Hey neighbors! Just a friendly reminder that the Open Enrollment Period for ACA plans is coming to an end soon! Don't miss out on the opportunity to get the best health insurance plan for 2024. If you're in South Dakota, Minnesota, Nebraska, Iowa, or Wisconsin, give me a call at
or
. Let's navigate through the options together. Time is running out, so don't wait!
The short answer is NO.
Straight from the horse's mouth https://www.medicare.gov/coverage/long-term-care
Medicare Part A covers short stays at a Skilled Nursing Home. For things like rehab therapy, IV medications and treatments.
You could pay dearly--
Here is the breakdown of covered costs depending on length of stay:
Days 1 through 20: Part A pays the entire cost of any covered services.
Days 21 through 100, you pay $194.50 per day.
After 100 days: Part A pays nothing. You’re responsible for the entire cost of Skilled Nursing Home services.
What pays the cost of Long Term Care?
Long term care Insurance and/ or Medicaid, even some wealth preserving products from companies like Securian.
You will be surprised that there are solutions that are affordable.
Call me if you have any questions, my advice for you is always free.
605-868-8330/480-400-9837
or reach me at GregNinkeAgency.com
Serving families and small business in South Dakota, Arizona, Nebraska, Minnesota, Wisconsin, Iowa, New Mexico, Texas and Nevada
Have you recently had a qualifying life event? “A qualifying what?” you might ask.
What is a qualifying life event?
A qualifying life event could be a situation like losing
your job, having a baby, moving to a new state, or becoming a U.S. citizen.
These events not only open new chapters in your life but also a window of
opportunity—or a Special Enrollment Period (SEP)—to
purchase healthcare coverage through an Affordable Care Act (ACA) plan.
There are good reasons to get one of these healthcare
plans: They can’t deny you service or raise your rates because of a preexisting
condition, for example. And if you fit certain income categories, you may be
able to save money with certain tax subsidies (discounts offered by the
government). But your ability to join is usually limited to an Open Enrollment
Period, which runs from the beginning of November to mid-January.
Now, here’s the good news: You may be able to get one of
these plans at other times of the year too, if you meet certain qualifications,
says Ryan Newport, a licensed insurance agent with HealthMarkets in Oklahoma
City. “I get asked this question all the time, and the answer is often yes, for
more reasons than you might think,” he notes.
Before you start, try researching out to Greg Ninke, your
local HealthMarkets agent at (605) 868-8330, (480) 400-9837or connect online to
discuss your options. Schedule an appointment today.
10 qualifying life events that may trigger your special
enrollment period
Here are 10 reasons you may qualify to purchase ACA health
insurance benefits outside of
the Open Enrollment Period.
1. You lost your health coverage.
You’ll be able to enroll in ACA benefits if anyone in your
household lost their health coverage in the past 60 days or expects to lose
coverage in the next 60 days, says Newport. That can happen for a few reasons:
You may need to submit a letter from either your employer or
your health insurance provider to confirm that the top two things have
happened.
2. You lost eligibility for Medicaid or the Children’s
Health Insurance Program (CHIP).
A gain in income is always great news, but it may make you
ineligible for Medicaid, points out Newport. (Medicaid is a type of state- and
federal-run healthcare program that’s offered to people who have limited income
and resources.) Also, once your children get to a certain age (usually 19),
they may be too old for CHIP. (CHIP is low-cost healthcare coverage for
children in families that earn too much money to qualify for Medicaid.)
3. You lost qualifying health coverage through a parent
or spouse.
That might have happened for a few reasons:
4. You’ve gained coverage through a parent or spouse.
Talk about a happy life event! Getting married, having a
baby, and adopting a child are all considered qualifying life events that make
you eligible to sign up for health insurance benefits.
5. Your boss offers to help pay for your insurance.
The most common way that this occurs is when a small
company (less than 50 employees) that doesn’t offer a group health plan offers
to reimburse some or all of the cost of marketplace premiums (monthly insurance bills)
through a Qualified Small Employer Health Reimbursement Arrangement. You’ll
need to apply for and enroll in individual health insurance before that begins.
