Frequently Asked Insurance Questions at Associated Benefits Group, Inc. Serving Douglas County, Oregon
Do I have a choice in how I receive Medicare Benefits?
Yes - there are two choices. You can either use the traditional fee-for-service delivery system, Original Medicare, in which you visit a hospital or doctor of your choice and pay a fee for services rendered, or you can enroll in a Medicare Advantage Plan with a Medicare contract. A Medicare Advantage Plan is a kind of Medicare Plan generally offered through an insurance company with a Medicare Contract that offers comprehensive health care coverage.
What are some basic differences between Medicare fee-for-service and Medicare benefits provided by a Medicare Advantage Plan?
Medicare coverage is the same under both of these systems, but the delivery of benefits, the method of payment, and the amount of out-of-pocket money is different.
Most people currently use the fee-for-service system, They visit a doctor or a hospital, which they choose, and pay deductibles and coinsurance for Medicare's Parts A and B (as described above). The majority of fee-for-service users supplement their Medicare plan with Medigap insurance, or with retiree coverage from their former employer or union.
An increasing number of people receive Medicare benefits through Medicare Advantage Plans which often require less out-of-pocket money than Medicare fee-for-service (Original Medicare), and sometimes provide benefits beyond those Medicare offers (Vision, Preventive Dental and Hearing). Medicare users who join Medicare Advantage Plans usually do not have to purchase Medigap insurance. While Medicare Advantage Plans are considered to be a health care bargain, you should consider joining one with caution. There is much debate about the access to doctors through provider networks and patients have found their access to specialists restricted to in-network providers.
If I am considering Medicare fee-for-service, what should I know?
You should know about Medicare Assignment, which will affect how much you pay for Medicare services. Medicare assigned physicians agree to accept Medicare's fee-for-service (The Medicare Allowed amount) as payment for services provided.
You should also know about Medicare supplemental insurance, which you will probably need.
Do I need Life Insurance?
The choices in life insurance policies are bewildering. Keep one thing in mind: if you don't need it, don't buy it.
Do I Need Life Insurance?
Life insurance needs vary depending on your personal situation. If you have no dependents, you probably don't need life insurance. If you don't generate a significant percentage of your family's income, you may not need life insurance.
If your salary is important to supporting your family, paying the mortgage or other recurring bills, or sending your kids to college, life insurance is important to ensure that these financial obligations are covered in the event of your death.
How Much Life Insurance Do I Need?
It's difficult to apply a rule-of-thumb because the amount of life insurance you need depends on factors such as your other sources of income, how many dependents you have, your debts, and your lifestyle. The general guideline is between five and ten times your annual salary.
Do I need to change my Medicare Advantage Plan
The answer here is individual. Most people enrolled in a Medicare Advantage Plan choose to stay with their plan. The reasons for changing to another plan fall in one of several categories. First is customer service. We have had a number of clients indicate their desire to change to another plan because they feel they are not receiving the customer service they certainly deserve. For example, unresolved issues involving claims. Claims not being paid. Calls to customer service not returned with information concerning the status of the issue. Another reason is co-payments. Most people who enroll in a Medicare Advantage plan do so to save premium over traditional Medicare Supplement Insurance. What they look at is the premium and the doctor co-pay. What they fail to see are the additional out of pocket expenses within the plan. And in addition, some physicians have problems being paid in a timely manner and thus recommend their patients change to another plan. Another issue involves the changing of drug tiers. For instance, a drug may go to a tier 2 or 3 from a tier 1. This causes additional expenses that may be unaffordable and certainly a need to change. These pressures should not take place but unfortunately they do.
On now to the flood of Sales Meetings and mailings. Because of the short Annual Enrollment Period insurance companies aggressively market their plans by holding a series of public meetings. It is very important to keep in mind these meetings are designed to steer you to the plan and to enroll. Often times it's without regard to your personal circumstances and preferences. These meetings are sales driven so attend with both eyes open. We don't recommend enrolling at the meeting. We do suggest you take the information and review it with your insurance professional. If you don't have an agent look for an independent agent that represents many plans and is Certified to sell Medicare Advantage Plans. These individuals can provide unbiased reviews and comparisons which will help you make an informed decision. As far as the mailings are concerned, these are advertisements. Don't respond as you will be contacted by insurance agents you don't know or by call centers for insurance companies attempting to enroll you in a plan.
