The Senior Insider

Can my child get Marketplace Health Insurance if it’s cheaper?

I was recently asked this question . . . 

If a child under age 26 is able to get coverage under a parent’s policy, can they get a lower cost plan with Marketplace insurance based on income if they apply themselves?

Answer:  It depends on whether the child is a dependent in the parent’s tax household.

If the under-26 child is claimed as a dependent in the parent’s tax household – and if they have access to a parent’s job-based coverage – they are not eligible for lower costs on a Marketplace plan. This is because they have access to job-based coverage.

If the child files taxes themselves, they may be eligible for lower costs on a Marketplace plan based on their income. This is true even if they have access to a parent’s job-based coverage.

But if the child is enrolled in a parent’s job-based coverage, they are not eligible for lower costs on a Marketplace plan.

My son is turning 26. What are his health insurance options?

Coverage for adult children ends on a child’s 26th birthday when they are required to secure their own health insurance. 

Regardless of whether their birthday occurs during Open Enrollment* or not, they will qualify for a Special Enrollment Period that allows them to sign up for a health plan outside of the Open Enrollment.The Special Enrollment Period will end 60 days after their birthday.

If they enroll before their 26th birthday, coverage can start as soon the first day of the month they lose coverage. If they enroll during the 60 days after their birthday, coverage will start the first day of the month after they pick a plan.

If they don’t enroll in health coverage within 60 days of their birthday, they will not have to wait to get coverage until the next Open Enrollment period and may have to pay the fee for being uninsured. For 2015, the fee is 2% of your income or $325 per adult, and $162.50 per child, whichever is more.
 
If they go without coverage for less than 3 months of the calendar year, they don’t have to pay the fee.


* Open Enrollment is going on now through February 15, 2015

Avoid these classic Medicare scams.

Medicare Open Enrollment always presents an opportunity for unscrupulous people to come out of the woodwork with financial scams designed to separate you from your hard earned money. Here are a few tips to help you avoid getting scammed:

– Never pay upfront fees. If someone asks for money to help you shop for insurance, it’s a sure sign they’re not legitimate.

–   Be wary of anyone calling you, claiming to be a Medicare representative or a representative of any other government agency. Official government agencies typically communicate by mail. If you’re concerned, ask the caller to send the information to you in writing through the mail.

– Do not fall for phone calls where someone pretends to be a representative from the government selling insurance or signing you up for Medicare. The government will not call you to sell you health insurance.

–  Do not provide personal information including your Social Security or banking info to anyone you do not know and trust. Your Medicare card has your social security number on it too, needs to be safeguarded. If you give out this information by mistake, immediately inform your banks and credit card providers.

–  If you are suspicious of a caller, simply hang up the phone.  Don’t count on caller ID to prove who the caller is.The phone number and/or organization name on your caller ID can be faked to look like a legitimate organization.

– Never give your medical history or specific treatments you have received, to anyone who asks you for it.

One of the easiest ways to protect yourself from insurance scams is to seek out a knowledgeable insurance professional who has a well-established reputation in your community. By doing so, you’ll know that your insurance agent will be around when you have questions or a claim. Mutsko Insurance Services, LLC is this kind of insurance agency. We are conveniently located in Mentor, OH and have been serving customers throughout N.E. Ohio for nine years. You can count on us to be here for you now and in the future. 

Call us at 440-255-5700 for all your health insurance needs

Here are three good reasons you should have health insurance.

Reason 1: 
1-day hospital stay                $1,910*
Physician, drugs and treatment costs not included
Reason 2:
5-day hospital stay                $9,550**
Physician, drugs and treatment costs not included
Reason 3:
Broken leg (with surgery)  $17,000-35,000***
Physician, drugs and treatment cost not included

According to the National Safety Council, one in eight people will need medical care for an accident. Will you be that one in eight?

Open enrollment for the Affordable Care Act begins November 15. If you don’t have health insurance, please make it your business to get insured this fall. Don’t risk the financial setbacks that one injury can cause.  

For a fast, no-obligation free quote, got to www.mutskoinsurance.com and click on ‘free quote.’


