Are You Covered? Open Enrollment is Here

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Medical bills and doctor visits can be expensive, but getting covered by health insurance can protect you and your family from the high unexpected costs of treating illnesses, accidents and other unforeseen health problems.

The Health Insurance Marketplace Open Enrollment period to receive coverage or make changes to your existing coverage, is getting close. This year it runs from November 1, 2019, to December 15, 2019.  Concurrently, Medicare Open Enrollment began October 15, 2019, and continues till December 7, 2019. Many employer health plans host an open enrollment period during the same period. 

So what does this mean? That it’s time to think about health insurance and reassess your family’s needs.  

Where can you find assistance?

Each state operates a little differently, therefore it is suggested that you connect with a Navigator or Assistor in that state.  A Navigator or Assistor is someone that specializes in the health field who can help you enroll in a health insurance plan or answer any questions you may have.  Medicare also provides resources if you have questions during the process.  If you have an employer-based plan, contact your Human Resources office for assistance.  

How much will it cost?

The cost of health insurance depends on your income.  Individuals that meet income guidelines can receive tax credits toward health insurance plans on the Marketplace.  A tax credit is money that you receive from the government to assist with paying your health insurance premiums. Premiums are the monthly payments you make to the health insurance company.  

My colleagues at the University of Maryland Extension have several great resources to assist in making health insurance decisions.  Click on any of the following topics for more information.

Choosing Health Insurance Workbook

How to Choose a Doctor

Making a Good Guess on Health Costs

Types of Health Insurance

For a complete list, click here.

Remember that we all need health insurance.  Use it to stay healthy. Routine checkups are an important element in staying healthy and preventing more serious health issues.  In the long run, health insurance will save you money.

 

Health Insurance – Are you ready for next year?

Right around the corner is open enrollment for health insurance with marketplace plans ‒ those offered by the government. It may seem early to think about health insurance if you are enrolled in the marketplace, but that is not the case. If you have one of these plans, the open enrollment period runs from November 1 to December 15, 2019, and right now is exactly the time of year when you need to think about whether your current plan is working for you.

Here are some questions to consider:

  • Are the doctors/providers you visit considered in-network?
  • Are you expecting any changes in your health that may lead to considering a different plan?
  • When adding your premium and out-of-pocket costs are you in the most affordable plan?
  • If you are using a flexible spending account or health savings account are you setting aside the right amount of money?
  • Are your prescription drugs covered by your current plan?
  • Is the type of plan you are enrolled in meeting your needs?  For example, you may be enrolled in an HMO and want more flexibility in your plan.

These are just some questions to consider. Most likely you have a gut feeling if your plan is working for you, but you should compare plans to ensure you have the best option for your financial situation.

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You may have an employer sponsored plan or selected private insurance. While your enrollment period may be different, your considerations about health insurance and whether your current plan is working for you remains the same. Employers typically send out notices to employees, and private plans will notify you in writing or electronically when open enrollment begins so that you may make changes or adjustments.

Keep in mind that health insurance is a year round process.  Once you select insurance, you need to use it.  Why not? You are paying for it. Throughout the year keep track of your records and how you use your insurance. Keeping records helps your track your medical conditions, prepares you to discuss issues with insurance companies, and plan for your future insurance needs.

The Health Insurance Literacy Initiative (HILI) team from University of Maryland and University of Delaware Cooperative Extension have resources to help you make informed decisions about health insurance.  The My Smart Choice Workbook can guide you through the process of comparing plans.  There are also a number of useful resources available on our consumer website.  There you can find information like considerations for selecting a doctor, estimating health care costs, and important words to know. You can also find valuable information on the Healthcare.gov website.

Don’t Let A Flood Wash Away Your Savings

As summer starts, it brings the threat of floods, hurricanes, tornadoes, wild fires, and other natural disasters that can threaten your life, property, and livelihood. We’ve previously talked about protecting your finances with health and auto insurance, so today, let’s talk about covering your losses from property damage with property insurance.

Types of property insurance:

  • Homeowners Insurance: required by lenders if you own a home with a mortgage. A standard policy will protect the structure of your home from things like fires and fallen trees. Policies usually include personal property coverage. If the things in your home are damaged or stolen, your policy will cover your loss.
  • Flood Insurance: protects against floods, since standard policies usually do not cover flooding or seepage. It is required by lenders if your home is located in a flood plain. Once purchased, flood insurance has a 30-day wait before it goes into effect.
  • Renters Insurance: not required, but if you rent your home, it’s recommended for covering personal property losses due to damage or theft.
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With increasing rain and extreme weather events, Maryland residents are at a greater risk of property damage from floods and other natural disasters. Insurance provides essential protection for you and your family.

