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Getting Diabetes Testing Supplies Covered by Health Insurance

“More than 100 million U.S. adults are now living with diabetes or pre-diabetes,” according to a new report released (2017) by the Centers for Disease Control and Prevention (CDC). The report finds that, “as of 2015, 30.3 million Americans – 9.4 percent of the U.S. population –have diabetes. Another 84.1 million have pre-diabetes, a condition that if not treated often leads to type 2 diabetes within five years.” There are some indicators that show this number is starting to level off and in truth the dramatic increase in numbers may be related to the awareness of the medical community. Regular testing for the disease is now part of every patient’s routine checkup. As a result more people than ever before fit frequent glucose monitoring into their daily life.

Monitoring blood sugar is a quick and easy way to help self-manage diabetes care but though the monitors alone aren’t usually expensive the testing strips can be. Add to this the cost of lancets, alcohol wipes, finger bandages, and gauze and it can strain the average American’s budget.

Insurance Preference

In most cases health insurance plans will cover the cost of the glucose meter (or glucometer) and the necessary supplies like strips and lancets. The key is to make sure your Healthcare Provider orders the kind of machine your insurance prefers. Keep in mind that the preferred brand can change, and often does so at the beginning of the year, so be sure to ask your pharmacist if the machine and supplies are covered before you buy them. If the co-pay is still too expensive on the brand of machine your company prefers you don’t have to use that machine. There are lower priced over the counter glucose meters (or glucometers) on the market with equally affordable strips. Walmart carries its own in-store brand and other name brands that are affordable and acceptable choices.

At National Health Insurance Agencies we are here to help you navigate the insurance plans available to you to find competitive rates and great coverage. Contact us today!

Copay vs Coinsurance: Understanding Insurance Plan Keywords

A recent survey by UnitedHealthcare showed only 9% of Americans truly understood the terms of their health insurance policies. This number is up 3% from the 2016 study by PolicyGenius, but is still low enough for serious concern. When comparing policies for purchase, it is essential to fully understand the policy in order to make the best choice for yourself and your family. Here are the definitions you need to get started.

  • Premium:  Your premium is the amount you pay per month to maintain your policy. This is separate from any costs incurred via medical appointments or procedures, and it is either billed to you monthly or taken out of your paycheck if you get insurance through your employer.
  • Deductible:  This is the amount you must pay for medical services per calendar year prior to your insurance company covering anything. However, many plans have certain things they cover prior to meeting your deductible, such as preventative care (your yearly physical, for example) or medications.
  • Copay:  This is the cost you pay per visit, procedure, or medication. It is typically a flat rate, such as $20 for a doctor’s office visit, no matter the cost of the visit. The cost may vary depending on if your provider is in network or out of network.
  • Coinsurance:  This is a percentage you pay of the total cost of a procedure. The difference between copay and coinsurance is that the amount you pay when you have coinsurance due differs depending on the cost of the procedure or visit, whereas the copay is a flat rate. Coinsurance typically begins after you meet your deductible, when the company begins to pay for portions of your services.
  • In Network and Out of Network:  Your insurance company has preferred providers or a preferred local area. This is their network. Providers that are outside this network are typically more costly to see.
  • Out of Pocket Maximum:  This is total amount, per calendar year, that your insurance company expects you to cover. Your out of pocket maximum includes anything you pay for copay, coinsurance, and deductible payments. It does not include your premium. Once you hit your out of pocket maximum, your insurance company will cover 100% of your medical costs, with the exception of your premium payment.

Knowing what these terms mean can make a big difference in the policy you choose. National Health Insurance Agencies can you help choose the best plan and answer your health insurance questions. Contact us today for more information.

Why Costs Keep Rising Under The Affordable Care Act

When the Affordable Care Act was signed into law under President Barack Obama, it was touted as a cost-reducing, life-saving plan. While this was true in many aspects, many people have found that the former point has not held up. Premiums have risen in many states, drug prices continue to sky-rocket, and profiteers like Martin Shkreli reach their hands into sick people’s pocket books.

