PLACERVILLE, CALIFORNIA

The Other Side of 50 Feb. 2013

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.

David Sayen

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