What to look for in your homeowner’s or rental policy:

  • The deductible is the amount you are responsible for paying before the insurance will pay the rest. Make sure it’s affordable, but remember, the policy cost will go up if you request a lower deductible. The deductible can either be a percentage of the value or a fixed amount.
  • Property values often increase over time, especially if you’ve made improvements on your home. Make sure your home value is accurately reflected in your policy, or you might not have adequate coverage. The same suggestion applies to personal property. Don’t try to save money on your rental policy by under-valuing your property, or your losses might not be sufficiently covered.
  • Policies can provide different type of coverage: replacement value or replacement cost. Replacement value coverage is often lower than replacement cost because it takes into account declining value due to age and use.
  • What sources of damage are covered? For example, water damage from a pipe leak is usually covered, but not water damage from flooding or seepage.

What might NOT be covered by your homeowner’s insurance policy?
Insurance has its limits! Read your policy carefully so you know which hazards may leave you unprotected. Common exclusions include:

  • Flooding and earthquake damage
  • Water seepage from outside your home
  • Injuries from certain high-risk dogs. Check with your company regarding breed.
  • Termite damage
  • Acts of violence or war
  • Damage caused by the homeowner negligence.

What other actions should you take to protect yourself?

  • Review your coverage annually to make sure your insurance policy meets your financial needs. The Maryland Insurance Administration has a helpful guide.
  • Keep an itemized list of the things you own. Take pictures or a short video of all of the rooms in your home. Record valuable possessions, and when possible, include descriptive information such as model and serial number.
  • Keep records in a safe, fireproof location so they won’t be damaged along with your property.

Does It Pay To Have Life Insurance?

Life Insurance is a topic that people like to avoid. No one wants to think about what will happen when they die, but to the best of my knowledge, it will happen to all of us at some point. So let’s take a step in understanding the value of life insurance and how it can protect your family.

When someone who contributes to your family income passes away, it greatly affects the ability to maintain your current lifestyle. In my family, both my wife and I work. If one of us should pass away, the family would need the life insurance to cover the lost income without making significant changes to our lifestyle.

In its most basic form, you have term life and whole life.

  • Term life insurance covers a specific period of time. For example, you buy a term life insurance policy for 20 years with a value of $125,000. If something should happen to you within those 20 years, your beneficiary (whomever you select to receive the money) will receive $125,000. If something happens to you after the term expires, say year 21, your beneficiary will get nothing from the insurance policy.
  • Whole life insurance policy will provide a payout when you die regardless of the term.
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It’s not easy to think about death, but if anyone relies on you financially, life insurance is an important risk management tool that will protect your family. Life insurance should also be purchased to cover anyone in the family that serves as a primary caretaker for your children. While that person may not bring in an income, he or she provides services to the family that would otherwise need to be paid for.

It seems like whole life is the better option, but is that true?

To answer that question, let’s discuss cost. Term life insurance costs much less than a whole life insurance policy. According to NerdWallet in 2017 the average price of a 30-year term policy with a $250,000 value is $240 per year. The average price of a $250,000 whole life police is $2,385 per year. That is a difference of $2,145, which is where it gets tricky. What will you do with that $2,145? If you invest that money with an 8% return, you will have about $270,000 at the end of 30 years. If you live an additional 10 years, you will have over $600,000 (that’s the magic of compound interest).

If you can discipline yourself to save the difference, you are probably better off with a term life policy, which would allow your family to draw enough income from the interest to replace your salary or at least cover their expenses.

Along with deciding whether you need whole life or term, you also need to consider how much coverage to get. To do so, ask yourself:

  • What will your life be like in 20 or 30 years?
  • Will you be married?
  • Have children?
  • Do you intend to replace lost income for your family or leave a financial gift to someone?
  • If you aim to replace lost income, how much is needed for those you leave behind?
  • What debts will your family need to pay?

On a final note, consider life insurance when you are younger. Life insurance is cheaper when you are young and healthy. Waiting until you are over 40 will result in significantly higher monthly payments.

Do You Know What Your Health Insurance Covers?

One the most frequently asked questions we get at our Smart Choice / Smart Use Health Insurance™ trainings is, “How do I know which insurance plan to choose?” You may have wondered this exact question during open enrollment last fall. You may be asking it right now if you’re starting a new job or experiencing other life changes, like adding a spouse or child on to your plan or turning 26. To answer this question you need to know what the insurance plan covers.

