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2019 Open Enrollment: 10 Essential Facts

2019 Open Enrollment: 10 Essential Facts

Open enrollment for 2018 health plans is over. Unless you  qualify for a special enrollment period, you are unable to obtain an individual insurance policy

until open enrollment begins in November1 1, 2018 for 2019 coverage.

 

Open enrollment for 2019 individual & family health plans

Begins
Nov. 1, 2018
Ends
Dec. 15, 2018

Here’s what you need to know for the open enrollment period for 2018 individual and family health insurance plans.

1. The open enrollment deadlines have changed

Open enrollment starts Nov. 1, 2018, and continues through Dec. 15, 2018. But your coverage doesn’t start immediately.

  • If you sign up between Nov. 1, 2018, and Dec. 15, 2018, your coverage will start Jan. 1, 2019.

In 2018, the federal government’s current rule changes the open enrollment period from 3 months (around 90 days), as it was the last two year, to a mere 45 days. However, some states extended the time that people have to buy health insurance. For 2019 coverage, only a few states have set extended dates. These states and dates are:

  • California – Oct. 15 to Jan. 15
  • D.C. – Oct. 15 to Jan. 31
  • Minnesota – Nov. 1 to Jan. 13

If you buy after the Dec. 15 date in the states that are extending the enrollment period, you’ll need to check to see when the coverage will start as most still require you to obtain your plan by Dec. 15 for it to start on Jan. 1, 2018. If you buy after Dec. 15 your plan’s start date may be Feb. 1 or March 1, 2019.

No matter how long you have in your area, it’s important to not delay in choosing a plan once open enrollment starts.

People who qualify for Medicaid or the Children’s Health Insurance Program (CHIP) can enroll at any time of the year. These are state-federal programs for people with limited incomes or disabilities.

2. You must sign up if you don’t have health insurance from another source

You need to sign up for health insurance during open enrollment if:

  • You don’t have health insurance through your employer or your spouse’s employer.
  • You don’t have government coverage (such as veterans, Medicare and Medicaid)
  • You’re over age 26 and can no longer be on a parent’s health insurance.
  • You qualify for tax credits to help you pay for health insurance coverage.

3. This is the time to make changes to your current plan

What you can do during open enrollment:

  • You can renew your current individual/family health insurance plan.
  • You can choose a new health insurance plan through the marketplace in your state or through private insurance.

If you are currently enrolled in a marketplace health insurance plan, it will automatically renew. However, the plan may make changes to its provider network, copays, co-insurance and drug coverage. Your plan must send you a notice of any changes it will make for 2019.

Take time to read the notice to see what it means for you.  Make certain your doctors and preferred hospital are still in your network.  Be aware, you may be able to use out-of-network doctors and hospitals, if you’re willing to pay more. In some cases, you might not be covered at all if you go out of network.

Your prescription drug coverage also could change. The plan may no longer cover the drugs you take to manage your chronic conditions. It’s important that you check your plan’s drug benefits for 2019 before you allow it to renew. You may need to find a different plan for your needs and now’s the time to do it.

Health plans must provide an online link to the list of drugs they will cover, known as formularies.

4. Marketplace open enrollment is only for health insurance

If you qualify for employer-sponsored health insurance, you will likely want to buy health insurance through your employer and will not be affected by the fall open enrollment period for the government-run marketplaces. Ask your employer when its open enrollment period is.

Open enrollment is not for auto, life insurance or long-term care insurance. Those are completely separate products that you can buy on your own any time of year. It’s also not for Medicare. The fall open enrollment period for Medicare is Oct. 15 to Dec. 7, 2018.

5. If you miss open enrollment, you may have to wait for a year to sign up

If you miss open enrollment on your state’s health insurance exchange, you won’t be able to sign up for coverage unless you qualify for a special enrollment period.

Here’s what might trigger a special enrollment period: divorce, marriage, birth or adoption of a child, death of a spouse or partner that leaves you without health insurance, your spouse or partner who has you covered loses his/her job and health insurance, you lose your job and with it your health insurance, your hours are cut making you ineligible for your employer’s health insurance plan, or you are in an HMO and move outside its coverage area.

Under the Affordable Care Act, you must have health insurance or pay a penalty at tax time.

6. Federal penalties for not having health insurance – done away with for 2019

Health plans that don’t count as “coverage”

If your state continues with a penalty you it is possible you will still pay a penalty for being uninsured if you have only these types of plans:

  • Coverage only for vision care or dental care.
  • Workers compensation.
  • Insurance that covers only a specific disease or condition, such as cancer insurance.
  • Plans that offer only discounts on medical services.

For the 2018 tax year, the penalty will remain at 2.5 percent of your income or flat amounts (whichever is more). The 2018 flat and maximum amounts have not been published yet as the government will adjust for inflation. In 2017, the flat amounts were $695 per adult and $347.50 per child. The maximum penalty was set at $2,085.

