Ever get confused by different terms used by Medicare or your Medicare Advantage Plan. Here are a few of the more common ones that you need to be familiar with. Test yourself and see how many you get right.
Accepts Assignment: An agreement that your health care provider will accept the Medicare-approved amount for services as full payment limiting your share of the cost to your coinsurance and deductible.
Benefit Period: A benefit period begins the day you are admitted as an inpatient to a hospital or skilled nursing facility and ends when you haven’t received any inpatient hospital care (or skilled care) for 60 days in a row. You may be in the hospital more than once during a benefit period. There’s no limit on the number of benefit periods Medicare will cover. Part A charges a deductible for each benefit period.
Coinsurance: The percent of the cost of a service which you pay. For example, Medicare pays 80% and you would pay 20% as coinsurance.
Deductible: A fixed amount that you pay for your medical care first, before insurance or Medicare starts to pay.
Lifetime Reserve Days: For Medicare Part A, there are a set number of hospital days you can draw on if your stay lasts longer than 90 days in a benefit period. You have 60 lifetime reserve days. A lifetime reserve day cannot be replaced.
Medicare-approved amount: In Original Medicare, this is the amount health care providers who accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. Providers who accept Medicare but not assignment can charge up to 15% above this amount.
Out of pocket limit: A limit that Medicare Advantage plans set on what you will have to personally spend in a plan year. For Medicare Part D plans, this is the maximum amount of money you will have to spend out of your own pocket before catastrophic coverage kicks in for the year.
If you have more questions, please join me for my class, Getting Started with Medicare. It will help you gain a basic understanding of Medicare, Medicare Advantage Plans and many other terms you’ll need to know. For a list of all my upcoming classes, visit my website at www.mutskoinsurance.com/seminars. (Pre-registration is required. These events are only for educational purposes and no plan specific benefits or details will be discussed.)
Many issues surrounding same-sex spouses and health care have already been addressed. HealthCare.gov, the official website for the Affordable Care Act, already states, “For coverage starting in 2015, an insurance company that offers health coverage to opposite-sex spouses must do the same for same-sex spouses.”
This means that as long as a couple is legally married an insurance company is not permitted to discriminate against them when offering coverage. The company must offer to same-sex spouses the same coverage it offers to opposite-sex spouses.
The Affordable Care Marketplace treats married same-sex couples the same as married opposite-sex couples when they apply for premium tax credits and lower out-of-pocket costs on private insurance plans. This is true in all states.
Legal questions remain about whether employers who provide health insurance benefits for spouses will be required to provide the same benefit to same sex couples. While the issue is not yet settled it is likely that many employers who offer health coverage to an employee’s spouse will simply offer that coverage to all spouses in the future. It simplifies administration of the plans and also avoids any discrimination issues that could result if the employer limited coverage to opposite-sex spouses.
The Supreme Court’s ruling also means that same-sex married couples have the same rights under Medicare as other married couple. If a spouse has not earned 40 credits to qualify for premium-free Medicare Part A they now can qualify for it based on the work record of their spouse, if he or she has achieved the required credits and is age 62 or older.
Same-sex spouses will now be treated as family, so that if one spouse requires hospitalization, the other will have access to medical information regarding the hospitalized spouse’s condition, as well as to visitation rights — without having to worry about whether the specific state recognizes their marriage.
If you have any questions concerning your health or life insurance coverage, please let me know. As an independent agent, I represent many of the nation’s most respected insurance companies and will help you find the right insurance plan for you Contact me at 440-255-5700 or email me and we’ll set up a time to talk.