There’s a good reason for this, and unfortunately, it was a part of the ACA’s design. Cost controls have never been a part of the ACA. They were purposefully left out in a successful effort to hand over more control to health companies at the expense of the patient.

Is It Obama’s Fault?

Despite the political divide that surrounds President Obama’s marquee legislation, the truth is, the left and the right were fundamental in setting up this style of system. There’s a reason that Obamacare was known as a recreation of Romney-care: both were largely designed by the think-tank The Heritage Foundation. Though Heritage will fume when presented with claim, Politifact overwhelmingly supports it.

Health Care Is Expensive No Matter What, Right?

Whether left or right, all Americans have been taken to task by the lack of cost controls in the ACA. In Canada, where cost controls do exist, it’s possible to get the same drugs, the same surgeries, the same level of health care as Americans do, but for a fraction of the cost. This is no accident; ostensibly, premiums and costs were designed to rise under the ACA.

If you’re interested in what this means for you, contact us.

Health Insurance Does Not Have To Be So Difficult!

Did you make a trip to the hospital? Do you have a ton of bills and you don’t know why since you have insurance? You are not alone! There are a lot of adults in the United States that don’t understand insurance. Health insurance may be hard to understand, at first. The Henry J. Kaiser Family foundation tested men and women in basic health insurance information and the results are shocking. Fifty percent of females and forty-seven percent of men failed the ten question test on basic health insurance information with scores under seventy percent. That is shocking! Here are some helpful terms that may confuse people.

Some helpful health insurance terms to get yours through this policy year and the next!

  • Premiums are the amounts you pay monthly to stay covered.
  • Deductibles are the amount you have to pay before your insurance pays anything. (Hint: Check to see if your deductible payment goes toward your out-of-pocket.)
  • Out-of-pocket is the amount you need to pay to assist the insurance. (Hint: Once you pay all of your deductibles and out-of-pocket most procedures are free!)
  • Co-pay is what you pay upfront to assist the insurance. (Hint: Check your plans to see if this goes toward the deductible, out-of-pocket, both, or neither!)
  • Coinsurance is the percentage that you assist the insurance to pay when the doctor’s office charges you. (Hint: The doctor’s office can ask for payment when they see fit. This has nothing to do with your insurance company.)
  • In Network is the doctors, labs, and hospitals that have a contract with the insurance and your plan; to bring you better deals. (Hint: Never go by your friends In Network status is.)
  • Out of Network is the doctors, labs, and hospitals that do not have a contract with your insurance or plan. This means no deals and it could get expensive very fast! (Hint: Even if the hospital or doctor is In Network the labs and other doctors maybe Out of Network. Always check with your insurance)
  • Procedure codes are codes that the doctor’s office or hospital use to bill the insurance company. (Hint: Talk to the medical billing and coding specialist after the doctor makes the order to receive the procedure codes.)
  • Prior authorizations give the insurance company the opportunity to check if a procedure will be covered under your plan before the procedure happens. (Hint: You can appeal a denial decision if you feel that the plan does cover it.)

Health insurance is not that difficult! Ask your insurance company questions we are here to help. The only questions that are crazy are the ones that are never asked! You can contact us with any questions concerning your plan or future plan. We are here to help you.

Your New Medicare Card – What You Need to Know

What is happening?

  • This April, Centers for Medicare & Medicaid Services (CMS) will begin mailing new Medicare cards. You don’t need to do anything and your benefits won’t change. You can use your new card as soon as you receive it.
  • There are over 50 million people enrolled in Medicare, so the roll-out of the new card will take place over the following 12 months

Why are the cards changing?

