Critics of the Current System Say: Chapter 15: Medical Expense and Disability Income Insurance. Defenders of the Current System Say:

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Critics of the Current System Say: Chapter 15: Medical Expense and Disability Income Insurance. Defenders of the Current System Say:"

Transcription

1 Chapter 15: Medical Expense and Insurance Critics of the Current System Say: Americans pay too much for health care Health care cost increases Many Americans do not have adequate access Waiting to change the system will make cost control and universal access worse Medical Expenses and Loss of Income About 3/4 of our population is currently covered by private health insurance Most coverage is group insurance associated with employee benefit programs Another large source of coverage is Medicare, part of the Social Security program Defenders of the Current System Say: Only minor changes are needed to deal with the problems Prevailing system is more consistent with current economic and political philosophy Loss of Income and Medical Expenses About 40 million people not covered. They tend to be the unemployed, spouses of covered people, and lower income groups Many Americans are one paycheck away from losing (family) health insurance coverage COBRA provides some protection The question is: Is coverage a right? And, how is the cost to be borne? Increasing Health Care Costs - Reasons Medical inflation Technological improvements Medical malpractice Hospital labor, energy and other costs Increased use of outpatient care Catastrophic cases Aging of the US population Economics of the health care system Cost shifting

2 Cost Shifting versus Cost Containment Politics and Philosophy Cost Containment Attempts to actually reduce or control costs Cost Shifting Tries to shift costs to another party to pay for them Main issues being debated Issues of universal access Quality of care issues Control of costs Methods of rationing scarce supply Market-based vs. Government-provided benefits Drugs branded vs. generic; domestic or imported (cost); safety issues Examples of Cost Containment Five Kinds of Health Insurance Coverage Pre-admission testing and case management Utilization review Second opinions Home health care, hospice care, skilled nursing care Generic drugs Basic Medical Expense Coverage Major Medical Insurance Medicare Supplemental Long-term Care Insurance Examples of Cost Shifting Increase deductibles Increase premiums Lowering reimbursement percentiles Eliminating coverage of certain procedures Changing the coinsurance percentages Medical Expense Coverage Generally "first-dollar" coverage associated with Blue Cross or private insurers Usually expensive Private insurers tend to reimburse insured, whereas Blue Cross pays hospitals directly Various types - hospitalization, surgical, doctor contracts

3 Major Medical Coverage Features high face amounts, deductible provisions, and a participation clause Tends to make the coverage more like an ideal insurance transaction where losses are of economic significance and affect a smaller number of the insurance pool Benefit period and amount paid are a function of: Waiting period Replacement ratio Length of benefit period Partial disability coverage Rehabilitation and transitional benefit Medicare Supplement Insurance (Medigap) Loss of income during a period when medical expenses are high can be devastating Even when medical expenses are covered, other expenses continue or increase Intended to fill in the gaps in coverage under the Social Security Medicare program The Omnibus Budget Reconciliation Act (November 1990) authorized the NAIC to develop ten standard Medigap policies with a core group of benefits Medicare Supplement Insurance Standards Because of the potential for the moral and morale hazard this coverage contains several limits (a waiting period, and a maximum duration are common) and restrictions Definition of disability extremely important in selecting coverage Open enrollment individuals 65 or older must be accepted regardless of health Pre-existing conditions can eliminate preexisting conditions diagnosed 6 months before policy issued Duplicative coverage bars selling a Medigap policy to a person who already has an existing policy except a replacement policy Loss ratios must have at least a 75 percent loss ratio

4 Long-term Care Insurance Provides custodial care but various levels of care are provided under these contracts Demographic changes demographics indicate that there is an increasing need for long-term care for the elderly and disabled Long-term Care Insurance Level premium payable for life; many benefits however are not for life Trigger of coverage not being able to perform a number of ADLs; few mention loss of cognitive capability (mental impairment) Long-term Care - The Financial Problem 1/3 of current cost is financed by families 2/3 by the federal and state governments Private insurance coverage pays less than 1 percent Long-term Care Insurance Benefits dollar amount per day regardless of expenses or 100% of costs incurred Waiting period days Maximum dollar amount of coverage set from $100,000 to $1,000,000 or number of years (or months) in a long-term care facility Long-term Care - The Financial Problem The Continuing Debate Glossary of Terms A stay for two years currently costs on the average $70,000 to $100,000 Causes people to spend down for Medicaid eligibility Leaves many people exposed to the loss of their savings Worsens the financial problems of the state and federal governments Activity of daily living (ADL) Adult day care Continuing care retirement community Custodial care Hospice care Intermediate care Respite care Skilled nursing care Skilled nursing facility

