Long Term Care Awareness Month

LTC Awareness Month >>>
Eight Things People Should Know

*REPOST* Brought to you by: Mutual of Omaha

November is LTC Awareness Month – time again to devote your efforts to helping people understand the importance of planning for their future long-term care needs.

This can be challenging...especially for those who find it hard to see themselves needing help with the most basic daily activities, like bathing or dressing. Yet, taking accountability for their future care and planning for that day is something everyone should do.

Here are eight things they should consider when developing a plan for long-term care:

1. Planning for long-term care is important. Most people will tell you they plan to live a long life. But with age comes the need for help with some of the things they always did for themselves. According to the U.S. Department of Health and Human Services, 70 percent of people who reach age 65 will need LTC services at some point in their lives
2. LTC services are expensive. Mutual of Omaha’s cost-of-care survey revealed that just one year in a nursing home can cost nearly $80,000 (based on national averages). Home health care is less expensive, but people still can expect to pay over $36,000 per year on average for care they receive at home.
3. You can’t rely on Medicare. Many people mistakenly believe their LTC needs are already covered. In reality, Medicare only covers services for a short time – typically just long enough to help people get back on their feet after an illness or injury.
4. Medicaid isn’t for everyone. It’s true. Medicaid does cover LTC services. But it’s important to remember that Medicaid is a program for people with low incomes and limited resources. That may mean your clients would have to spend down their assets just to qualify. Not an attractive option for people who want to protect the assets they worked a lifetime to accumulate and leave a legacy for their children.
5. There’s a hidden cost to family caregivers. It’s easy to say, "My family will take care of me." But a spouse may not be physically able to provide all the care that’s needed. And children have their own family and career obligations. The fact is family caregivers frequently suffer from stress and illness themselves. Not to mention lost wages if they have to give up a job or reduce work hours.
6. The best time to start planning is now. How will you pay for the care you need? Where will you live? Who will take care of you? These are questions people need to ask themselves now while they’re young and in good health. The need for LTC services can arise at any time. Having a plan in place when that day comes can help alleviate the emotional strain many families face. It also can help ensure your clients get to make the important decisions about the care they receive and the setting they prefer.
7. The cost of waiting can be high. The ability to obtain an LTCi policy is based on age and good health. So it’s important for people to understand that if something happens to cause a change in their health status, they may not be able to purchase LTCi at any price.
8. Some coverage is better than none. Many people who think they can’t afford an LTCi policy neglect to consider what would happen if they didn’t have one. Without a policy to help pay the bills for LTC services, they may have to liquidate assets, sell stocks, dip into savings or retirement accounts or sell property to come up with the cash they need. Even a modest LTCi policy offers some protection for their important assets.

Read More @: http://www.mutualofomaha.com/yourchoice/tips-tools-training/article-eight-things-people-should-know.php

Open Enrollment

It’s your choice: Take advantage of open enrollment

*REPOST* Brought to you by UHC:

https://www.uhc.com/newsletters/september-2016/take-advantage-of-open-enrollment?srcName=smf-ban

If your employer offers health benefits, you may start hearing soon that it’s time for open enrollment. This is the time of year when you can make choices about your coverage for the next year. Open enrollment is sometimes called annual enrollment or benefits enrollment.

Before you know it, it will be time to choose your coverage. So take a moment to review these tips and tools that may help you prepare.

Seven questions to ask

Your employer may offer one health plan or multiple options for health coverage. When deciding what’s right for you and your family, keep these questions in mind:

1. Is my doctor in the network?

If you have doctors or specialists you like, be sure they’re in the network of the plan you choose. Why? Your costs are usually lower when you use a network doctor.

Visit myuhc.com® to find out if your doctor is in the plan’s network. You can also find a doctor with theUnitedHealthcare Health4Me® mobile app.

2. Is my medicine covered?

Most plans have a list that shows which prescription medicines are covered. It’s called a formulary or Prescription Drug List (PDL).

To see which medicines are on your plan’s list, go to myuhc.com — and click on “Pharmacies & Prescriptions.”

3. Who else needs to be on my plan?

Some plans offer coverage for your spouse, partner or children. These are your dependents. If the plan offers dependent coverage, children under age 26 without their own health coverage can be on your plan.

4. What type of health coverage is right for me?

You may be offered a choice between a “traditional” copay health plan and a high-deductible health plan. With a traditional copay plan, your monthly premium will be higher — and you will pay a fixed copay amount, such as $25, for each doctor visit. With a high-deductible plan, your monthly premium may be lower. But you may have a higher share of out-of-pocket costs.

How do you decide what’s right for you? Think about what health care services you and each family member might need in the coming year. For example:

• Are there medications you take routinely?
• Are you planning to have surgery?
• Do you see a doctor regularly for a health condition?
• Are you planning to have a baby?

5. What other costs should I plan for?

In addition to the premium and deductible, you may also have copays or coinsurance. To learn more about the difference, see this infographic.

Then try this worksheet to help you plan for your potential costs.

6. Will I have access to an HSA, HRA or FSA?

Check with your employer to see if a health savings account (HSA), health reimbursement account (HRA) or flexible spending account (FSA) is available to you.

These are all ways to use tax-free money to help pay for medical expenses. But there are differences. Learn more in this infographic.

7. What other benefits does my employer offer?

Carefully read the information your employer sends you. Some health plans include incentives for healthy living. And your employer may offer dental, vision or disability benefits too.

