Friday, August 1, 2014
PLACERVILLE, CALIFORNIA
99 CENTS

Coming soon: A new way to buy health insurance

By
From page OSF8 | February 27, 2013 |

When key parts of the health care law take effect in 2014, you’ll have a new way to buy health insurance for yourself, your family or your small business: the Health Insurance Marketplace. The Marketplace is designed to help you find health insurance that fits your budget, with less hassle.

Every health insurance plan in the new Marketplace will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality, and other features that may be important to you, in plain language that makes sense.

You’ll know you’re getting a quality health plan at a reasonable price, because there’s nothing buried in the fine print.

When you shop at the Marketplace, all your costs are stated upfront. So you’ll get a clear picture of what you’re paying and what you’re getting before you make a choice.

California’s Marketplace is called Covered California (CoveredCa.com).

Under the health care law, you and your family also will have new protections. Health insurance companies can’t refuse to cover you or charge you more just because you have a chronic or pre-existing condition. And they can’t charge more for women than for men.

Here are three things to keep in mind about the Health Insurance Marketplace:

• It’s an easier way to shop for health insurance. The Health Insurance Marketplace simplifies your search for insurance by gathering all your options in one place. One application, one time, and you and your family can explore every qualified insurance plan in your area — including any free or low-cost insurance programs you may qualify for, such as Medi-Cal or the Children’s Health Insurance Program.

• Most people will be able to get a break on costs. Programs that lower costs are available for almost everyone. You may be eligible for a free or low-cost plan, or a new kind of tax credit that lowers your monthly premiums right away. New rules and expanded programs mean that even working families can get help paying for health insurance at the Marketplace.

• Clear, apples-to-apples comparisons. All health insurance plans in the Marketplace present their price and benefit information in simple terms you can understand, so you don’t have to guess about your costs.

Starting on Oct. 1, you’ll be able to enroll in a health plan through Covered California. Detailed information will be available about all the insurance plans offered in your area.

You can sign up now at CoveredCa.com to get e-mail updates that will let you know how to get ready to enroll in the plan of your choice.

If you have difficulty finding a plan that meets your needs and budget, there’ll be people available to give you personalized help with your choices. These helpers aren’t associated with any particular plan, and they don’t receive any type of commission, so the help they give you will be completely unbiased.

CoveredCa.com will be much more than any health insurance Website you’ve used before. Insurance companies will compete for your business on a level and transparent playing field, with no hidden costs or misleading fine print. You’ll have more choice, more control, and more clout when it comes to health insurance.

Insurance coverage offered through Covered California takes effect on Jan. 1, 2014.

 

How Medicare works with other insurance

You may have wondered how Medicare works with other insurance coverage, such as a group health plan from a former employer or union.

It’s an important issue because it determines whether your medical bills are paid correctly and on time.

If you have Medicare and other insurance, always be sure to tell your doctor, hospital, and pharmacy.

When there’s more than one insurance payer, certain rules determine which one pays first.

This is what’s called “coordination of benefits.”

The “primary payer” pays what it owes on your bills first — and then sends the balance to the “secondary payer” to pay.

In some cases, there may also be a third payer.

The primary payer pays up to the limits of its coverage. The secondary payer only pays if there are costs the primary insurer didn’t cover.

But keep in mind that the secondary payer (which may be Medicare) may not pay all of the uncovered costs.

If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before that insurance will pay. (The Part B premium for most Americans in 2013 is $104.90 per month.)

Here’s who pays first in various situations:

If you have retiree insurance (coverage from a former job), Medicare pays first.

If you’re 65 or older, have group coverage based on your or your spouse’s current employment, and the employer has 20 or more workers, your group plan pays first. (If the company has fewer than 20 employees, Medicare pays first.)

Your group plan also pays first when you’re under 65 and disabled, have group coverage based on your or a family member’s current employment, and the employer has 100 or more employees. (Medicare pays first if the company has fewer than 100 employees.)

If you have Medicare because of end‑stage renal disease (permanent kidney failure), your group plan pays first for the first 30 months after you become eligible for Medicare. Medicare pays first after this 30‑month period.

Medicare may pay second if you’re in an accident or have a workers’ compensation case in which other insurance covers your injury or you’re suing another entity for medical expenses.

In these situations you or your lawyer should tell Medicare as soon as possible. These types of insurance usually pay first for services related to each type:

• No-fault insurance (including automobile insurance);

• Liability (including automobile and self-insurance);

• Black lung benefits;

• Workers’ compensation.

Medicaid and TRICARE (the healthcare program for U.S. armed service members, retirees, and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans, and/or Medicare Supplement Insurance (Medigap) have paid.

For more information visit medicare.gov/publications and read the booklet “Medicare and Other Health Benefits: Your Guide to Who Pays First.”

You can also call 1-800-MEDICARE (1‑800‑633‑4227) and ask for a copy to be mailed to you. TTY users should call 1‑877‑486‑2048.