5 Providers of Health Insurance Blue Cross and Blue Shield Life and health insurance companies HMOs and PPOs Patient s Bill of Rights Main Issues Access to Care Quality Assurance Patient Privacy and Information Grievances and Appeals Procedures Protecting the Doctor-Patient Relationship Managed Care Common Contract Provisions Almost all insurers are engaged in managed care as opposed to making indemnity payments Interferes with the doctor - patient relationship Financial incentives to encourage members to use the health care plan Contractual arrangements with providers or use own employees Quality assurance plans Entire contract clause Grace period Reinstatement Incontestable clause Claims Physical exam and autopsy Legal actions Change of beneficiary Patient s Bill of Rights Aim is to protect patients in managed care and other plans. Introduced in 1999 as the Patient s Bill of Rights Act Designed to address a variety of complaints concerning health care. Optional Contract Provisions Change in occupations and illegal occupation Misstatement of age Intoxication and narcotics Unpaid premiums Cancellation

6 Definitions and Exclusions Disability: inability to engage in (any,your own, or closely related) occupation. The latter definition is obviously more advantageous for insured Guaranteed Renewable: individual rates can be raised Noncanellable: rates cannot be raised for the life of the contract Definitions and Exclusions Pre-existing condition: a health problem arising before health insurance was purchased Coordination of benefits clause: prevents over-insurance and determines which insurance contracts or plans pay first when multiple policies apply

2006 Choosing a Medigap Policy:

2006 Choosing a Medigap Policy: CENTERS FOR MEDICARE & MEDICAID SERVICES 2006 Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare This official government guide can help you Learn what a Medigap (Medicare

More information

Effective Date: The date on which coverage under an insurance policy begins.

Effective Date: The date on which coverage under an insurance policy begins. Key Healthcare Insurance Terms Agent: A person who represents an insurance company and solicits or sells the company s insurance products. An agent may represent a single company or multiple companies.

More information

2007 Choosing a Medigap Policy:

2007 Choosing a Medigap Policy: CENTERS FOR MEDICARE & MEDICAID SERVICES 2007 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This is the official government guide with important information about what

More information

Senior Health Insurance Benefits Assistance. Section 3 Medigaps and Other Insurance to Supplement Medicare

Senior Health Insurance Benefits Assistance. Section 3 Medigaps and Other Insurance to Supplement Medicare Senior Health Insurance Benefits Assistance Section 3 Medigaps and Other Insurance to Supplement Medicare SHIBA Volunteer Training Program, April 2008 Section 3, Medigaps and Other Insurance to Supplement

More information

Health Insurance Beyond Medicare

Health Insurance Beyond Medicare Chapter 3 Health Insurance Beyond Medicare John J. Campbell, Esq. Law Offices of John J. Campbell, P.C. Michele M. Lawonn, Esq., P.T., C.A.P.S. Medical-Legal Advocates, LLC 3-1. Know Medicare Gaps SYNOPSIS

More information

A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA

A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA Published by the Arizona Department of Insurance Janet Napolitano, Governor Charles R. Cohen, Director of Insurance August 2003 1 Table of Contents

More information

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line INSURANCE FACTS for Pennsylvania Consumers A Consumer s Guide to Health Insurance 1-877-881-6388 Toll-free Automated Consumer Line www.insurance.pa.gov Pennsylvania Insurance Department Website Increases

More information

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line

Health Insurance. INSURANCE FACTS for Pennsylvania Consumers. A Consumer s Guide to. 1-877-881-6388 Toll-free Automated Consumer Line INSURANCE FACTS for Pennsylvania Consumers A Consumer s Guide to Health Insurance 1-877-881-6388 Toll-free Automated Consumer Line www.insurance.state.pa.us Pennsylvania Insurance Department Website Increases

More information

Bancorp Insurance Medicare Vocabulary

Bancorp Insurance Medicare Vocabulary Bancorp Insurance Medicare Vocabulary Advance Beneficiary Notice (ABN) A notice indicating the cost of a service that Medicare might not cover. Accepting Assignment Your Doctor agrees to accept payment

More information

What is a Medicare Advantage Plan?

What is a Medicare Advantage Plan? CENTERS FOR MEDICARE & MEDICAID SERVICES What is a Medicare Advantage Plan? A Medicare Advantage Plan (like an HMO or PPO) is a way to get your Medicare benefits. Unlike Original Medicare, in which the

More information

Understanding Health Insurance

Understanding Health Insurance Understanding Health Insurance Health insurance can play an important role when it comes to medical bills and prescription medications it can help protect you from high expenses. There are many types of

More information

Welcome to Medicare! Module 1A

Welcome to Medicare! Module 1A Welcome to Medicare! Module 1A Welcome to Medicare Introduction to Medicare Original Medicare Plan Medicare Supplement Insurance (Medigap) Medicare Advantage and other Medicare plans Medicare prescription

