Had a call the other day from an acquaintance whose 30-something daughter had been experiencing severe and debilitating health issues for the past two or so years. She had lost significant weight (and she was hardly exactly 'zaftig' to begin with), and had begun seeking non-traditional, "alternative medical" treatments, to the tune of tens of thousands of dollars.
My acquaintance called because he knew I dabbled in the health insurance field, and hoped I could give his family some advice and insight on what options might be available.
Oh, there's an interesting twist, which may play an integral part: the daughter, who had never given up her US citizenship, had nonetheless spent the past few years living abroad, and had moved back here just before she became ill.
"Moves that may qualify you for a Special Open Enrollment Period [include] ... To the US from a foreign county."
Which seems a slam dunk, but then there's this caveat:
"Important: To qualify for an SEP, you must prove you had qualifying health coverage for at least one day during the 60 days before your move except moves from a foreign country)." [emphasis in original]
This is crucial because it seems to be referring to the so-called "60-day rule;" that is, you must exercise your SEP opportunity within 60 days of becoming eligible for it. I think she's missed that window, but I'm not entirely sure, and so I urged my acquaintance to call the nice folks at the Marketplace to confirm, and also to see if the daughter might be eligible for a subsidy.
We then looked at what plans and carriers were available in their area, to get an idea of costs and benefits. The less expensive Bronze level plans were, of course, very affordable even without the subsidy, but the out-of-pockets were pretty hefty. The other issue is that, at least in Ohio in 2019, all plans are built on an HMO chassis, which means basically zero out-of-network coverage, which might be an issue (or maybe not: after all, she doesn't have insurance now).
Okay, that's the insurance side, but maybe there's another line of attack open to us?
And indeed there may well be:
I then suggested that they also consider other options. For one thing, a call to the local Medicaid office might be helpful: those folks have access to information on all kinds of medical financing options.
I also asked if he was aware of Direct Primary Care. I explained that these practices worked like a gym membership, with monthly dues granting 24/7 access to a physician. They also often have big-ticket diagnostic equipment in the office, saving even more (eg: MRI's costing hundreds of dollars, not thousands), as well as discounted prices on meds. They are also very helpful in referring patients to fellow cash-only-type providers in the area for non-primary care services.
I promised to send him the link to the latest directory of DPC practices, but I also cautioned him to beware that they aren't much help with catastrophic medical issues, and that's something to consider, as well.
Looking forward to seeing how this plays out and, of course, always happy to help.
So one of my hats is CE (Continuing Education) provider. My primary role in that capacity these days is "back office support;" that is, I file courses for state approval, create and provide class rosters and completion certificates, and file completed class rosters to the states in which I'm a licensed provider. Unfortunately, I don't get much opportunity these days to actually teach, and I miss that dearly.
One of my CE clients taught a couple classes the other day (well, technically, the same class, twice, at two different locations). She had previously taught this same class last fall (at the same locations). In Ohio (and, I imagine, in most if not all other states), one cannot get credit for taking a course more than once in a cycle. Determining whether or not this applies is fairly simple; agents can check their transcripts online in a matter of seconds.
Of course, this doesn't always happen, and in today's little object lesson, 5 of the 15 students at Location 1, and 2 of the 8 at Locatoin 2, had taken this exact same course within the past 6 months.
And it gets better (for certain value of "better"): for at least 15 years, agents have been required to use their National Producer Number (not their social security or state insurance license number) to sign in and get credit for a course.
Let me repeat that: the NPN requirement is a decade and a half old.
Which of course 2 students completely ignored, causing me to then go to the state insurance department website and drill down to their personal info and obtain that information so that they could get their CE credits.
And these rocket surgeons "advise" their clients on transactions worth thousands of dollars.
And of course "accidental death" nature of the plans was a nice touch: these policies are generally a fraction of the cost of a regular term or whole life plan. And if the goal is to collect in a couple years anyway, who needs long term premium guarantees?
Be a darned shame if anything untoward happened to him in prison.
Today is especially relevant for my late sister's friends and family:
July 17, 2019 is Glioblastoma Awareness Day. We hope today will bring added awareness, building on the efforts of the GBM advocacy community and organizations like @NBTStweets who have dedicated so much time and energy to fighting this disease and supporting those affected by it.
Medicare questions you never asked (because there are things no one ever told you about). Don't you hate it when you buy something and then find out it didn't work as promised? Some things can be returned for a refund.
Others cannot . . .
Your Medicare plan is one of those things. Easy to get into at age 65. But you could run into a roadblock if you later have buyers remorse.
Medicare Things You Don't Know But Wish You Did - GA Medicare - YouTube
Gary is a friend and is learning about Medicare the hard way. Gary is just now learning prior authorization.
Before he can have a test ordered by his doctor, the carrier must APPROVE the test. It’s all about the money.
His oncologist wants him to have proton therapy but his plan will only pay for a less expensive protocol. Dollars drive many medical decisions when an insurance carrier controls your benefits.
Proton Therapy – It Helps Only a Few at a Wildly Extravagant Cost – MedPage Today
All he wants to do is get well but his Advantage plan is running interference. His carrier is interested in saving money. THEIR money. Not his.
It’s all about the dollars. Just another Medicare thing he did not know.
Medicare Advantage plans good or bad? Like everything else, it depends on your perspective. But how will you know if an Advantage is right for you if you don't know the right questions to ask?
Too many people don't UNDERSTAND MAPD plans. No premium to pay. Dental and vision coverage included. What's not to love?
How about access to health care?
What is Wrong With Advantage Plans? - GA Medicare Expert - YouTube
Some folks have medical conditions that require specialized care and there may only be a handful of Medicare Advantage providers in your area that offer that kind of treatment. There are patients who have a level of trust with their provider that cannot bridge saving $$$ to follow the path allowed by the HMO.
The choice of plans is not JUST dollars and cents. Too many agents either ignore this aspect or don't understand it. How Medicare Advantage plans are sold, what you are told and what is omitted, can make Advantage plans bad for you.
Learn more about Medicare Advantage plans - https://www.georgia-medicareplans.com/are-medicare-advantage-bad/
The resurgence to repeal the Cadillac Tax is front and center - again. This time it is due to the overwhelming support in the House of Representatives which allows for a bill to move to the floor when there is a supermajority of co-sponsors.
In this installment of Congressional drama the supermajority will use the opposite angle saying that they can't kill the tax without offsetting revenues. They will again claim to be good stewards of our tax dollars and voice how much they dislike the tax.
But when the dust has settled the Cadillac Tax will live. Probably to never see the light of day except on those occasions where playing politics allows it to briefly see the light of day.
Now, the taxes on this difference are, obviously, a lot less than the debt itself, so this isn't a slam on the idea. But if the recipients are unaware of the largess, or of this tax rule, they may be in for a nasty surprise at year's end.
At my recent annual physical, i was prescribed, at the tender age of 39(shut up), my first-ever maintenance med: 10 mg daily of Lisinopril for moderately high blood pressure.
[ed: this came as somewhat of a shock, inasmuch as I'd heretofore been considered a carrier]
It's become fashionable of late to dump on Pharmacy Benefit Managers (PBM's) and specifically Aetna and CVS. Well, I'm insured under an (HSA-compliant) Aetna plan, and I had the scrip filled at my local CVS for the princely sum of .... wait for it ... $2.21 for a monthly supply.
I think we can swing that (at least for the nonce). #ForWhatItsWorth
Short take: North Carolina Health Plan honchos have proposed a new reimbursement scheme for Tar Heel State hospital systems that include some pretty draconian caps, and one provider's manager followed orders (maybe a bit too zealously).