And finally, do you need to change your plan? If you are happy with your current plan and are OK with the changes to your plan for the next year then the answer is no. Simply do nothing and you will be enrolled for the next year in your current plan. If you are not sure and don't know where to turn feel free to contact us. Our toll free number is 800-821-9876 and our agents are trained and Certified to discuss these plans with you. Our promise is to provide unbiased and straight forward answers to your questions.
How can my Oregon business benefit from the Affordable Care Act?
Have you received your notice about your health care tax credit from the IRS? If not, you may still qualify read on for more information.
The Affordable Care Act contains tax provisions that take effect this year and more that will be implemented over the next several years. Of interest to small businesses is the recent implementation of the small business health care tax credit.
Here's the basics on qualifying for the tax credit:
Your business must cover at least 50% of the cost of healthcare coverage for some of your workers based on the single rate.
Your business must have less than the equivalent of 25 full time workers. (i.e. An employer with fewer than 50 half-time workers may be eligible.)
Your business must pay average annual wages of less than $50,000
As you may see from the above, this tax credit is meant to cover smaller employers. These are the businesses that need more help.
What is the amount of the health care tax credit?
The credit is worth up to 35% of a small business's insurance premium cost in 2010. In 2014 this credit increases to 50% of a small business's insurance premium cost but it gradually phases out for firms with average wages between $25,000 and $50,000 and for firms with the equivalent of between 10 and 24 full-time workers.
Associated Benefits Group has a number of clients who are employers in Oregon. We seek to bring information to our current and possible future clients that will help save money and make better decisions about health care insurance. If you are an employer in Oregon and would like to consult with an experienced insurance agent
How can your service help me?
eQuoteLink.com provides Fast, Free and Easy Health, Life, Medicare Plans and Annuity Quotes.
Shopping for insurance can be a daunting task at best. Insurance plans are constantly changing and premiums continue to rise. eQuoteLink.com makes insurance shopping fast and easy helping you find the best plans at the best rates. Let us save you time and money by taking the guesswork out of the shopping process. Using our online tools to get insurance quotes FREE with no obligation from America's best companies.
Insurance Quotes for Health Insurance.
Whether you are an individual, family or a small business (50 or fewer employees) we have the health insurance coverage you need. Simply complete our short online form to get quotes and start comparing plans and rates to find the best health insurance plan for you based on your personal circumstances.
Insurance Quotes for Seniors.
If you are 64 1/2 or older you are probably already looking into available Medicare Plans in your area. With so many Medicare Supplement and Medicare Advantage plans to choose from deciding which plan is best can be very confusing. We understand the task of looking at and comparing Medicare Supplement and Medicare Advantage plans and the process of deciding which is the best plan for you. We have the information you need to make the right choice. With us, you will receive the information you need from a licensed professional who understands the rights of seniors as well as the programs, both private and government, available to you.
In addition to Medicare Supplement and Medicare Advantage Plans you will need to choose a Medicare Part D Prescription Drug Plan. The licensed professionals at Associated Benefits Group, Inc. have the specialized training and experience to assist in this decision.
Oregon Medical Insurance Pool (OMIP) - Federal Medical Insurance Pool (FMIP)
The Oregon Medical Insurance Pool (OMIP) - Federal Medical Insurance Pool (FMIP) is the high-risk health insurance pool for the state of Oregon. The Oregon Medical Insurance Pool (OMIP) - Federal Medical Insurance Pool (FMIP) was established by the Oregon Legislature to cover adults and children who are unable to obtain medical insurance because of health conditions. OMIP - FMIP is also available to those who have exhausted COBRA benefits and no other options are available to them. For more information please call us at 1-800-821-9876.
How do I choose a Health Plan?
Today there are more health plans to choose from than ever before. Not everyone has a choice. But if you do, this section can help you choose the plan that offers the best quality for you and your family.