More information

Medicare Supplement (Medigap) Coverage for Medicare Beneficiaries

Medicare Supplement (Medigap) Coverage for Medicare Beneficiaries Medicare Supplement (Medigap) Coverage for Medicare Beneficiaries Brian Webb Manager, Health and Life Policy Nat l Assoc. of Insurance Commissioners February 6, 2009 Original Medicare Created in 1965,

More information

ACCIDENT AND HEALTH ONLY PRODUCER INDIANA EXAMINATION CONTENT OUTLINE *80 QUESTIONS TOTAL **TIME LIMIT 1 hour 20 minutes REVISED 7/10/2015

ACCIDENT AND HEALTH ONLY PRODUCER INDIANA EXAMINATION CONTENT OUTLINE *80 QUESTIONS TOTAL **TIME LIMIT 1 hour 20 minutes REVISED 7/10/2015 ACCIDENT AND HEALTH ONLY PRODUCER INDIANA EXAMINATION CONTENT OUTLINE *80 QUESTIONS TOTAL **TIME LIMIT 1 hour 20 minutes REVISED 7/10/2015 I. INSURANCE BASICS (11 QUESTIONS TOTAL) A. The Very Basics (2

More information

SERIP & Medicare. What are your options if you drop your State of Iowa Retiree Insurance?

SERIP & Medicare. What are your options if you drop your State of Iowa Retiree Insurance? SERIP & Medicare What are your options if you drop your State of Iowa Retiree Insurance? Presented by Senior Health Insurance Information Program Iowa Insurance Division 1-800-351-4664 What is SHIIP? Objective

More information

PHA s Insurance Guide

PHA s Insurance Guide INSURANCE GLOSSARY OF TERMS Welcome to our Insurance Guide: Glossary of Terms edition! Use this resource to decipher common insurance vocabulary mysteries. Affordable Care Act (ACA) - the comprehensive

More information

The Pennsylvania Insurance Department s. Your Guide to Choosing a MEDIGAP POLICY. Understanding Medigap

The Pennsylvania Insurance Department s. Your Guide to Choosing a MEDIGAP POLICY. Understanding Medigap Your Guide to Choosing a MEDIGAP POLICY Understanding Medigap Medigap is private health insurance designed to help pay healthcare costs that aren t covered by Medicare. Each Medigap plan covers different

More information

Medicare Supplement Insurance

Medicare Supplement Insurance Helping Older Persons With Legal & Long-Term Care Problems Medicare Supplement Insurance 1. What Is Medicare Supplement Insurance? Medicare Supplement Insurance, also known as MedSupp or MediGap is designed

More information

Medicare has four components, Part A, Part B Part C and Part D:

Medicare has four components, Part A, Part B Part C and Part D: Medicare What is Medicare? Medicare is a National Health Insurance Program for people 65 years of age and older Certain persons with disabilities under the age of 65 People with end stage renal disease

More information

STEPPING INTO MEDICARE. Invaluable help from the name you know and trust Blue Cross and Blue Shield of Illinois

STEPPING INTO MEDICARE. Invaluable help from the name you know and trust Blue Cross and Blue Shield of Illinois STEPPING INTO MEDICARE Invaluable help from the name you know and trust Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Illinois offers a great array of plans that pick up where Medicare

More information

Guide to Purchasing Health Insurance

Guide to Purchasing Health Insurance Guide to Purchasing Health Insurance What are your health insurance choices? Which type is right for you? Sample questions Looking for insurance in specific situations Tips for shopping for health coverage

More information

Solutions for Today Flexibility for Tomorrow.

Solutions for Today Flexibility for Tomorrow. Solutions for Today Flexibility for Tomorrow. Medicare Products and Services For More Information call our Senior Care Specialist, Raun Lynch at 856.380.5079 Or visit us on the web at www.cbdi-inc.com

More information

Choosing a Medigap Policy:

Choosing a Medigap Policy: CENTERS FOR MEDICARE & MEDICAID SERVICES 2010 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about the following:

More information

GLOSSARY OF MEDICAL AND INSURANCE TERMS

GLOSSARY OF MEDICAL AND INSURANCE TERMS GLOSSARY OF MEDICAL AND INSURANCE TERMS At Westfield Family Physicians we are aware that there are lots of words and phrases we used every day that may not be familiar to you, our patients. We are providing

More information

MEDICARE STEP-BY-STEP. A guide to your benefits, choices and next steps.