Before the Affordable Care Act, comparing plans was more difficult. You had to review the Evidence of Coverage and Benefits, which is a document provided by the insurer that details what the plan does or does not cover, and which services may be limited. Now, you can just compare the ten Essential Health Benefits that all Marketplace plans, and most non-Marketplace plans, incorporate. These benefits ensure that you receive a minimum of services on health insurance plans.

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Was your flu shot free this year? If not, you may want to review and compare plans during Open Enrollment. Most plans offer the flu shot for free. (Photo by Hyttalo Souza)

Once you select a plan, it is important you know which Essential Health Benefits you are paying for and how to use them. Maximizing on your benefits keeps you healthy, prevents illness, and saves you money.

What services do Essential Health Benefits cover?

Preventive and Wellness Services: Health care that includes screenings, check-ups, and patient counseling to help prevent illness or other health problems.

Prescription Drugs: A list of prescription drugs that are fully or partially paid by your health plan.

Laboratory Services: Testing needed for diagnoses, preventative screenings, and monitoring.

Pregnancy, Maternity, and Newborn Care: Covers outpatient and inpatient services for pregnancy, maternity, and newborn care.

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Preventative care for infants can require several well-child visits in the first few years of life, which include vaccinations and possible screenings. If you know that you’ll be having a baby, make sure to compare co-payments or co-insurance for different plans. While all marketplace plans cover these costs as preventative care, some employer-offered plans may not. (Photo by Kelly Sikkema)

Pediatric Services: Preventive services for children, including annual visits until the child turns 21.

Mental Health and Substance Use Disorder Services: Health care to manage mood, feelings, behaviors, and substance abuse.

Ambulatory Services: When you receive care in a hospital or other health care facility and leave the same day. Also called outpatient services.

Emergency Services: Any health care service that checks or treats an emergency medical condition.

Hospitalization: When you receive care in a hospital or other health care facility and stay overnight. Also called inpatient services.

Rehabilitative and Habilitative Services: Services that help you keep, recover, learn or improve skills and activities for daily living that have been lost or limited due to illness, injury, or disability.

Some of these services are free, such as annual check-ups, while others may include costs that count towards your deductible, or have co-payments or co-insurance. These services can serve as the foundation for comparing health plans. If you are not purchasing from the Marketplace, make sure your plan includes these benefits. When selecting a plan, remember to compare the co-payment or co-insurance for these services.

If you want to learn more, join us in-person or online for one of our Smart Choice or Smart Use Health Insurance seminars. You can contact me at jketterm@umd.edu for more details.

Open Enrollment: Will Your Adult Child Be Moving?

How well does your health insurance plan travel? We recently had to investigate this question for ourselves when our oldest child (who gave me permission to include her story in this post) decided to go to graduate school more than 900 miles away. Since she was invited to teach, the university covered her tuition and provided a stipend for living expenses, but health insurance was her own responsibility.

If your adult child is currently considering a big move (of any sort) within the next year, you and your child may benefit from researching health plans now, during open enrollment. Many health insurance plans allow changes or updates due to a move, but some may not. So if you and your child do the research now, you can make the smartest choice for his or her health and, possibly, your financial needs.

Here are some of the options we looked into:

Stay on the family plan: Although your adult child can maintain coverage under your employer-sponsored or privately purchased insurance plan until the age of 26, most plans make a contract with specific caregivers for services. These in-network providers are usually only found in or near your home area. Your insurance plan might pay less—or not at all—for care received from an out-of-network provider. However, many plans have provisions for those who move. To learn more about networks and costs, check on your provider’s website, or in your plan’s Evidence of Coverage booklet. You can also call their customer service number found on your insurance card.

Purchase a student health plan: If your child is going to attend college or graduate school, check to see if the university provides access to a health insurance plan.  Many schools require and offer access to health insurance plans designed to meet the needs of students. Terms and requirements vary, as do family constraints. You can learn more from the college to determine if staying on the family plan or getting a student plan will be more advantageous.

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One consideration that may factor into your research is whether the student plan applies during travel, such as trips home during breaks.

Obtain individual coverage through the health insurance marketplace: A marketplace navigator can help you find an insurance plan in the new state. Financial help might be available from the government. Medicaid may also be an option for those with income limitations.

