure, cholesterol and colorectal cancer.  Well woman visits are also included.  Preventive care visits have no co-payments.

5. Maternity and Newborn Care – care before and after your baby is born.  If a woman gave birth to a premature baby who required care in an intensive care unit for three months, medical costs can easily exceed $1 million in a large city hospital.

6. Mental and Behavorial Health Treatment – includes treatment for mental health condition  as well as drug and alcohol problems.  There are co-payments and the number of therapy visits may be limited.

7. Prescription Drugs – Medications will be covered for an illness or treatment like high blood pressure. There will be coverage for at least one prescription drug for each category of federally approved drugs.

8. Laboratory Services – The law requires that 100% of preventive tests like breast cancer screening must be covered at no cost.

9. Pediatric Care — dental and vision care services plus well-child care, vaccines and immunizations must be included in plan coverage for children under age 19 for the first time.

10. Rehabilitative Services and Devices — these services will help you gain or recover mental or physical lost due to an accident or chronic condition. Health plans will provide 30 visits for either physical or occupational therapy or chiropractor visits.

Other ACA Information

Several million Americans got letters from their health insurance companies in the fall, 2013 that their health insurance plans would end on December 31, 2013.   These letters were sent out because their health insurance plans did not contain one or more plan services that are now required under ACA.

Most uninsured Americans must enroll in health insurance to avoid paying a penalty to the IRS. ACA offers four health insurance plans if you do not have health insurance through your employer. These plans are commonly called the four “metal” plans – bronze, silver, gold and the platinum plan plus a catastrophic plan for people under age 30.  These plans are based on a percent of how much each plan will cover of medical expenses:

…Bronze, expected to cover 60% of your medical expenses

…Silver, expected to pay 70% of your medical expenses

…Gold, expected to pay 80% of your medical expenses

…Platinum, expected to pay 90% of your medical expenses

All four plans will contain the same ten Essential Health Benefits as noted above.   They will differ on the amount of out of pocket expenses.  Bronze plans have the lowest premium and the highest out of pocket expenses and Platinum plans having the highest premium and lowest out of pocket expenses.

Individual insurance companies are not required to offer all four plans and will have different premiums for the same metal plans.  States may also require that carriers offer plan benefits beyond the above ten Essential Health Benefits.   Some insurance companies will only offer in network plans (using their contracted doctors and hospitals) and others will have both in network and out of network plans.  Check to see if your preferred doctor(s) and local hospital are available to you.  Preexisting conditions can no longer be used to deny health insurance coverage.

The success of the new health insurance program will depend on key factors in 2014 and 2015.   How does the American public view the law over the next 1-2 years? How many people will enroll in these plans?  How many young people (ages 21 to 35, mostly healthy) will enroll? Will there be continuing improvements in the performance and effectiveness of the federal government’s web site (healthcare.gov) to interface accurately with the public, insurance companies and multi-government agencies?  Will there be changes in the ACA law in the next two years?  Future blogs will cover more information about the ACA plans.

Medicare has two options for eligible consumers. One option is to select Medicare Part A (hospital insurance and premium free) and Part B (medical insurance) to see your doctor(s) and for services like home care. The premium for Part B is based on your income from two years ago. Medicare Part D is used when you purchase prescription drugs; its premium is also based on your income. You can go to any doctor or hospital in the US that accepts payment under Medicare Parts A and B.

To cover the out of pocket expenses (deductibles and co-payments) under Medicare Parts A and B, you may also want to purchase a Medicare supplement insurance policy.   These plans (also known as Medigap plans) are offered by private insurance companies.  You must also enroll in Medicare Parts A and B.

The second option is to select one of the Medicare Advantage Plans under Part C.  These are managed health insurance plans like a Health Maintenance Organization/HMO plans or Preferred Provider Organization/PPO plan.  The Medicare Advantage plans are also sold by private insurance companies that offer the same basic services that are found in Medicare Part A and B.  Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage plans.  Insurance companies are offering these plans today with low or no monthly premiums.

These plans are governed by the Medicare rules.  If you enroll in one of these Part C plans, you must be also enrolled in Medicare Parts A and B.  These plans may also offer additional benefits not found in Medicare Parts A and B like drug coverage, gym membership in some states, dental and vision plan services.  Check to see if your provider (your doctor and hospital) is participating in these network plans.  And there will be out of pocket expenses like co-insurances when you need medical care.  You cannot purchase a Medicare Supplement plan if you are enrolled in a Medicare Advantage plan.

Call us or email us at Quinlan Care if we can help you choose the best Medicare plan(s).

Employees can contribute up to $2,500 a year into the Flexible Spending Account to pay for ‘out of pocket’ expenses including qualified medical, dental and vision expenses not reimbursed by your health insurance plan. The FSA must be first set by the employer. Only employee contributions are permitted; no employer dollars are allowed.

Check with your tax advisor for more details and any application for you.