MEDICARE STEP-BY-STEP. A guide to your benefits, choices and next steps. MEDICARE STEP-BY-STEP A guide to your benefits, choices and next steps. Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association. The right Medicare

More information

Thank you... 1 www.bcbsga.com WPADVBR005M(11)-GA 20550WPSENMUB_004_G 9/11

Thank you... 1 www.bcbsga.com WPADVBR005M(11)-GA 20550WPSENMUB_004_G 9/11 Thank you... for your interest in our Medicare Supplement plans. We designed them to help you stay healthy and keep your medical costs down. It s why they are so popular. You get an added layer of security,

More information

It s Time for Medicare

It s Time for Medicare It s Time for Medicare med-waageinbook-1214 Medicare What you need to know. You re turning 65. Or you re already 65 and getting ready to retire and lose your healthcare coverage. You re almost ready for

More information

Supplementing Medicare: Your Rights to Purchase a Medigap Policy

Supplementing Medicare: Your Rights to Purchase a Medigap Policy FACT SHEET Supplementing Medicare: Your Rights to Purchase a Medigap Policy (B-005) p. 1 of 5 Supplementing Medicare: Your Rights to Purchase a Medigap Policy This fact sheet describes your rights to purchase

More information

If you decide to retire or have been laid off from your job before you turn 65 and you are not yet eligible for Medicare, what do you do?

If you decide to retire or have been laid off from your job before you turn 65 and you are not yet eligible for Medicare, what do you do? CONTENTS Health Insurance Considerations for Empty Nesters Medicare Considerations Long-Term Care Insurance Considerations Health Insurance Considerations for All Life Situations Disability Insurance Considerations

More information

MEDICARE SUPPLEMENT INSURANCE

MEDICARE SUPPLEMENT INSURANCE Illinois Insurance Facts Illinois Department of Insurance Rev Feb 2014 MEDICARE SUPPLEMENT INSURANCE What is Medicare? Medicare is a federal health insurance program for people 65 or older, some people

More information

Health Insurance. A Small Business Guide. New York State Insurance Department

Health Insurance. A Small Business Guide. New York State Insurance Department Health Insurance A Small Business Guide New York State Insurance Department Health Insurance A Small Business Guide The Key Health insurance is a key benefit of employment. Most organizations with more

More information

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare CENTERS FOR MEDICARE & MEDICAID SERVICES 2009 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about the following:

More information

You ARE EMBARKING ON THE NEXT CHAPTER OF YOUR LIFE

You ARE EMBARKING ON THE NEXT CHAPTER OF YOUR LIFE You ARE EMBARKING ON THE NEXT CHAPTER OF YOUR LIFE DO YOU HAVE A PLAN? HIGHMARKBCBSDE.COM APPLYING FOR Your MEDICARE SUPPLEMENT To apply for coverage through Highmark Blue Cross Blue Shield Delaware (Highmark

More information

MENDOCINO COUNTY 2010 HEALTH CARE BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS Questions and Answers

MENDOCINO COUNTY 2010 HEALTH CARE BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS Questions and Answers MENDOCINO COUNTY 2010 HEALTH CARE BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS Questions and Answers Q. Why the change? A. Anticipated exhaustion of the retiree health reserves by the end of

More information

How Medicare Works. Helping you make the most of Medicare. MedicareBlue SM Rx (PDP) S5743_101415_B02_RE Internal Approval 11/12/2015

How Medicare Works. Helping you make the most of Medicare. MedicareBlue SM Rx (PDP) S5743_101415_B02_RE Internal Approval 11/12/2015 How Medicare Works Helping you make the most of Medicare 2016 MedicareBlue SM Rx (PDP) S5743_101415_B02_RE Internal Approval 11/12/2015 About Medicare Whether you re new to Medicare or want a refresher,

More information

Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.

Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy. Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should

More information

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare CENTERS FOR MEDICARE & MEDICAID SERVICES 2011 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about the following:

More information

HEALTH INSURANCE. Types of Health Plans and How They Operate. Reimbursement and Fixed Allowance Insurance Plans (Department of Insurance Jurisdiction)

HEALTH INSURANCE. Types of Health Plans and How They Operate. Reimbursement and Fixed Allowance Insurance Plans (Department of Insurance Jurisdiction) HEALTH INSURANCE Illness for non-work related injuries can be financial devastating. Insurance can help protect against disastrous health care expenses and lost wages. If you have a job, your employer

More information

EXAMINATION CONTENT OUTLINE

EXAMINATION CONTENT OUTLINE EXAMINATION CONTENT OUTLINE LOUISIANA EXAMINATION FOR LIFE, HEALTH AND ACCIDENT INSURANCE SERIES 103 # of Questions Minimum Passing Score Time Allowed 150 70% Correct 160 Minutes CONTENT OUTLINE Louisiana

More information

Indiana Department of Insurance Filing Company Checklist INDIVIDUAL MEDICARE SUPPLEMENT Review Standards (Checklist must be submitted with filing.