Medical care can be costly! Making the right health insurance choices can protect both your family’s health and finances. When shopping for the best insurance plan, or deciding to stay on a parent’s plan, it is important to check the services provided and compare costs. The plan with the lowest deductibles might not be the smartest choice if there are large out-of-pocket costs for care. University of Maryland Extension’s Insuring Your Health webpage offers many tested resources that can help guide this process.

 

Editor’s Note: You can learn more about each of the underlined terms by checking out our SmartChoice and SmartUse Health Insurance glossary

Tis The Season… For Health Insurance

Now that Halloween is over, you may have started preparing for the upcoming holidays—but you should also be thinking about health insurance.  November 1 to December 15 is open enrollment for the Health Insurance Marketplace, which is where you can get health insurance if you can’t otherwise get it through your job, Medicare, Medicaid, or the Children’s Health Insurance Program.

Do you really need health insurance?
When money is tight, it’s easy to overlook the importance of health insurance. But without insurance, you are less likely to get medical care when needed. What you think is a minor ailment could end up lasting longer than necessary, or even result in a major medical condition going undiagnosed. All of which can lead to lost time from work, less money in your pocket, and possibly even a shorter life span. Having and using health insurance helps you stay healthy by preventing illness, and identifying and managing chronic conditions. Health insurance also reduces your health care expenses.

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Health insurance not only pays for doctors visits, but also medical equipment, like blood glucose meters. Every plan differs in coverage, so when choosing a plan, you want to make sure to select one that meets your needs.

You may still be worrying about the cost, but don’t let that stop you from getting a plan. When you apply in Maryland, you may qualify for financial assistance! Maryland Health Connection reports that last year, 90% of people who enrolled in insurance received financial assistance. So why not give it a try? The risk of not having insurance is far worse.

Here’s how you can get insurance now!
Between now and December 15 make sure that you get health insurance.  If you live in Maryland, visit the Maryland Health Connection, click on the “How to Enroll” tab, and sign up for a plan.

If you need help, assistance is always available by clicking the “Find Help” tab.  Local navigators are also available to meet with you in-person, or you can call 1-855-642-8572.

If you live outside of Maryland visit www.healthcare.gov. You can also find local assistance by clicking the “Find Local Help” button.

Use our guides to help make your decision.
We have also developed some consumer resources to help you through this process. I highly recommend that you look at the following resources:

  • Marketplace Health Insurance Financial Help information sheet, which provides some background information on availability of financial assistance.
  • My Smart Choice Workbook helps you choose the best insurance policy for you and your family. We provide two versions, both with the same content. Version 1 is a downloadable file for you to manually enter information. Version 2 works as an online form that will automatically calculate totals once you enter in your numbers.

Know All Your Care Options Before You Get Sick

We’ve all had those moments when we realize we are very ill and need to see a doctor immediately. In the medical world, this is sometimes referred to as an “acute care visit”, which means that you need care for something that has come up suddenly, rather than a chronic issue, like diabetes. With cold and flu season upon us, it’s important to be prepared for those moments when you realize that you need a doctor—STAT! And since options for medical care have expanded to provide flexibility for our busy lives, you may not be familiar with all the available options.

Did you know you can access care online or on the phone? Many insurance companies offer a way for people to get in immediate contact with a doctor. Check your insurance card for a 24-hour nurse/help line, a website, or a similar option. The idea is that you can get in touch with a medical professional right away, rather than having to leave work or drive to an office. This service can be a great option when you aren’t sure about what’s going on and what to do next.

Another option is to access a clinic that is located in a local pharmacy (sometimes called retail clinics). You may be familiar with CVS Minute Clinics, Healthcare Clinics at Walgreens, and other similar places. These stores offer walk-in appointments where you can talk with a medical professional either in-person or online. They can diagnose acute issues and, if necessary, prescribe medication to treat it. They can also provide physicals, vaccinations, and other services.

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Retail clinics at local pharmacies are a big improvement from the old blood pressure machines.

Yet, another option is an Urgent Care Clinic, which look and feel more like traditional doctors’ offices. These offices provide walk-in appointments with medical professionals who can assess and treat more types of medical concerns than retail clinics. They also work closely with hospitals, so if a situation becomes an emergency, they can get people to an emergency room quickly.

Finally, you should check if your primary care physician offers acute care hours. Some doctors set aside time where they will only see people who have had something come up suddenly. Acute care hours allow you to go to the same office as you would for regular check-ups, and you might even be able to see your primary care doctor.

For any of these options, it is important to check out your health insurance policy before making any appointments to make sure that your plan covers the service. You should also check what you will need to pay for co-pay. And as always, for severe situations you should go directly to the emergency room!