If you owe a penalty, it will be taken from your 2018 tax refund. Unlike nonpayment of child support or other activities, the federal law prohibits the government from garnishing your wages or filing liens to collect an insurance penalty.

The ACA individual mandate penalty for not having health insurance has been eliminated for 2019 and beyond. However, some states may replace it with a state-based mandate for individuals to have health insurance or receive a penalty. Massachusetts has had such a mandate since 2006 and New Jersey is starting the mandate in 2019. Other states may follow suit, so be aware of what your specific state may require.

7. You have a choice of four levels of individual/family health insurance plans

Plans in the health insurance marketplace are divided primarily into four categories:

  • Bronze – highest out-of-pocket expenses for services (lower premiums)
  • Silver
  • Gold
  • Platinum – least out-of-pocket expenses for services (higher premiums)

The metal level indicates how much cost-sharing they require, explains Bob Fredericks of Fredericks Benefits in Redlands, Calif. Cost-sharing includes deductibles, copays and co-insurance that you must pay until you reach your out-of-pocket maximum limit.

Bronze plans have the highest deductibles and other cost-sharing, meaning more spent out of pocket for you when you use your health care, Fredericks says. Silver plans have lower cost-sharing than bronze, and gold plans even lower than silver. Platinum plans have the lowest deductibles and copays, etc.

Generally, the more you pay in premiums the lower your cost-sharing.

Which plan is right for you depends on how much you’ll need health care in 2018. If you go to doctors frequently to help manage a chronic condition, you likely want a plan with lower copays and deductibles. If you’re pretty healthy, you may be better off signing up for a plan with lower premiums but higher costs when you use your insurance.

Of course, it’s a gamble, because you never know what’s going to happen, Fredericks says. When it comes to bronze plans, Fredericks’ advice: “Caveat emptor.” (Buyer beware.) Once you sign up for a level of coverage, you are locked into that level for the year. If you choose a bronze plan and discover you need surgery, you can’t change to a plan with a lower deductible.

Health insurers also offer plans outside the marketplace that have a variety of benefit choices.

8. All health plans must cover 10 essential benefits

All health plans, no matter the level, must provide some coverage for at least 10 essential benefits. They are:

  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

The level of coverage for these services can vary. All the plans in the marketplace must provide consumers with a brief, understandable description of what they cover and how their plan works. The Summary of Benefits and Coverage (SBC) must be posted on the plan’s website. Check out the SBCs for the different plans you are considering. This is a good way to compare plans and benefits.

9. Your family size and income determines your eligibility for tax credits

2018 federal poverty level guidelines (applies to 2019 coverage)

Persons in Household 2017 federal poverty level for continental U.S. Premium subsidy threshold (400% of federal poverty level)
1 $12,140 $48,560
2 $16,460 $65,840
3 $20,780 $83,120
4 $25,100 $100,400
5 $29,420 $117,680
6 $33,740 $134,960
7 $38,060 $152,240
8 $42,380 $169,520

You may qualify for a premium tax credit which is based on income and family size. To qualify, your family income must fall between 100 and 400 percent of the federal poverty level (FPL).

For 2019 coverage for a family of four, the income bracket would be $25,100 to $100,400 to quality for these credits. (The government uses FPL standards from the previous year to determine eligibility.)

If you qualify, the credits can be applied to your monthly insurance premiums. If your income changes during the year and you no longer qualify for the credits when you file your taxes, you will have to repay.

10. If you suffered a hardship, you may not be required to buy health insurance

You may not be required to buy health insurance during open enrollment if you qualify for a hardship exemption. These include:

  • Being uninsured for less than three months of the year.
  • You are the victim of domestic violence or suffered from a natural or human-caused disaster such as a fire or flood that damaged your property substantially.
  • A close family member recently died or you had unexpected expenses related to caring for an elderly, ill or disabled family member.
  • You have been evicted from your home or suffered bankruptcy.
  • You found you are ineligible for Medicaid because your state did not expand eligibility under Obamacare.
  • You are not in the U.S. legally.
  • You are incarcerated — either detained or in jail.

You also are exempt if you are a member of a recognized religious sect that has religious objections to insurance.

Finally, you aren’t required to have health insurance if you live abroad for more than 330 days out of the year.

 

 

 

 

 

By Insure.com – Last updated: Sep. 4, 2018

PREPARING THE ELDERLY FOR AUTUMN AND RELATED HAZARDS

PREPARING THE ELDERLY FOR AUTUMN AND RELATED HAZARDS

 

Wear Layers, When Going Out.

Throughout the fall, temperatures can begin to feel cooler. However with the fall season, especially in Texas, one can find that it may be warm during the day and chiller by the evening. Be prepared for both instances with a sweatshirt, light jacket, or a hat, according to where you are located.

Senior Care and Seasonal Vaccines.