Indiana Department of Insurance Filing Company Checklist INDIVIDUAL MEDICARE SUPPLEMENT Review Standards (Checklist must be submitted with filing. Indiana Department of Insurance Filing Company Checklist INDIVIDUAL MEDICARE SUPPLEMENT Review Standards (Checklist must be submitted with filing.) Company Name NAIC # Form number(s) Filing date Statute/Regulation

More information

What types of benefits are available in a long term care policy or certificate?

What types of benefits are available in a long term care policy or certificate? What is long term care? Long term care encompasses a wide range of medical, personal and social services. People may need this care if they suffer from prolonged illness, disability or cognitive impairment.

More information

What s a Medicare Advantage Plan?

What s a Medicare Advantage Plan? Revised April 2015 What s a Medicare Advantage Plan? You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the

More information

CHAPTER 20:06:13 MEDICARE SUPPLEMENT INSURANCE. 20:06:13:02.01 Requirements for definition of "accident" and similar words in policies.

CHAPTER 20:06:13 MEDICARE SUPPLEMENT INSURANCE. 20:06:13:02.01 Requirements for definition of accident and similar words in policies. CHAPTER 20:06:13 MEDICARE SUPPLEMENT INSURANCE Section 20:06:13:01 Repealed. 20:06:13:02 Definitions. 20:06:13:02.01 Requirements for definition of "accident" and similar words in policies. 20:06:13:02.02

More information

www.booneinsuranceassociates.com Copyright by BIA 1 MEDICARE MADE SIMPLE BIA 1/14/2016 Boone Insurance Associates Education Guide: New

www.booneinsuranceassociates.com Copyright by BIA 1 MEDICARE MADE SIMPLE BIA 1/14/2016 Boone Insurance Associates Education Guide: New www.booneinsuranceassociates.com Copyright by 1 MEDICARE MADE SIMPLE Boone Insurance Associates Education Guide: New Today s Agenda 2 About Introduction & History of Medicare Medicare Parts A, B, C, D

More information

Medicare 101 Guide Your Guide to Medicare Basics

Medicare 101 Guide Your Guide to Medicare Basics Medicare 101 Guide Your Guide to Medicare Basics Y0013_16_MEDGUI Accepted 11232015 bcbstmedicare.com Get More from Your Medicare This guide helps you understand how Medicare s different parts work and

More information

Kansas Insurance Department Medicare supplement. insurance shopper s guide. effective March 1, 2015. Ken Selzer, CPA Commissioner of Insurance

Kansas Insurance Department Medicare supplement. insurance shopper s guide. effective March 1, 2015. Ken Selzer, CPA Commissioner of Insurance Kansas Insurance Department Medicare supplement insurance shopper s guide effective March 1, 2015 Ken Selzer, CPA Commissioner of Insurance Medicare supplement insurance shopper s guide March 2015 Dear

More information

Medigap Insurance 54110-0306

Medigap Insurance 54110-0306 Medigap Insurance Overview A summary of the insurance policies to supplement and fill gaps in Medicare coverage. How to be a smart shopper for Medigap insurance Medigap policies Medigap and Medicare prescription

More information

Choosing a Medigap Policy:

Choosing a Medigap Policy: CENTERS FOR MEDICARE & MEDICAID SERVICES 2015 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: Medicare Supplement

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage options, also known as Traditional Blue (Medigap) policies. The Medicare Supplement Plans, when combined

More information

Your Long-Term Care Insurance Benefits

Your Long-Term Care Insurance Benefits Long-Term Care Long-Term Care Insurance can help you or an eligible family member pay for costly Long-Term Care assistance when you can no longer function independently. For more information on See Page

More information

Your Long-Term Care Insurance Benefits

Your Long-Term Care Insurance Benefits Long-Term Care Long-Term Care Insurance can help you or an eligible family member pay for costly Long-Term Care assistance when you can no longer function independently. For more information on See Page

More information

MEDICARE MYSTERY. Taking the OUT OF. Your how-to guide for finding the right plan for your needs

MEDICARE MYSTERY. Taking the OUT OF. Your how-to guide for finding the right plan for your needs Taking the MYSTERY OUT OF MEDICARE Your how-to guide for finding the right plan for your needs S6506_071015_B01a CMS Accepted 08/15/2015 H0302_565_2016 CMS Accepted 08/15/2015 An independent licensee of

More information

Life & Health Insurance Advisor

Life & Health Insurance Advisor Life & Health Insurance Advisor MRCT Benefits Plus is a comprehensive employee benefits, wellness and Human Resources consulting firm offering a variety of financial services to businesses and individuals

More information

For issues on or after June 1, 2010, Medicare Supplement Basic Benefit Plans A, B, C, D, F, G, M, and N coverage includes:

For issues on or after June 1, 2010, Medicare Supplement Basic Benefit Plans A, B, C, D, F, G, M, and N coverage includes: 1. What are the basic benefits on a Medicare Supplement Policy? For issues on or after June 1, 2010, Medicare Supplement Basic Benefit Plans A, B, C, D, F, G, M, and N coverage includes: a.) First 3 Pints

More information

CHAPTER 16 HEALTH INSURANCE POLICY PROVISIONS

CHAPTER 16 HEALTH INSURANCE POLICY PROVISIONS CHAPTER 16 HEALTH INSURANCE POLICY PROVISIONS UNIFORM POLICY PROVISIONS The National Association of Insurance Commissioners developed the Uniform Individual Accident and Sickness Policy Provision Law.