The quality of health plans varies widely. In 1997, a study published by the National Committee for Quality Assurance (NCQA) showed differences in the ways managed care organizations provide access to care, keep people healthy, treat illness, deliver high-quality service, and satisfy patients. For example, studies show that treating heart attack patients with beta blocker drugs saves lives. The NCQA found that in some health plans, most heart attack patients got beta blockers. In other health plans, only one in three did.
Research shows that Americans say that quality is the most important thing they think about when choosing a health plan. But research also shows that few people understand their options well enough to make an informed choice.
Quick Check for Quality
The highly trained and licensed insurance professionals at Associated Benefits Group, Inc. are well qualified to assist you in researching available health plans in your area. Click here for assistance or call toll-free 800-821-9876.
Look for a plan that:
Has been rated highly by its members on the things that are important to you.
Does a good job of helping people stay well and get better.
Is accredited, if that is important to you.
Has the doctors and hospitals you want or need.
Provides the benefits you need.
Provides services where and when you need them. Meets your budget.
I have questions concerning Medicare. Where can I go?
For Information about....
Enrolling in Medicare, correcting your medicare Card or getting a new card
Health Insurance Counseling and help making health insurance decisions
State Health Insurance Assistance Program (SHIP)
Call Medicare 1-800-Medicare for local number
For questions about local Medicare Plans, Medicare Supplement, Medicare Advantage and Prescription Drug Plans please contact our office at 1-800-821-9876 or use our Contact Form.
We here at Associated Benefits Group, Inc. realize getting straight forward unbiased information regarding health insurance, Medicare Supplement Plans and Medicare Advantage Plan is difficult and confusing. As an independent agency with over 20 years' experience working with Seniors and Senior Insurance we are very familiar with the issues facing today's seniors. We are always looking for ways to be better advocates for seniors in Oregon. To do this we continually research the market seeking the best insurance plans available.
We will also assist you in getting assistance for help paying for prescription drug coverage through Social Security at no cost to you.
For answers to the many questions concerning Medicare and Social Security we urge you to contact the agencies listed above.
UCR / Usual, Customary and Reasonable Charges
An amount customarily charged for or covered for similar services and supplies which are medically necessary, recommended by a doctor, or required for treatment in a given geographic location. i.e.: the UCR in Los Angeles may be higher than the UCR in Portland, OR.
What is a Deductible?
The "Deductible" is the amount an insured must pay before an insurance company begins paying claims. This is typically found in Health Insurance as well as Home and Auto Insurance Policies. Once the "deductible is met" the insurance company begins paying its share of the claim, i.e.: 80% / 20%. The 20% is the insured's co-insurance which is a cost share until the Out of Pocket Maximum is met. At this the insured has reached his/her the Stop Loss and where the company pays 100% of the claim based on Usual, Customary and Reasonable charges or the contracted amount. See co-insurance, Out of Pocket Maximum, Usual, Customary and Reasonable (UCR), Contracted Amount and Stop Loss.
What is Life Insurance?
Life insurance or life assurance is a contract between the policy owner and the insurer, where the insurer agrees to pay a designated beneficiary a sum of money upon the occurrence of the insured individual's or individuals' death or other event, such as terminal illness or critical illness. In return, the policy owner agrees to pay a stipulated amount (at regular intervals or in lump sums) i.e. a premium.
The value for the policyholder is derived, not from an actual claim event, rather it is the value derived from the 'peace of mind' experienced by the policyholder, due to the negating of adverse financial consequences caused by the death of the Life Assured.
Life policies are legal contracts and the terms of the contract describe the limitations of the insured events. Specific exclusions are often written into the contract to limit the liability of the insurer; for example claims relating to suicide, fraud, war, riot and civil commotion.
Life-based contracts tend to fall into two major categories:
Protection policies - designed to provide a benefit in the event of specified event, typically a lump sum payment. A common form of this design is term insurance.
Investment policies - where the main objective is to facilitate the growth of capital by regular or single premiums. Common forms (in the US anyway) are term life,whole life, universal life and variable life policies.
