COVID-19 and My ACA or Medicare Health Plan
If you are wondering whether the COVID-19 test is covered by your individual health insurance plan. All ACA-compliant health insurance plans generally cover any Medically-Necessary (M-N) tests and/or procedures. The administration designated a new COVID-19 test as an Essential Health Benefit (EHB). EHBs are defined in the Affordable Care Act (ACA) as a set of benefits which individually purchased health insurance in the U.S and insurance plans in small group markets must cover (both inside and outside of the Health Insurance Marketplace). If you have individual health coverage OR have group health insurance, check with your carrier or employer for more details.
The major change is that we may be seeing an easier path to accessing medical services. For example, many insurers are waiving Prior Authorizations for (M-N) diagnostic testing. Additionally, many insurers are not requiring member cost-sharing (co-payments and/or co-insurances) for (M-N) COVID-19 testing and services. Similar rules typically apply to Medicare and Medicaid beneficiaries. Also, many plans are encouraging Tele-Medicine services to reduce the strain on the doctor’s offices and hospital (and most at no co-pay).
Although U.S. law requires that people who are truly sick get the emergency care they need regardless of ability to pay; it does not mean that you will leave with NO BILLS. Do you qualify for a Special Enrollment Period (SEP) to gain access to ACA-compliant health coverage? Short-term health plans and Christian Medi-share health plans may be options to help reduce Out-of-Pocket financial exposure.
Give us a call if we can be of service at 866-901-7233 or 972-332-4263.
2020 Medicare Cost Increases Outpace C.O.L.A.
Many of you have noticed over the last few months that the amount of your Social Security check is different than last year. There are two reasons for this change: Cost of Living Adjustment (C.O.L.A.) and Medicare cost increases.
If you have been receiving social security benefits for any length of time; you are probably familiar with COLA increases that are periodically announced by the Social Security Administration. If you are one of these recipients, then you also know it’s a bit of “robbing Peter to pay Paul”. The SSA announced a 1.6% increase to benefits for most Social Security recipients for 2020. Not long after, the Center for Medicare and Medicaid Services (CMS) announced 7% increases to the base Medicare Part B premium and the Medicare Part B deductible. The Part B premium is the amount that we pay for MEDICAL benefits under Original Medicare – generally deducted from social security check. The Part B deductible is the amount that we are generally responsible for under Original Medicare before Medicare covers 80% of our remaining Part B medical expenses. Additionally, CMS increased fees for other Medicare related services.
Let’s break this down. The 1.6% increase from the SSA is projected to be about a $24 per month increase for the average retiree. However, the 7% increase to the base Medicare Part B premium ($144.60 in 2020) will deduct another $9.10 from the average Senior’s check. Added to that, for those that are still in Original Medicare (not a Medicare Advantage/Part C) will be responsible for a new Part B deductible of $198. That’s a $13 increase over 2019. Simple math says that is about $24 IN and about $22 OUT. Hey; you still have enough to buy 2 non-taxable items from Dollar Tree®.
Give us a call at 866-901-7233 if you would like a benefits check-up to ensure that you are getting all the benefits you qualify for. Be Blessed!