More information

Choosing a Medigap Policy:

Choosing a Medigap Policy: CENTERS FOR MEDICARE & MEDICAID SERVICES 2015 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: Medicare Supplement

More information

UNDERSTANDING HEALTH INSURANCE TERMINOLOGY

UNDERSTANDING HEALTH INSURANCE TERMINOLOGY UNDERSTANDING HEALTH INSURANCE TERMINOLOGY The information in this brochure is a guide to the terminology used in health insurance today. We hope this allows you to better understand these terms and your

More information

Health Insurance in Missouri

Health Insurance in Missouri Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.cancerlegalresourcecenter.org

More information

Vanguard Financial Education Series. Understanding your health care coverage in retirement

Vanguard Financial Education Series. Understanding your health care coverage in retirement Vanguard Financial Education Series health care Understanding your health care coverage in retirement When you retire, you ll need good health care coverage. Even if you re in the best of health now, you

More information

The Pennsylvania Insurance Department s LONG-TERM CARE. A supplement to the Long-Term Care insurance guide.

The Pennsylvania Insurance Department s LONG-TERM CARE. A supplement to the Long-Term Care insurance guide. LONG-TERM CARE A supplement to the Long-Term Care insurance guide. These definitions are offered to give you a general understanding of the terms you will hear when looking for Long-Term Care insurance.

More information

Long-term Care Insurance & Maine s Long-term Care Partnership Program

Long-term Care Insurance & Maine s Long-term Care Partnership Program A Consumer s Guide To Long-term Care Insurance & Maine s Long-term Care Partnership Program Published by: The Maine Bureau of Insurance July 2014 Paul R. LePage Governor Eric A. Cioppa Superintendent A

More information

Recovery After Stroke: Health Insurance

Recovery After Stroke: Health Insurance Recovery After Stroke: Health Insurance Stroke recovery can require lots of time and medical attention. Ideally, some of that medical care is covered by health insurance. Dealing with health insurance

More information

The A, B, C & D s of Medicare GeorgiaCares

The A, B, C & D s of Medicare GeorgiaCares The A, B, C & D s of Medicare GeorgiaCares Atlanta Regional Commission, Area Agency on Aging Applying for Medicare Initial Enrollment Period Apply 3 months before age 65, the month of 65 th birthday, or

More information

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare CENTERS FOR MEDICARE & MEDICAID SERVICES 2013 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: What is a Medicare

More information

Understanding your. Medicare options. Medicare Made Clear TM. Get Answers Series. Y0066_120629_084915 CMS Accepted

Understanding your. Medicare options. Medicare Made Clear TM. Get Answers Series. Y0066_120629_084915 CMS Accepted Understanding your Medicare options. Medicare Made Clear TM Get Answers Series Y0066_120629_084915 CMS Accepted learning about Medicare Choices. Eligibility Coverage options When to enroll Next steps and

More information

2016 Medicare Supplement Insurance Plans

2016 Medicare Supplement Insurance Plans Mutual of Omaha Insurance Company 2016 Medicare Supplement Insurance Plans We ve got you covered. Go Play! 105831 Policy Forms MM20-21669 Plan A, MM21-21670 Plan B, MM22-22407 Plan C, MM23-22408 Plan D,

More information

Shopping for Medicare Supplement Insurance Vermont Consumer Handbook January 2011

Shopping for Medicare Supplement Insurance Vermont Consumer Handbook January 2011 VERMONT DEPARTMENT OF BANKING, INSURANCE, SECURITIES AND HEALTH CARE ADMINISTRATION Shopping for Medicare Supplement Insurance Vermont Consumer Handbook January 2011 OTHER FORMATS FOR THIS PUBLICATION

More information

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare CENTERS FOR MEDICARE & MEDICAID SERVICES 2014 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: Medicare Supplement

More information

Medicare Made Clear. Helping your employees and volunteers understand Medicare.