  • The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that social security numbers be removed by April 2019.
  • To reduce your risk of identity theft and illegal use of your benefits. Social security numbers tracked earnings for social security. Today, Social Security identify individuals for financial purposes. For this reason, it is good practice to keep your social security number private, and separate from your date of birth and address.

What is different?

  • Your social security number will no longer be on the card. Instead you will see a new, 11 digit number. This identifier, called a Medicare Beneficiary Identifier (MBI), is randomly generated and is not associated with your social security number.
  • Your new MBI number is confidential – protect it

Watch out for scammers already taking advantage of the new card. Remember, the new card is free and you do not need to do anything to receive it. If you receive a call about Medicare, do not share information – Medicare will not call you. If you are unsure, always hang up and call back using the number on your card.

Read this helpful article from AARP

Five Things to Get Checked as Soon as You Have Health Insurance

Has your back has been bothering you? That rash from last summer still there? If you have been without health insurance for while, you may have some health concerns that have not been tended to.

Yearly Physical

Depending on how long it has been since your last physical, even missing one can be dangerous. Physicals are vital for you to do to catch anything that can or is harming your body. Early detection involving cancer and other fatal diseases can be caught at this stage. Insurance companies usually pay the full amount, meaning no co-pay for your yearly physicals.

Mammograms

About 1 in 8 US women will develop invasive breast cancer over the course of her lifetime. Once you have gotten your insurance, be sure to set an initial appointment to get a mammogram.

Pap Smears

This year, an estimated 12,820 women in the United States will be diagnosed with cervical cancer. It is estimated that 4,210 deaths from the disease will occur this year. A pap smear is used to screen for cervical cancer. The assessment is usually done in combination with a pelvic exam that you could get during your yearly physical.

Prostate Cancer

Gentlemen, approximately 11.6% of men will be diagnosed with prostate cancer at some point during their lifetime. Be sure to get your prostate checked once a year by a medical professional.

Dental

If you miss cleanings and don’t go in for routine checks, bacteria can not only rot your mouth but find their way into your bloodstream, possibly resulting in death. Get a healthcare plan that includes dental; you and your loved ones will appreciate it. And contact us to let us know how we can help you get insured.

Things not Covered by Medicare

Medicare is a federal health insurance plan for those aged 65 or older to pay for hospital care and outpatient medical services. Once you reach age 65 and apply for Social Security benefits, you are also eligible for Medicare. Medicare pays for 80 percent of the cost for these services, while you are left to pay the remaining 20 percent co-pay. That 20 percent can add up to quite a large dollar amount, especially for very expensive medical procedures. For those on a limited budget, this could be financially devastating. In addition, there are some services/procedures that are not covered by Medicare. Let’s take a look at those:

Medicare Part A (Hospitalization) Exclusions to Coverage

  • Prescription Drugs (expect those administered during a hospital stay)
  • Nursing home custodial care stays
  • Medical care outside of the United States
  • Cosmetic procedures/surgery
  • Private nursing care

Medicare Part B (Outpatient Care) Exclusions to Coverage

  • Podiatry (foot care)
  • Dental exams and procedures such as fillings, extractions or dentures
  • Hearing exams/hearing aids
  • Wellness programs
  • Eye examinations/prescription eyewear
  • Prescription drugs

Medicare Supplemental Insurance is available to provide coverage for things that Medicare does not cover or to help with co-pay amounts. There are 10 different types of standardized Medicare Supplemental insurance available (Plans A-M) offering a variety of coverage options depending on your needs.

If you are on Medicare but find that Medicare does not cover your medical care adequately, you can contact us for a consultation. We have trained agents who can consult with you and find you the right policy to meet your health care needs as well as one that will fit within your financial budget. We want to help you get the medical coverage you need and deserve.

Do You Need a Supplemental Medicare Plan to Complete Your Healthcare Needs?

If you are moving into Medicare for the first time, you may be separating from an employer healthcare plan that includes prescription  drug coverage and additional covered services, such as dental, vision or hearing.

