Author Archives: Laura Mutsko

Do Marketplace insurance plans cover mental health and substance abuse services?

Yes.  All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.

Health insurance plans available in the Marketplace must cover 10 categories of essential health benefits. One of these categories is mental health and substance abuse services, also known as substance use disorder.

These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.  There is a full list of what each plan covers in the Health Insurance Marketplace.

Mental and behavioral health and pre-existing conditions
Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions.
Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage is in effect. There’s no waiting period for coverage of these services.

There are also no lifetime or yearly dollar limits for mental health services. Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits which includes benefits for mental health and substance use disorder services.
Parity protections for mental health services

Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.
This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:

· Financial, like deductibles, co-payments, coinsurance, and out-of-pocket limits
· Treatment, like limits to the number of days or visits covered
· Care management, like being required to get authorization of treatment before getting it

(taken from HealthCare.gov)

 

Allergy Strategies before Medicine

How to keep your spring allergies in check.

Suffering from springtime allergies?  Your first impulse may be to reach for allergy medicines. Instead, think about taking some practical steps to help reduce the pollen, dust mites and other allergens inside your home. 

1.  Windows: Wash curtain and wipe down blinds. Keep windows closed to keep pollen outside.

2.  Bedding: Wash pillowcases, sheets and blankets regularly – at least once a week or more. Cover your pillows, mattress and box springs with covers that are dust-mite-proof.  

3.  Stuffed Animals:  If you cannot wash your kids’ stuffed animals, run them through an air fluff cycle in the dryer. Store stuffed animals in a plastic bin to keep dust to a minimum.

4.  Clothing:  Leave your shoes at the door, change your clothes and take a quick shower after being outside to reduce pollen inside your home.

5.  Flooring:  Replace carpeting with hardwood floors, tile and linoleum.  All of these harbor  fewer allergens than carpeting and rugs. If you cannot replace your carpeting, wash your rugs regularly and deep clean your carpeting.

6.  Smoking:  Allergies are simply one more reason to ask smokers not to light up inside your home.



Search for Unclaimed Funds

The Department of Commerce has released a new list of unclaimed funds accounts.  You may have hundreds, even thousands of dollars waiting for you to claim.

Unclaimed funds are accounts that have gone dormant. They may be a forgotten insurance policy, an uncashed check or a forgotten rent, phone or electricity deposit.  More than 53,000 claims were paid out in 2013, with each one averaging $1292.

An updated list of unclaimed funds accounts is available on the Department of Commerce’s Online Treasure Hunt at http://www.com.ohio.gov/unfd/.  The website also has forms for individuals and organizations to use in claiming their money.

Anyone with questions about unclaimed funds can call the Division toll free at 1-877-644-6823 (OHIO UCF).

Getting the best buy on prescription drugs

Don’t automatically use your insurance for prescription drugs.  

Hundreds of commonly used generic medications can be purchased for as little as $10 for a three-month supply at grocery stores, major drugstores and club stores like Costco and Sam’s Club. You may find some drugs usually covered by your insurance might be less expensive if you pay cash instead using your insurance.

 

 

Oops! Did you miss the deadline?

I bet you have a hundred good reasons for missing the deadline to sign up for health insurance. But, regardless of why you did not sign up, if you are without health insurance after March 31st, you missed the deadline. You will likely be facing a fine for not having coverage and, you have missed your chance to purchase an Affordable Care Plan until the next open enrollment period begins in November.

Are there any exceptions?

In order to get Affordable Care coverage or make a change in your existing coverage outside the open enrollment period, you must have a qualifying life event. Qualifying life events include:

  • Getting married
  • Having, adopting, or placement of a child
  • Permanently moving to a new area that offers different health plan options.
  • For people already enrolled in Affordable Care coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.
  • Losing other health coverage due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified. Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.

Most special enrollment periods last 60 days from the date of the qualifying life event.

Enrollment for small businesses

Employers generally can start offering health insurance coverage to their employees at any time during the year.

Medicaid and CHIP: Enroll any time

You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time You can find out if you qualify for Medicaid or CHIP by filling out an Affordable Care application or going directly to your state Medicaid agency.

If you have a qualifying life event or are shopping for coverage for your small business, call me at 440-255-5700 to discuss your options. Let me help you choose the coverage that’s right for you.

 

Coming down the home stretch for Affordable Care

We’re in the home stretch to sign up for insurance under the Affordable Care Act for this year. Open enrollment ends March 31 for most people.