Medicare Made Clear. Helping your employees and volunteers understand Medicare. Medicare Made Clear Quick Reference Guide Helping your employees and volunteers understand Medicare. Medicare helps nearly 50 million older and disabled Americans save on their health care expenses. But

More information

Medicare Basics and Medicare Advantage

Medicare Basics and Medicare Advantage Medicare Basics and Medicare Advantage Medicare The federal health insurance program for people age 65 and over, some disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent

More information

Outline of coverage. January 2015 May 2015

Outline of coverage. January 2015 May 2015 January 2015 May 2015 Outline of coverage The federal government has asked us to provide this outline of coverage to help you decide which plan best fits your needs and meets your budget. D98, 10/14, SM

More information

Outline of coverage. June 2014 May 2015

Outline of coverage. June 2014 May 2015 June 2014 May 2015 Outline of coverage The federal government has asked us to provide this outline of coverage to help you decide which plan best fits your needs and meets your budget. D98, 3/14, SM Marks

More information

What Federal Employees Need to Know About Their Health Insurance and Medicare

What Federal Employees Need to Know About Their Health Insurance and Medicare What Federal Employees Need to Know About Their Health Insurance and Medicare Federal employees have been paying the Medicare Part A (hospital insurance) payroll tax since Jan. 1, 1983. That means all

More information

Outline of coverage. June 2015 - May 2016

Outline of coverage. June 2015 - May 2016 June 2015 - May 2016 Outline of coverage The federal government has asked us to provide this outline of coverage to help you decide which plan best fits your needs and meets your budget. D98, 2/15, SM

More information

How Group Disability Income and Individual Disability Income Policies are Similar and Different

How Group Disability Income and Individual Disability Income Policies are Similar and Different Agenda Item 5.A. How Group Disability Income and Individual Disability Income Policies are Similar and Different As you review the Draft standards, you will find that in many respects provisions for group

More information

RETIREE MEDICAL BENEFITS Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group

RETIREE MEDICAL BENEFITS Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group RETIREE MEDICAL BENEFITS - 2016 Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group Pre-65 Retiree Medical Options Pre 65 1. GVSU Retiree Medical Plan 2. COBRA continuation coverage 3. Individual

More information

Making the most of Medicare

Making the most of Medicare Making the most of Medicare S5743_102714_K04_RE Internal Approval 10/27/2014 Today s Topics What is Medicare Who s eligible Medicare coverage Options to fill coverage gaps When you can enroll Finding the

More information

Supplementing Medicare: Your Rights to Purchase a Medigap Policy

Supplementing Medicare: Your Rights to Purchase a Medigap Policy FACT SHEET Supplementing Medicare: Your Rights to Purchase a Medigap Policy (B-005) p. 1 of 6 Supplementing Medicare: Your Rights to Purchase a Medigap Policy This fact sheet describes your rights to purchase

More information

Regence Bridge Medigap (Medicare Supplement) Plans

Regence Bridge Medigap (Medicare Supplement) Plans Information Brochure Regence Bridge Medigap (Medicare Supplement) Plans Making sure you have the coverage that is right for you. Regence BlueShield of Idaho is an Independent Licensee of the Blue Cross

More information

Finding Your Way With Medicare. Investor Guide

Finding Your Way With Medicare. Investor Guide Finding Your Way With Investor Guide Health Care Costs on the Rise Do you know how much health care will cost during retirement? Health care can be one of the biggest expenses in retirement and one you

More information

Revised 9/15/15. INDIVIDUAL MEDICARE SUPPLEMENT POLICIES Plans A through D, F, F*, G, K through N COMPANY: FORM(S): DATE: SERFF TRACKING NO.

Revised 9/15/15. INDIVIDUAL MEDICARE SUPPLEMENT POLICIES Plans A through D, F, F*, G, K through N COMPANY: FORM(S): DATE: SERFF TRACKING NO. INDIVIDUAL MEDICARE SUPPLEMENT POLICIES Plans A through D, F, F*, G, K through N Revised 9/15/15 COMPANY: FORM(S): DATE: SERFF TRACKING NO.: This checklist is not required to be included with a form filing.

More information

MEDICARE Medigap-PFFS-Long-Term Care Insurance

MEDICARE Medigap-PFFS-Long-Term Care Insurance MEDICARE Medigap-PFFS-Long-Term Care Insurance Medicare is a health insurance program for persons age 65 and older, people who have received Social Security Disability benefits for 24 consecutive months,

More information

Georgia Life and Health Insurance Cross Reference Study Guide

Georgia Life and Health Insurance Cross Reference Study Guide Georgia Life and Health Insurance Cross Reference Study Guide This cross reference provides you with the exam outline for your state insurance exam and a reference code where the specific topics can be

More information

Understanding Medicare Fundamentals

Understanding Medicare Fundamentals Understanding Medicare Fundamentals A Healthcare Cost Planning Overview By Mark J. Snodgrass & Pamela K. Edinger JD July 7, 2012 Money Tree Software, Ltd. 2430 NW Professional Dr. Corvallis, OR 98330 2012