If you have questions about who pays first or you need to update your other insurance information call Medicare’s Coordination of Benefits Contractor at 1‑800‑999‑1118. TTY users should call 1-800-318-8782.

You can also contact your employer or union benefits administrator. You may need to give your Medicare number to your other insurers so your bills are paid correctly and on time.

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Do you know someone who has been denied health insurance due to a pre-existing condition? If so, they may be eligible for the Pre-Existing Condition Insurance Plan. Call toll free 1-866-717-5826 (TTY 1-866-561-1604) or visit pcip.gov and click on “find your state” to learn more.

Comments

comments

.

News

Cameron Park house burns

By Dawn Hodson | From Page: A1 | Gallery

 
Supes delay petition

By Chris Daley | From Page: A1

Fire generated small city, inspired volunteers

By Dawn Hodson | From Page: A1 | Gallery

 
Sand Fire 95% contained

By Cole Mayer | From Page: A1

 
Two fires in town

By Cole Mayer | From Page: A3

SUV hits parked cars

By Dawn Hodson | From Page: A12

 
.

Opinion

The weekly Daley: The wrong side of history

By Chris Daley | From Page: A4

 
Billingsley’s bullets: Advice from my psychiatrist

By Bob Billingsley | From Page: A4

.

Letters

EID rate discrimination

By Letters to the Editor | From Page: A5Comments are off for this post

 
Second Amendment

By Letters to the Editor | From Page: A5Comments are off for this post

Pollock Pines’ Fourth of July Parade

By Letters to the Editor | From Page: A5Comments are off for this post

 
Water conservation

By Letters to the Editor | From Page: A5Comments are off for this post

Koby

By Letters to the Editor | From Page: A5

 
Debt reduction at EID with Coco?

By Letters to the Editor | From Page: A5

Time for change in CP

By Letters to the Editor | From Page: A5

 
Olives need less water

By Letters to the Editor | From Page: A5

.

Sports

Camp draws good numbers

By Jerry Heinzer | From Page: A9Comments are off for this post | Gallery

 
New law tackles gridiron concussion problem

By Mike Bush | From Page: A9 | Gallery

Outside with Charlie: Rafting denied

By Charlie Ferris | From Page: A9

 
Racing returns with big 5-division card

By Bill Sullivan | From Page: A9

Roundup: July 31, 2014

By Democrat Staff | From Page: A10

 
.

Prospecting

Sing while you paint

By Placerville Arts Association | From Page: B1Comments are off for this post | Gallery

 
Plenty of golden fun during SlugFest

By Democrat Staff | From Page: B2 | Gallery

Things to do: Aug. 1, 2014

By Democrat Staff | From Page: B2

 
The making of a champion

By Special to the Democrat | From Page: B2

Art on the Divide is showing new exhibitor

By Art On The Divide | From Page: B3

 
‘The Flu Season’ stirs emotions

By Ovation Stage | From Page: B4

Guitar group performs in Sutter Creek

By Sutter Creek | From Page: B5

 
Time to register for classes at Center Stage

By Center Stage Dance Academy | From Page: B5

Get a groove on in Sutter Creek

By Sutter Creek | From Page: B8

 
Chris Young in concert at Carson Valley Inn

By Carson Valley Inn | From Page: B8

The music continues at Bear Valley Music Festival

By News Release | From Page: B8

 
Sacramento Museums are celebrating

By Sacramento Association Of Museums | From Page: B9

 
.

Essentials

Weather stats

By Michael Raffety | From Page: A2

 
Crime Log: July 17-19

By Cole Mayer | From Page: A2

.

Obituaries

Larry A. Randall

By Contributor | From Page: A2

 
Mark A. Smith

By Contributor | From Page: A2

Jeffie “Jeff” Lee Callahan

By Contributor | From Page: A2

 
Patsy Ruth Wing

By Contributor | From Page: A2

Lisa Oliver Rose

By Contributor | From Page: A2

 
.

Real Estate

Decorating your home by the numbers

By Marni Jameson | From Page: HS4

 
Avoiding the deal killers

By Ken Calhoon | From Page: HS4

Hilltop home views outrank water-front views

Press Release | From Page: HS7

 
Luxury home sales jump

Press Release | From Page: HS11

 
Pending home sales decrease in June

Press Release | From Page: HS13

 
Sheryl Lindroos joins American Heritage

Press Release | From Page: HS17

Sunny Rosabella exudes a warm ambiance

Press Release | From Page: HS23

 
.

Comics

.

Home Source

Decorating your home by the numbers

By Marni Jameson | From Page: HS4

Avoiding the deal killers

By Ken Calhoon | From Page: HS4

Hilltop home views outrank water-front views

Press Release | From Page: HS7

Luxury home sales jump

Press Release | From Page: HS11

Pending home sales decrease in June

Press Release | From Page: HS13

Sheryl Lindroos joins American Heritage

Press Release | From Page: HS17

Sunny Rosabella exudes a warm ambiance

Press Release | From Page: HS23