Since young adults are notorious for waiting until the last minute, it should be no surprise that many have postponed signing up for health insurance. If you or someone you care about has not signed up yet, it’s time to get moving. Health Insurance can be one of the most important financial decisions a young person can make.

Young adults need to consider that all Affordable Care Plans provide coverage for the following ten essential health benefits, including:

  • Emergency services
  • Hospitalization
  • Laboratory tests
  • Maternity and newborn care
  • Mental health and substance-abuse treatment
  • Outpatient care
  • Pediatric services including dental and vision care
  • Prescription drugs
  • Preventive services and management of chronic diseases
  • Rehabilitation services

Without insurance, any of these medical needs can cause serious financial setbacks.

Young people need to know that the new Affordable Care Plans provide valuable, preventive care.

Screenings, mammograms and immunizations along with flu shots, smoking cessation programs, diet counseling, children’s’ services and much more are all covered.

Those who don’t sign up risk having to pay a penalty.

Those who choose to pay the penalty will receive nothing for it and will still be responsible for the full bill for any of their routine or emergency medical expenses. For the 2014 tax year, the penalty will be $95 per person or 1 percent of a household’s taxable income, whichever is greater, with the amount decreased by one-half for dependents under the age of 18.

Open Enrollment for the Affordable Care Act ends March 31st so time is running out to sign up. Call me at 440-255-5700 to discuss your options. Let me help you choose the coverage that makes the most sense for you.

What will happen if I don’t get health insurance?

The deadline to sign up for a healthcare is March 31. Anyone who has not signed up for health coverage by then will be charged a penalty. The penalty in 2014 will be calculated one of two ways . . . either 1 percent of the annual household income or $95 per person for the year, whichever is higher. If there is a child in the home under the age of 18 the penalty will be $47.50 for that child. The penalties increase next year to 2 percent of the yearly household income or $325 per person. The penalty for children will be $162.50.

Choosing to pay the penalty may not save you as much as you think. Many consumers are eligible for insurance plans at surprisingly low rates. Those who choose to pay the penalty will receive nothing for it, and will still be responsible for the full bill for any of their routine or emergency medical expenses. A one-time trip to the emergency room can run into thousands of dollars making insurance the smarter choice.

Open Enrollment for the Affordable Care Act ends March 31st so time is running out for you to get signed up. To learn more, call me at Mutsko Insurance Services, LLC at 440-255-5700 to discuss your options. Let me help you choose the coverage that makes the most sense for you, your family and your budget.

The Positive Side of the Affordable Care Act

Let’s face it. Health Care Reform got off to a rocky start. For months, we have been hearing all the negatives about the program. But, in spite of all the negative publicity, there are a lot of good things about Health Care Reform that will be life-changing for you and your family.

Let’s take a few moments to put aside everything we’ve been hearing and take a look at some of the positive aspects of Health Care Reform.

Coverage for Pre-Existing Conditions

Health insurers can no longer raise your premiums, refuse to cover you or drop you from your plan because you have cancer, asthma, diabetes, arthritis – – – or any other medical condition.  You will be able to get health insurance coverage regardless of any pre-existing conditions.

Coverage will Include Preventive

Diabetes and cholesterol screenings, mammograms and immunizations are all covered. This means you can catch the little things before they turn into bigger problems. Your coverage will also include services like flu shots, and smoking cessation and diet counseling to make staying healthy a lot easier. Under the law, children under age 19 will be able to get their teeth cleaned twice a year, as well as receive X-rays, fillings and medically necessary orthodontia. In addition, children under age 19 will be entitled to an eye exam and one pair of glasses or set of contact lenses a year.

Lifetime Dollar Limits are Gone

In the past, health insurers could set a limit on how much your plan would pay over a specified period of time. If you had a bad year or an expensive illness, your coverage might run out. This dollar limit will be fully phased out by 2014. 

Financial Help with Tax Credit or a Subsidy

Many people will qualify for a tax credit or a subsidy if they purchase coverage through the Federal Health Insurance Marketplace. Not everyone will qualify for this help, but if your earnings are below a certain level and you don’t have access to other affordable coverage through an employer-sponsored plan or state assisted plan like Medicaid, you may qualify for this financial assistance.

The plan you select will determine your premiums, deductibles and co-pays. Call me at 440-255-5700 to learn more.  I’ll help you choose the coverage that makes the most sense for you, your family and your budget. Let’s get started today.