You could also contact your licensed agent Greg Ninke at at (605) 868-8330, (480) 400-9837 to
talk about what insurance benefits might be right for you.
6. You have a change in residence.
So you’re on the move. But this is about more than just
moving to a different ZIP code. Maybe you’re a student going off to graduate
school, a seasonal worker moving to the place where you’ll be working, or
you’re someone who is moving into a shelter. The new plans available in your
area may be the next thing you unpack.
7. You just became a U.S. citizen.
Congratulations! Becoming a U.S. citizen is hard work. One
of the many doors that will be opened to you is being eligible for health
insurance benefits.
8. You just got released from prison.
If you’ve recently been incarcerated, your first taste of
freedom could also include an open window to sign up for health benefits.
9. You’re starting or ending service as an AmeriCorps
State and National, VISTA, or NCCC member.
Government-run agencies such as AmeriCorps State and National
(which send volunteers to work at nonprofit organizations), AmeriCorp VISTA (a
national service program designed to alleviate poverty), and AmeriCorp NCCC
(National Civilian Community Corps) are all great ways to serve your country.
And if you’re beginning or ending your time with one of them, it can also
trigger an SEP that allows you to register for health benefits.
10. You gain membership in a federally recognized
Native American tribe or get status as an Alaska Native Claims Settlement Act
corporation shareholder.
Congratulations on officially joining your Native American
community or your new shareholder status! Now, it’s time to review the new
health insurance options available to you.
But wait! What happens if I get turned down?
If you fit into one of the above categories but still get
turned down, you can appeal the decision within 90 days, notes Newport. If you
think waiting out the decision may seriously jeopardize your health (for
example, you won’t be able to pay for your medications), you can ask for a
faster appeal.
If you think you may qualify, don’t hesitate to chat with
me at (605)
868-8330, (480)
400-9837or connect with Greg Ninke online.
“Life changes happen pretty quickly, and it’s good to know
that you’re covered,” says Newport. “If you move to another state, for example,
you may not know the ins and outs of obtaining health insurance through the
state marketplace. Your agent can help find you a good plan that’s the best fit
for you and your family.”
48513-HM-0522
6 Things to Not Overlook When First Enrolling in Medicare
That’s because your Initial Enrollment Period (IEP) for
Medicare will likely begin shortly. That’s a seven-month Medicare sign-up
window that includes the three months before, the month of, and the three
months after your 65th birthday.
“Any time someone is approaching age 65, it’s a great idea
for them to talk to a licensed insurance agent,” says Silas Jessup,
HealthMarkets’ contracted licensed insurance agent and executive sales leader
in Indiana. “That’s true even if you’re still employed and plan to stay on your
employer-based insurance.”
Enrolling in Medicare can feel really difficult. Make it
easier on yourself by learning about possible oversights and how to avoid them.
If you know someone on Medicare, they probably have a story or two about how
signing up was not a walk in the park. Here are some potential oversights
to avoid and tips that could help you make the stroll easier.”
Potential
Oversight #1: You don’t know your ABCs… or Ds of Medicare
Medicare is the U.S. government’s national healthcare
program for adults ages 65 and older. (It’s also for individuals with
disabilities, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s
disease.).) It’s divided into sections, each of which provides a certain type
of coverage and is identified by a letter:
There’s a third letter of the Medicare alphabet— Medicare
Part C. These plans are also known as Medicare Advantage plans, and they’re
the equivalent of coverage under Medicare parts A and B (also called Original
Medicare). They may also include additional benefits, including coverage for
prescriptions, vision, hearing, dental services, expanded telehealth, and even
fitness. And you get them all in one plan. However, you may need to use the required
networks, much like many employer-offered health plans.
Potential
Oversight #2: You don’t compare your current plan to Medicare
Let’s say you turn 65 and you’re comfortable with the group
health insurance plan that you’re already on through either your employer or
your spouse’s. (Yes, you may still be working at age 65.)
If you still have one of these traditional plans, you don’t
have to switch to Medicare right away. But you might save money if you do.
“Sometimes group insurance is the better option, and other
times Medicare can be a better solution,” says Jessup. “It all depends on your
personal situation, the cost of the group insurance, and the benefits that are
being provided. An insurance agent can help you decipher which coverage would
be better for your individual circumstances.”