Medicare A (Hospital Insurance) and B (Medical Insurance) combined  are referred to as original Medicare. If you are used to ( and comfortable with) an HMO sort of plan, then a Medicare Advantage Plan may be right for you. An Advantage plan replaces  original  Medicare and may offer many services that you want to keep as well.(Some may also  include prescription  drug  coverage) Advantage Plans offered vary in different states, you  may want to contact us to discuss   Advantage Plans available in your area.

A Medicare Supplemental plan (aka Medigap)  is in addition to Medicare Parts A and B. You  most likely pay a premium  for Part B, and you can choose  from a number of available Medigap plans  in your area to cover additional costs to you that original Medicare does not cover.  Medicare Part B, for instance  may pay 80 % of a covered service costs. With a supplemental plan, that insurance kicks in and will pay an additional percentage of the 20% of costs that you would be responsible for otherwise, perhaps even all of it.

Supplemental plans ( also know as the ‘alphabet plans’), range from Plan A – Plan N, are offered by private insurance companies, are standardized and offer a wide variety of additional coverage. Here you will  most likely pay your part B  premium and a premium for the plan you have selected.

Open enrollment period begins October 15, 2017. Now is the time to  consider which options are right for your personal healthcare needs. Please  contact us with any questions you may have.

What is the Health Insurance Marketplace Anyway?

All Americans need health insurance. This fact is something that we can all agree on, but where to begin? The Health Insurance Marketplace would be an excellent place to start. Many individuals do not know about this health insurance emporium, let alone what it is designed to do. Let us take a look.

The Health Insurance Marketplace was constructed to help individuals and small business owners find the health insurance they need for themselves, their families, and/or their employees. The word “marketplace” could never be more fitting. The Marketplace enables the user to customize a healthcare plan by showing all of the different options, companies, what is covered under each plan, estimated premium rates, and guidelines including checklists on what the best fit would be to meet their needs. The Health Insurance Marketplace is an excellent place to learn about and find materials on health insurance. Even if an individual has never purchased health insurance before, the Marketplace is excellent for them to use as it is very user-friendly.

Not only can a person customize a healthcare coverage plan, they can also update an existing plan, request tax information from a previous year, search for information regarding dental insurance, Medicaid and CHIP (Children’s Health Insurance Program), and contact someone in their area for additional assistance.

No matter where an individual is in life, the Health Insurance Marketplace is designed to help everyone succeed in finding the best plan for their personal healthcare needs.

For more information on the Health Insurance Marketplace, please contact us.

The Difference Between ACA and Medicaid

Do you know the difference between the Affordable Care Act and Medicaid? On the ACA health exchange health insurance is payed in the form of subsidies from the federal government. It can be confusing as to how government-subsidized private health insurance is really all that different from government-funded Medicaid. Although the ACA (Affordable Care Act) does expand Medicaid coverage to more people, the Affordable Care Act is not an insurance plan, it is a set of regulations. The ACA’s purpose is to regulate the health insurance industry.

  • ACA is offered by private insurance companies. It provides assistance to businesses, individuals and families and it allows you to keep the insurance you already have if you chose to do so. Medicaid requires you to be on one of their government-funded insurance plans.
  • Medicaid is effective as soon as your approved. ACA goes into effect the following year.
  • ACA only allows you to enroll or switch health insurance carriers during open enrollment. Medicaid allows you to enroll all year around.
  • Medicaid is retroactive.
  • ACA requires Americans to either have qualifying health insurance or pay a tax penalty. Medicaid is considered health insurance.
  • Medicaid sends funding straight to the doctors. The ACA gives the power of health insurance back to the agents.
  • ACA or Obamacare programs have co-payments, coinsurance and deductibles. Medicaid is 100% free.
  • Medicaid is funded through federal and state taxes. ACA is market for purchasing private insurance.

If you have any questions,concerns or feedback please contact us today. We’d love to hear from you!