What to do next

Start planning for your health care costs in the coming year:

• Fill out this helpful health costs worksheet.
• Watch for emails from your employer about open enrollment dates.
• Take time to consider your options — so you can choose a plan that’s right for you.

© 2016 United HealthCare Services, Inc.

Medicare 101: What is Part D?

What Is Medicare Part D and Who Qualifies?

*Repost* Brought to you by: TransAmerica: http://blog.transamerica.com/what-is-medicare-part-d#.V_QNDOUrJhE

Medicare Part A and B together make up what is known as Original Medicare and provide coverage for many things that are typically categorized as hospital insurance and medical insurance, including emergency care. But often, taking care of your daily health comes with medicines prescribed by your doctor. This is where Medicare Part D enters your healthcare picture.

What does Medicare Part D cover?

Simply put, Medicare Part D covers a patient’s prescription drugs. In the Medicare system, drugs are put intotiers based on formularies, which results in different price levels. Medicare Part D plans are generally set up to provide coverage at levels that correspond to the prescription drug tiers. In this guide, you can find a description of some common situations people face, as well as things to consider in each scenario regarding coverage options.

Who qualifies?

Medicare Part D is voluntary for everyone except those enrolled in Medicaid, or Medi-Cal for those in California. Because of that, anyone who is eligible for Medicare can sign up for a Part D coverage during the annual open enrollment period.

When should I enroll?

Enrollment follows the same initial rules as Plans A and B. You can apply three months before the month of your 65th birthday, within your 65th birthday month, and the three months following. Likewise, if you don’t select drug coverage when you first become eligible, and don’t qualify for an exception, you may encounter a late enrollment penalty that stays with you as long as you have Medicare drug coverage.

You don’t have to re-enroll each year, but you will have a chance to review your coverage and change plans if needed. In addition, certain changes in your circumstances throughout the year may prompt the need for aSpecial Enrollment Period (SEP). Rules for what you can change and when you can change it are different for each SEP.

How much does it cost?

The cost for prescription drug coverage isn’t as clear cut as with Parts A and B, since your cost will largely depend on which prescription drugs you take. Other variables include the plan you choose, if you use a pharmacy in your plan’s network, and if your prescriptions are part of the formulary of your chosen plan.

Since coverage for Part D is distributed through independent companies, you have a lot of options to choose from. We can assist you in getting started.

What about Part C?

Original Medicare is enough coverage for some people, but if you feel like you need extra benefits, that’s where Part C comes in. Part C plans are sometimes called Medicare Advantage plans. Medicare Advantage Plans are administered by private insurance providers, but are regulated by the government. They include most Part A and B benefits as well as prescription drug coverage, vision, hearing and dental services. Opting into a Part C plan means that you’ll receive benefits from Medicare Advantage instead of Original Medicare. Costs vary by plan.

For more information on Medicare, Transamerica Center for Health Studies^® has a guide that can help you compare the features of the different parts.

About Transamerica Center for Health Studies^®.
The Transamerica Center for Health Studies^® (TCHS) is a division of the Transamerica Institute^®, a nonprofit, private foundation. TI is funded by contributions from Transamerica Life Insurance Company and its affiliates and may receive funds from unaffiliated third parties. TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. For more information about TCHS, please visit www.TransamericaCenterforHealthStudies.org.

2016 || Part D Donut Hole

Medicare Coverage & Costs | Tue, Apr 26, 2016 @ 09:00 AM

The Medicare Part D Donut Hole: Going…Going…Not Quite Gone

Posted by Medicare Made Clear

The prescription drug donut hole is a gap in Medicare Part D’s prescription drug coverage.

Once you and your Medicare Part D plan have spent a certain amount on covered prescription drugs during a calendar year ($3,310 in 2016), you reach the coverage gap. You are now in the Part D donut hole.

You pay a larger percentage of your prescription drug costs while you’re in the donut hole until another dollar limit ($7,062.50 in 2016) is reached. Then Medicare Part D coverage kicks in again.

Closing the Part D Donut Hole

The good news is the donut hole isn’t as big as it used to be. When Medicare Part D launched in 2006, Medicare beneficiaries had to pay 100% of their prescription drug costs during this gap in coverage. With the passage of the Affordable Care Act, that percentage started to drop.

In 2016, you pay 45% of the cost of brand-name prescription drugs and 58% for generics while in the donut hole. These percentages are scheduled to decrease every year, bottoming out at 25% for both brand-name and generic drugs in 2020.

This will effectively close the donut hole, putting costs on par with what you pay between the time you meet your deductible (if you have one) and when you hit your out-of-pocket spending limit.

Getting Into and Out Of the Donut Hole

It’s important to note that it’s not just your share of your prescription drug costs that get you into and out of the donut hole. The amount your plan pays also counts towards the first milestone that puts you into the donut hole.

Drug companies may help pay your way, too. They provide a 50% discount on brand-name drugs purchased while in the donut hole.

The drug company discount counts toward the second dollar limit, the one that marks the end of your passage through the coverage gap. For generic drugs, only the amount you pay out-of-pocket applies to your spending limit.

Conclusion

This will all get simpler in 2020 when the donut hole closes. Until then, following these tips may help you climb out of it more quickly – or keep you from falling into it in the first place:

• Stick with your plan’s formulary whenever possible. Only medications on the formulary, or for which you get an approved exception from the plan, count toward your spending limit.
• Make sure to get your drugs from a network pharmacy. Prescriptions you fill outside your network pharmacy don’t apply to your spending limit.
• Opt for generics if your doctor thinks they’re appropriate. The lower costs for generics may be enough to keep you from slipping into the donut hole.