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Health Insurance Gets Even Trickier

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It’s always been difficult and confusing to figure out whether you have the best health insurance to meet your family’s needs. This year, it’s going to be harder than ever! And because it’s the time of year that most people can make changes in their insurance coverage—for 2019 coverage, open enrollment for Medicare plans runs from October 15 to December 7…and from November 1 to December 15 for Affordable Care Act (ACA), “Obamacare,” plans—it’s crucial that you review your needs to find the best options to protect you. Some key changes you should know about…

• Short-term health plans now are available. When Congress did not repeal the ACA last year, the administration cleared the way for insurers to sell short-term policies (with renewability options ranging from 12 months to a maximum of three years) that are aimed at people who are unable to afford the comprehensive plans mandated by the ACA. While the average premium of an ACA Silver Plan (second-lowest, and most popular, in terms of coverage out of the four levels of coverage provided) is about $481 a month for a 40-year-old nonsmoker, a short-term plan may cost that same person as little as $160 a month. But there are strings attached. With these plans, benefits are limited, plus they can exclude anyone with a preexisting condition, which could be any condition, such as chronic bronchitis, previous skin cancers or a history of heart disease, including high blood pressure. My take: If you cannot afford a comprehensive ACA plan, this may be a viable, short-term option, particularly if you are healthy.

• Medicare Advantage programs are offering extras. Medicare Advantage programs are allowed to offer supplemental benefits not available in the traditional Medicare program, such as limited dental coverage and discounts on eyeglasses, hearing aids and gym memberships. But now Medicare Advantage programs may offer additional benefits if they are deemed “health-related.” This could cover services such as adult day care, home aides to help with daily living activities (such as bathing or dressing), transportation to medical appointments and home-safety modifications such as bathtub grab bars and wheelchair ramps. Note: These programs are not available to enrollees in the traditional Medicare program, and each insurer with Medicare Advantage plans may offer none…some…or all the various new options. The plan also can modify their premiums to cover costs. My take: If you are currently enrolled in a Medicare Advantage plan, call or go online to see if your plan is offering any of these programs and if they will be available to you (some services may require a doctor referral).

• You must review your existing coverage. Even if you don’t want to change health insurance, you need to review your plan to see whether any changes are being made for next year. My take: If you have prescription drug coverage, check to see that the medications you are taking will still be covered. Plans are required to send you a list of all covered drugs each year before re-enrollment. And you can call the insurer to ask about your drug coverage—a smart move, since their lists can change at any time. Make sure all your doctors and any hospitals that you might use remain in the plan. If you are on an ACA plan, go to Healthcare.gov to see whether new plans have been added that will better suit your needs.

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Source: Charles B. Inlander, a consumer advocate and health-care consultant based in Fogelsville, Pennsylvania. He was the founding president of the nonprofit People’s Medical Society, a consumer advocacy organization credited with key improvements in the quality of US health care, and is the author or coauthor of more than 20 consumer-health books. Date: November 1, 2018 Publication: Bottom Line Health
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