More information

2013 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE

2013 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE Hospitalization Medical Expenses Blood Hospice 2013 OUTLINE OF MEDICARE SUPPLEMENT COVERAGE Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After June 1, 2010 These charts show

More information

MAP TO MEDICARE. H2461 101314 T01 CMS Accepted 10/21/2014 S5743 101414 K01 MN CMS Accepted 10/21/2014

MAP TO MEDICARE. H2461 101314 T01 CMS Accepted 10/21/2014 S5743 101414 K01 MN CMS Accepted 10/21/2014 2015 MAP TO MEDICARE H2461 101314 T01 CMS Accepted 10/21/2014 S5743 101414 K01 MN CMS Accepted 10/21/2014 MAP TO MEDICARE What is Medicare?...1 Part A: Hospital coverage...2 Part B: Medical coverage....3

More information

Your Exam Content Outline

Your Exam Content Outline Your Exam Content Outline The following outline describes the content of one of the New York insurance examinations. The examination will contain questions on the subjects contained in the outline. The

More information

Medicare Supplement Coverage Options

Medicare Supplement Coverage Options A Division of HealthNow New York Inc. An Independent Licensee of the BlueCross BlueShield Association. Medicare Supplement Coverage Options Thank you for your interest in our Medicare Supplemental coverage

More information

407-767-8554 Fax 407-767-9121

407-767-8554 Fax 407-767-9121 Florida Consumers Notice of Rights Health Insurance, F.S.C.A.I, F.S.C.A.I., FL 32832, FL 32703 Introduction The Office of the Insurance Consumer Advocate has created this guide to inform consumers of some

More information

FUNDAMENTALS OF HEALTH INSURANCE: What Health Insurance Products Are Available?

FUNDAMENTALS OF HEALTH INSURANCE: What Health Insurance Products Are Available? http://www.naic.org/ FUNDAMENTALS OF HEALTH INSURANCE: PURPOSE The purpose of this session is to acquaint the participants with the basic principles of health insurance, areas of health insurance regulation

More information

Getting Started with Medicare Beginning Medicare Training

Getting Started with Medicare Beginning Medicare Training Getting Started with Medicare Beginning Medicare Training This Medicare Counselor Training program was developed under a grant from UnitedHealthcare through a joint project with the National Association

More information

Annual Notice of Changes for 2016

Annual Notice of Changes for 2016 Premera Blue Cross Medicare Advantage (HMO) offered by Premera Blue Cross Annual Notice of Changes for 2016 You are currently enrolled as a member of Premera Blue Cross Medicare Advantage (HMO). Next year,

More information

Health Care. Why medical insurance. Group plan

Health Care. Why medical insurance. Group plan Health Care You positively must have a health plan HMO s vs. health insurance Deductibles, co-payments, coinsurance Ben Affleck Why medical insurance To cover three types of financial losses due to injury

More information

Long-Term Care Insurance

Long-Term Care Insurance About Assurity Life Assurity Life Insurance Company s origins are rooted in a century-long legacy of providing long-term security to policyholders that has earned generations of customers confidence and

More information

13. Insurance 3: Health, Long-Term Care, and Disability Insurance

13. Insurance 3: Health, Long-Term Care, and Disability Insurance 13. Insurance 3: Health, Long-Term Care, and Disability Insurance Introduction Having adequate health insurance is crucial; health insurance ensures that you and your loved ones will receive necessary

More information

Patient Financial Services

Patient Financial Services Acute care Short-term medical care provided for serious acute illness or episode. Patient Financial Services Allowable charges The specific dollar amount of a medical bill that one s health plan, Medicare

More information

2016 Evidence of Coverage for Passport Advantage

2016 Evidence of Coverage for Passport Advantage 2016 Evidence of Coverage for Passport Advantage EVIDENCE OF COVERAGE January 1, 2016 - December 31, 2016 Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Passport

More information

Chapter 91. Regulation 68 Patient Rights under Health Insurance Coverage in Louisiana

Chapter 91. Regulation 68 Patient Rights under Health Insurance Coverage in Louisiana D. A copy of the certification form shall be maintained by the insurer and by the producing agent or broker in the policyholder's record for a period of five years from the date of issuance of the insurance

More information

2015 Standard Medicare Supplement Insurance Plans

2015 Standard Medicare Supplement Insurance Plans 2015 Standard Supplement Insurance Plans Product Overview 77345_TX 0515 2015 MEDICARE SUPPLEMENT INSURANCE PLANS Like all Supplement insurance plans, Transamerica Premier Life Insurance Company s Supplement

More information

medicare Outline of Coverage

medicare Outline of Coverage 2015 medicare SUPPLEMENT Outline of Coverage Benefit Chart of Medicare Supplement Plans sold on or after June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement

More information