*statehealthfacts.org, The Henry J. Kaiser Family Foundation.
**National Hospital Discharge Survey, Centers for Disease Control and Prevention.

***Costhelper: http://health.costhelper.com/broken-leg.html. 


Will Medicare cover my dental work?

If you plan to stay with Original Medicare, your dental options will be very limited. 

Original Medicare DOES NOT pay for routine dental care, including the cost of exams, teeth cleaning, tooth extractions, x-rays and dentures. This means that you can expect to pay 100% of the costs for all these services if you want to keep your healthy smile.

Original Medicare will only cover the cost of dental procedures related to covered medical procedures. For example, Medicare will cover extractions before cancer radiation therapy or jaw reconstruction after an injury. Procedures such as these are covered because they are necessary to treat a non-dental condition. They must be treated at the same time and by the same doctor as the covered condition.

There are,  however, other affordable options for dental coverage available to you. At Mutsko Insurance Services, LLC we offer a number of Medicare Advantage Plans that include coverage for routine dental care as well as vision, hearing and prescriptions.

Coverage and costs will vary from plan to plan, and some plans may charge additional for dental coverage. There are plans that cover a percentage of your costs for cleanings, x-rays and exams while other are more comprehensive and will cover major dental services like crowns, bridges, root canals and denture, in addition to your routine care. It all depends on which plan you choose.

Before you sign up for any Medicare Advantage Plan, compare the dental coverage and costs and the find out whether your dentist is in the provider network. At Mutsko Insurance Services, we’ll do the work for you. We’ll show you your coverage options and determine whether your dentist is in the network. Our job is to help you find the plan that works best for you.

For more information on Medicare Advantage Plans, Medicare Supplements, dental, vision and other coverage options, please contact Mutsko Insurance Services, 6966 Spinach Drive in Mentor, OH or call 440-255-5700 or at lmutsko@mutskoinsurance.com to make an appointment for a Medicare review.

Is a Medicare Advantage Plan the right choice for you?

Most people understand the basics about Medicare; that Medicare is a federal health insurance program managed by the Centers for Medicare & Medicaid Services (CMS) in which the government pays your Medicare benefits when you receive them. However, many people do not have a clear understand of Medicare Advantage Plans and how they work.

Basically, Medicare Advantage Plans are a different way for you to get your Medicare benefits. Advantage Plans, are offered by private insurance companies that have been approved by Medicare. Medicare pays these companies to cover your Medicare benefits and in turn, these companies must follow rules set by Medicare.
Medicare Advantage Plans provide the same coverage as Original Medicare.* In addition, many Medicare Advantage Plans offer extra coverage like vision, hearing, dental, and health and wellness programs. Many Plans include Medicare prescription drug coverage (Part D). All Medicare Advantage Plans cover you for emergency and urgent care services as well.

You must have Medicare Part A and Part B and live in the Medicare Advantage Plan’s service area to be eligible to join.

In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan. The total cost of the premiums, copayments and deductibles you pay under a Medicare Advantage Plan is often lower than those same total costs through Original Medicare.

A number of companies offer Plans with “zero premiums.” Although you pay no premiums to the Advantage Plan, you are still responsible for payment of your Medicare Part B premium.
Now, during Medicare’s Annual Open Enrollment Period, is the time for you to look into your Advantage Plan options. You’ll want to talk to a trusted insurance professional who can help you compare plans to determine which Plan is best for you. At Mutsko Insurance Services, we routinely provide our customers with comparisons to help them select the right Plan.

For more information on Medicare Advantage Plans, Medicare Supplements or Medicare Prescription Plans, please contact Laura Mutsko at Mutsko Insurance Services, LLC, 6966 Spinach Drive in Mentor, OH. Call 440-255-5700 or email lmutsko@mutskoinsurance.com.

*An exception is hospice care. Original Medicare covers hospice care for those in a Medicare Advantage Plan.

Is Open Enrollment the same if I get my coverage from my Union or former employer?

 
I heard that I should review my Medicare coverage during Fall Open Enrollment and I have until December 7 to make changes. Does that apply to me if I get my insurance through my former employer or a union?
 