Comparing costs on your own can be difficult, Jessup says.
One option can be to call me, your licensed health insurance agent from
HealthMarkets at (605) 868-8330 or
visit GregNinkeAgency.com to
figure out what insurance plans are available to you.
Potential
Oversight #3: You don’t take time to read the fine print
If you stick with Original Medicare, you’ll be getting Part
A (and likely Part B), and that means about 80% of your medical costs will be
covered, says Jessup. That leaves you to pay for the other 20%.
Original Medicare has no out-of-pocket expense limits.
Costs may add up if you end up going to the doctor a lot or if you need an
expensive medical procedure.
Check with me to learn about ways to cover some of the
expenses that Medicare does not.
Potential
Oversight #4: You don’t check the medication lists for Medicare Part D or the
Medicare Advantage plan you’re interested in
If you’re taking multiple prescription medications, you’ll
probably want to add coverage for that—that is, Medicare Part D.
All Medicare Part D plans must cover a wide range of
prescription drugs, including most drugs in “protected classes” like those that
treat cancer or HIV/AIDS. But before you sign up for a plan, you’ll want to
make sure your prescriptions are on your plan’s list of covered drugs, which is
called a formulary (each plan has its own).
Many plans place medications into different levels, called
“tiers,” on their formularies. Drugs in each tier have a different cost,
with lower tier ones usually costing you less than higher tier ones.
So, take some time to learn which of your prescriptions may
be covered and the tiers they fall into. Having that information on hand will
help you determine how much you’ll be spending on prescriptions.
Potential
Oversight #5: You don’t check the out-of-pocket limits on the Medicare
Advantage plan
In general, Medicare Advantage plans usually have a lower
premium, but the out-of-pocket limits can be different from plan to plan says
Jessup.
Out-of-pocket costs can vary, but you won’t have to pay
more than the out-of-pocket limit—the government capped it at $7,550 in 2022.
And many Medicare Advantage plans have out-of-pocket limits below that.
Potential
Oversight #6: You don’t pay attention to the deadlines
Remember: Your Medicare IEP is only seven months. So, depending
on when you sign up during the IEP, you’ll just need to pay attention to
deadlines, based on where your 65th birthday falls.
As we mentioned earlier, you can sign up for Medicare
starting three months before the month of your 65th birthday,
and you have until three months after the month of your 65th birthday
to enroll. Or, if your birthday is on the first of the month, your seven-month
window starts four months before the month you turn 65 and ends two months
after.
In short, your Medicare or Medicare Advantage coverage will
start anywhere from one to three months after you sign up for it.
If you miss your IEP, though, you’ll likely have to pay a
late enrollment fee, which goes up the longer you wait to enroll. For Part B,
for example, it’s 10% of the premium—or your monthly payment—for every 12
months you delay. The standard premium for 2022 is $170.10, but it can change
every year (and your penalty can too). That can really add up.
There’s also a late penalty for Medicare Part D. It’s equal
to 1% of the national base beneficiary premium times the number of months that
you didn’t have Part D or other qualified continuous coverage.
Late enrollment can also mean you’ll have some serious gaps
in coverage. Keep track of your deadlines. They could end up saving you a lot
of money.
Make
no mistake: If you’re on Social Security, life is good
Good news if you’re on Social Security: You don’t have to
worry about signing up. (Yes, you read that right.) If you’ve been receiving
Social Security benefits for at least four months before you turn 65, you’ll be
automatically enrolled in Medicare parts A and B.
You only need to be concerned with your Initial Enrollment
Period if you’d like to choose a Medicare Advantage plan instead of Original
Medicare, or if you’d like to delay enrollment.
Along with the birthday cards you’ll get for turning 65,
you’ll also get a welcome package in the mail plus your Medicare card.
Looking for the Medicare plan to fit your lifestyle? Contact me at (605) 868-8330 or (480) 400-9837. Visit GregNinkeAgency.com to schedule an appointment.
I Lost My Job! Should I Do COBRA or ACA, or a Short Term Plan?
