Now is the Health Insurance Season

(773) 742-6626 or anna.ruseva@gmail.com

Where do we belong when we seek health insurance?

First, and very important thing is to learn to distinguish between programs and insurance related to our health:

1. Medicaid - a program for the poor and children (CHIP, KidCare, All Kids) and parents with relatively low incomes.

2. Health Insurance through Marketplace - reduced amounts of health insurance premiums according to individual or family income.

3. Health Insurance directly from the insurer - for people with relatively high and high incomes - over 4 times the poverty line plus other factors.

4. Health Insurance through an employer - the employer pays at least 20% of the amount of the selected plan, and may or may not offer to include an offer for the employee's family members. It can offer different participation with its help for different workers. (there are other details valid for small and large employers)

5. Medicare - insurance for people over 65 or people with specific diseases and disabilities. Medicare can be combined with Medicaid when incomes are very low. (October 15^th – December 7^th is the annual enrolment).

These are the main products for serving the different groups of the population in the country. There are some others that we do not comment on, due to their small percentage (railway workers, for example).

Annual inclusion in the health insurance for people under 65 is:

November 1st to December 15th

The novelties this year on Medicare market are more than two, but let's first reiterate the concepts of importance:

1. The original Medicare we get after the age of 65 includes parts A and B. 
2. Part A is free of charge and covers hospital expenses. Part B is paid, approximately $ 145 per month if it's purchased at the age of 65. Parts A and B cover 80% of treatment costs, 20% is our responsibility. 
3. Part B is not mandatory, but if it is not purchased at the age of 65, it will be fined. These fines can only be avoided if your income is very low and you qualify for full Medicaid.
4. Part D is for medicines and is being offered from private insurance companies. It also collects fines if it is not bought in combination with another product or alone at the age of 65.

5. Part C is offered by private insurance companies and covers parts A and B, and typically includes part D and or other incentives. It can cost $ 0 and more per month. It always offers more services than A and B, but there are specific networks of doctors and hospitals to use. Networks may be PPO (PPO) or HMO (HMO).

6. Medicare Supplements are products that aim to eliminate our 20% co-pay responsibility, keeping access to the entire network of doctors accepting Medicare. They have different prices and are also offered by private insurance companies. They do not offer more coverage; they only claim to eliminate parts or all of these 20% of our responsibility. These insurances can be bought throughout the year. They cannot be combined with part C.
•    The new one for 2019 year was that insurance companies offering Part C will include products where B is paid by Medicaid. This means that if the Medicaid program has fully paid the Part B payment, we can get involved in C: Enriching our coverage and making it more desirable for network service providers and doctors. Drugs or so-called part D are also included in the coating and do not have to pay extra for them. To remember: You could be with Medicaid and Medicare and subscribe for Part C called Medicare Advantage. 

•   The other new offer is also for part C. It is a new product for our state market called Medicare Advantage with a Medical Saving Account (MSA). This product is with high deductible but after January 15th will deposit $ 2,500 in enrollee’s medical savings account. I think it is suitable for people in good health who are looking rarely for medical services and are in good financial situation as well. It does not include part D-medication coverage. This product also allows you to use the entire Medicare network: every provider who accepts Medicare.

Remember that the enrolment and changes for 2021th time is limited. Special enrolments in some cases will apply. For questions, call and/or text me (773) 742-6626, the phone only (773) 988-7608.