Retirees who receive health insurance or a supplement from their former employer or union may not have the same open enrollment time-frame as people with Original Medicare or individually purchased Medicare Advantage or Prescription Part D Plans.Their “annual open enrollment” period is the time period established by their former employer or union. It is probably not the same as Medicare’s Open Enrollment period.
 
This is very confusing if their time-frame occurs within the Medicare Open Enrollment period. Many people have ignored an October mailing from their former employer or union, thinking they have until December 7 to act, only to find later that they needed to make changes much sooner.
 
I advise everyone with insurance from a former employer or union to open and read all mail regarding their insurance right away. Pay particular attention to the dates by which you need to respond. Don’t sign up for Medicare C, D or a Medicare Supplement without consulting your former employer or union insurance administrator. Signing up individually may end your retiree insurance and make it extremely difficult to get back if you make the wrong choice.
 
If however, you find that your employer or union provided plan no longer suits your needs, it may be time to look into other plans with better coverage. Call Mutsko Insurance Services, LLC to set up a Medicare health insurance review. We are conveniently located in Mentor at 6966 Spinach Drive. Call 440-255-5700 or email lmutsko@mutskoinsurance.com today.

How can you expect your older friends or relative to figure out Medicare?

If you find yourself confused by 
Medicare and all the choices available to you . . .

. . . . imagine how much more confusing it can be for your older friends or relatives who may not have access to all the information you have at your fingertips.

If you have elderly family members or friends, PLEASE see if they need help reviewing their Medicare Advantage and Medicare Rx plans. 

If after talking to them about their coverage you both still have questions, call me. We’ll set up an appointment to do a Medicare review together.  We have until December 7 to make changes.

1 out of 5 surveyed describe Medicare as confusing.

So, if Medicare has you stumped, you’re not alone!
According to a 2013 survey of 1000 older adults, 1 in 5 Medicare beneficiaries could not correctly identify what Medicare Parts A, B, C and D covered. And, that’s just the beginning when it comes to Medicare!
A health care crisis or hospital confinement is no time for you to begin trying to figure out how to make the most of your Medicare benefits. You owe it to yourself and your family to learn as much as you can NOW, so you have the coverage best suited for you before a need arises.
I invite you to invest two hours of your time learning the ‘ins and outs’ of Medicare at one of my upcoming classes called Getting Started with Medicare.  I will be presenting the class throughout the fall at locations in Lake, Geauga, Lorain and Cuyahoga Counties including:
09/23  Willoughby Library
09/24  Kenston
09/25  Peninsula Library
09/29  Lorain County Community College
09/30  Chagrin Falls
10/01  Concord
10/02  Mentor Senior Center
10/06  Lakeland Community College
10/07  Hudson
10/08  Euclid Public Library
For more dates, times and registration information, please visit, www.mutskoinsurance.com/seminars.  
This is your opportunity to begin learning about the options and services you have as a Medicare beneficiary.

What to do if you’re not happy with Medicare or your Advantage Plan

Your chance to switch to a new plan is coming soon!


Medicare Open Enrollment begins on October 15 and is the time of year when you can make changes in your Medicare health plan or prescription drug coverage for the coming year. While many people are happy with their current coverage, it’s always smart to check to see what changes will be made in your plan and take a look at other options that are available.
 
Start by looking for these four C’s:

1.  Cost:  Will your out-of-pocket costs change? Will there be increases in your premiums, deductibles and co-payments in 2015?

2.  Coverage:  Does your plan cover all the medications you’re taking? Are your preferred doctors, health care providers and hospitals covered by your plan?

3.  Convenience:  Do you need prior authorizations or referrals? Are you restricted to using specific pharmacies? Can you get your prescriptions through the mail if you wish?

4.  Customer Service:  Do you have someone who provides personal service when you run into problems? Is your plan responsive when you have a question?

If you find your plan falls short of your expectations, give me a call. We will set up a time to review your options and help you find the coverage that best suits your needs at an affordable price. I can be reached at 440-255-5700 or via email at lmutsko@gmail.com.