Losing your job comes with many
headaches, including a change in health insurance in many cases.
COBRA coverage is one option, but so is a plan under the
Affordable Care Act (ACA). So how do you know which one to choose? The decision
may be easier than you think.
What’s
the difference between COBRA and ACA?
It may seem like you’re wading through alphabet soup
when you look at these two options. Start by understanding what
each one is.
COBRA, or the Consolidated Omnibus Budget
Reconciliation Act, allows you to stay on your employer’s group health plan at
your own expense, says Tasha Riggs, sales leader
for HealthMarkets in Westminster, Colorado. It also covers
your spouse and any dependent children if they elect to be on the plan.
The most important thing to know: You’ll pay the
full cost of the premiums, including the
amount your employer used to pay. You might also pay an
additional 2% administrative fee, says Katie Keith, JD, MPH. Keith
is an associate research professor at Georgetown University’s
Center on Health Insurance Reforms in Washington D.C. who specializes
in the Affordable Care Act and private health insurance.
ACA plans, or Affordable
Care Act plans, refers to individual health insurance plans that meet the minimum
essential coverage and other requirements set by the
federal government.
“People often think that there’s a government
plan called ‘Obamacare’ or ACA and a separate private market, but there’s not,”
Riggs says. “ACA is a law, not a healthcare policy. Every major
medical plan has to comply with it.”
Feeling overwhelmed? Let a HealthMarkets licensed
insurance agent help you sort
through your insurance options. Start online today or call us at (605)
838-8330.
COBRA
vs. ACA: How to Decide
Several factors can help you determine
whether COBRA or ACA is better for you.
1. Consider the cost. “For
most people who just lost their job, COBRA is too expensive,” Riggs
says. ACA plans tend to be much cheaper than COBRA
rates. “If your adjusted gross income fits the guidelines, you can get a
premium subsidy,” she says. How much the subsidy lowers your monthly
premium depends on your age, who’s on your tax return and whom you
claim, your ZIP code, and adjusted gross income.
2. Check your deductible. When you switch
to an ACA plan, your deductible will reset. But if you opt for COBRA,
you’ll keep any progress you made toward your annual deductible while you were
employed.
“Those deciding between COBRA and ACA coverage will want to
consider how much they have already expended toward out-of-pocket costs,
whether they expect to need additional care (or, say, have a chronic
condition), and the time of year,” Keith says.
For instance, if you’re close to the
end of the calendar or plan year, it might make sense to sign up
for COBRA before shifting to ACA coverage. To figure
it out, you’ll want to add up the cost of COBRA
premiums for the rest of the year against potentially higher
out-of-pocket costs with an ACA plan.
If you’ve met your deductible and are close to (or have
reached) your out-of-pocket maximum,
your remaining COBRA payments might be
less than starting a new plan with a brand-new deductible.
3. Think about whether you’re open to switching physicians. “No
matter what plan you have, you have to see if your doctor is in network,” says Riggs. Networks change
regularly, so it’s important never to assume your doctors will be covered.
If you want to keep your doctors, make sure they
accept the new plan you’re choosing. This is especially critical
if you have ongoing healthcare needs or chronic conditions and need to
maintain access to your providers for continuing care, Keith says.
4. Pay attention to timing. People who
lose their job-based coverage generally qualify for a 60-day special
enrollment period through the ACA marketplace.
That’s true even if you’re offered COBRA, Keith says. That means you
have about two months to decide what to do.
However, if you choose to enroll in COBRA,
you have to stick with that plan until the policy ends or until
the annual ACA Open Enrollment
Period, says Keith. You can’t switch
to marketplace coverage simply because you want to drop COBRA coverage
midyear.
So which should you choose?
The answer, of course, depends on your current situation,
which includes everything from your family medical
needs to the names on the tax return. The good news?
You don’t have to navigate the decision alone. If you need help
reviewing your options and finding the right
plan, HealthMarkets licensed insurance agents can help at no
cost to you. Start online today or call us at (605)
868-8330 or in AZ, NM (480) 400-9837.
It's National Chicken Wing Day! I Had to sign a WAIVER! You know what that means: it's time to measure your life in terms of how man...