What is Medicare?
Medicare is a federal health insurance program for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure, called End-Stage Renal Disease or ESRD. This is permanent kidney failure requiring dialysis or a kidney transplant.
Medicare consists of 4 parts. Medicare Part A - Hospital Insurance, Medicare Part B - Medical Insurance, Medicare Part C - Medicare Advantage and Medicare Part D - Prescription Drug Coverage.
Who Qualifies for Medicare?
To qualify for Medicare you must be a United States citizen or permanent resident age 65 or older and receive or are eligible to receive Social Security benefits. Or you receive, or are eligible to receive railroad retirement benefits; or your spouse (living or deceased, including divorced spouses) worked long enough in government employment where Medicare taxes were paid; or you are the dependent parent of someone who worked long enough in government employment where Medicare taxes were paid.
Also, certain people younger than age 65 can qualify for Medicare, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis - Lou Gehrig's Disease.
What is Medicare Part A?
Medicare Part A can be best defined as hospital insurance. It covers all Medicare approved in-patient hospital services and skilled nursing facilities. Also covered under Part A is home health services and hospice care. Medicare part A is automatically available to those who worked a sufficient number of quarters to qualify and is without premium. For those who do not qualify Part A is available for a premium.
What is Medicare Part B?
Medicare Part B is best defined as medical insurance. It provides coverage for doctor's services such as office visits and outpatient care, and other Medicare services not covered by Part A. For instance, physical and occupational therapists and some home health care. A premium is paid for Medicare Part B. This is usually deducted from Social Security Benefits before the benefit check is paid. This premium is adjusted annually.
What is Medicare Part C?
Medicare Part C, formerly known as "Medicare+Choice," is now known as "Medicare Advantage. Private insurers, under contract with Medicare, manage Medicare Advantage Plans. These plans can be Private Fee For Service, PFFS, Preferred Provider Organization, PPO, Regional Preferred Provider Organization, RPPO, Health Maintenance Organization, and HMO.
Medicare Advantage Plans can provide benefits in addition to those provided by Original Medicare such as Dental, Vision and Prescription Drug Coverage.
What is Medicare Part D?
Medicare Part D is defined as Prescription Drug Coverage. Part D provides coverage for certain prescription drugs listed on the plan formulary and is offered by private insurance companies. Formulary drugs are listed in tiers 1 - preferred generics, tier 2 - non-preferred generics and preferred brands, tier 3 - non-preferred brands and tier 4 - specialty drugs (may include injectables)
When can I apply for Medicare Part B?
You can apply for Medicare Part B when you turn age 65. For most of us this will take place automatically. You will receive your Medicare ID card by mail usually 60 to 90 days prior to your 65th birth month. You have 3 months prior to your birth month, your birth month and 3 months following your birth month to enroll in Part B.
If you are still working or will continue to work past age 65 and have group health coverage through your employer you can wait to enroll in Part B until that coverage ends. You can do this without a late enrollment penalty. It's best to contact Social Security at least 30 days prior to the end of your group coverage to be sure you receive your Part B benefits without a lapse in coverage.
What Should I Consider When Choosing or Changing My Medicare Coverage
8 Things to consider when choosing or changing your coverage
Coverage - Are the services you need covered?
Your other coverage - If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator, insurer, or plan before making any changes.
Costs - How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out of pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
Doctor and hospital choice - Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
Prescription drugs - What are your drug needs? Do you need to join a Medicare drug plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary (drug list)?
Quality of care - The quality of care and services given by plans and other health care providers can vary. See the "Resource Locator" for more help comparing plans and providers.
Convenience - Does the plan include the doctors you see and the pharmacies you use? Can you get your prescriptions by mail? Do the doctors use electronic health records or E-prescribe?
Travel - Will the plan cover you if you travel to another state?
If you're in a Medicare plan, review the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) your plan sends you each year. The EOC gives you details about what the plan covers, how much you pay, and more. The ANOC includes any changes in coverage, costs, or service area that will be effective in January. If you don't get an EOC or ANOC, contact your plan.