Cold and flu season begins in the fall , so getting a seasonal flu vaccine can help prevent unwanted illnesses. Washing your hands thoroughly with hot, soapy water for at least 30 seconds prevents the spread of bacteria and germs. Be sure to lots of sleep to strengthen your immune system to help your body naturally fight intruders.

Residential Maintenance.

For the elderly that are living by themselves may want to have a professional to check their heating systems. Even for those who reside in assisted living communities, now is an excellent time to grab a space heater or even two for those who feel cold. Never leave them unsupervised. Place at least 3 ft. between the heater and walls or curtains.

Outdoor Precautions and Senior Care.

Autumn remains warm enough to get out and enjoy outsides activities. The autumn weather can present certain obstacles for the elderly since rains cause slick surfaces and falling foliage could cause risky and low visible walking conditions. There is plenty of work associated with maintaining a safe outside area and driveways throughout autumn, so hiring a professional service prevents debris buildup and keeps walking paths clear.

Be Prepared For an Emergency

Transitioning weather can cause storms leading to power outages, loss of heat, water and phone services. Inclement weather means a difficult time venturing out for essential supplies. Prepare for emergency situations:

  • Store lots of non-perishables and clean water.
  • Keep candles, fresh batteries, flashlights, extra blankets, Sterno fuel and a battery-operated radio available.
  • Don’t wait on a crisis to establish a system of communication. Everyone, not just the elderly, living alone ought to create a “buddy system.”

Keeping appropriate heat levels inside the home is an integral part of elderly care. It is unfortunate that, many people are not able to afford for heating. Senior care and assistance programs provide a safe and clean environment for seniors where they have access to care and necessities to experience a high quality of life.

 

by  | Oct 10, 2015 | GeneralHelpful Information for Family MembersSenior Safety Tips |

Medicare vs. Medicaid

Difference Between

Medicare & Medicaid

Medicare and Medicaid are

Two Entirely Different Programs

 Medicare

 Medicaid

Government health insurance program for people over 65 and for those who are on Social Security disability. Funded jointly by the Federal Government and the individual states. Individuals must meet specific financial and “need for care” requirements in order to receive benefits.
Qualification based on age and/or disability. Participation not subject to income, asset or “needs” test. Qualification based on “need for care” and financial need. Single (unmarried) individuals must be essentially broke (below $2,000 in most states). Rules allow certain strategies to protect assets.
Provides coverage for hospitalization, doctors and other types of medical expenses. Medicare is a medical insurance program, and except for a limited short-term nursing home benefit, is not coverage for nursing home or other long-term care. Provides benefits for long-term nursing home care, and, in many states, benefits for other types of long-term care.
In order to get Medicare coverage for a nursing home stay, you must be in an approved skilled nursing facility, have been in the hospital for at least three days prior to entering the facility, and to be deemed by Medicare to be medically benefiting from that skilled nursing. Custodial care is not covered. Technically, there is a maximum of 100 days of nursing home benefit. In actuality, the requirement about medically benefiting usually limits the benefit to a period of 10-20 days for rehabilitation. Those individuals who meet the definition of “need for care,” as well as the financial requirements, can qualify for nursing home care (including custodial care). There is no maximum limit on the period of time that care can be provided.
Under no conditions does Medicare pay for assisted living, residential care facilities, and adult foster care. In many states, Medicaid will provide care in assisted living, residential care and/or adult foster care facilities.
Except during the time you’re in the hospital, Medicare does not cover medications. Medications are covered.
Medicare does have some benefit for home health but this is purely for medical reasons, not for caregivers to come in and attend to someone who needs help with personal needs on a long-term basis. In many states, in-home care is provided to allow for caregivers to come into the home to provide care and help with personal needs and activities of daily living.

10 Early Signs and Symptoms of Alzheimer’s

Age-Related changes in memory such as forgetfulness can be a normal part of aging. But It can also be a symptom of Alzheimer’s or another dementia. Alzheimer’s is a brain disease that causes a slow decline in memory, thinking and reasoning skills. There are 10 warning signs and symptoms, and every individual may experience one or more of these signs in a different degree. Therefore if you notice any of them, please see a doctor.

Read more

Help Your Senior Prepare For Winter

Winter is approaching and as the temperature drops, it’s important for older adults to prepare for the potential risks that cold weather can bring.

For the thousands of seniors living in the Northwest, winter may pose a number of risks. Reports have shown much higher incidences of injury and illness due to icy sidewalks, cold and dry air, flu viruses and in many cases, hypothermia.

According to the Healthy Aging Partnership, a coalition of more than 40 Puget Sound not-for-profit and public organizations dedicated to the health and well-being of older adults, older adults should keep these tips in mind to help ensure safety and optimum health this winter.

  • Older adults are more susceptible to hypothermia, which occurs when too much heat escapes from the body. It is important to dress warmly and keep dry, but equally important to remember good nutrition. Food provides the fuel we need to keep warm. Hot food and warm drinks are best to warm the body.
  • When going outdoors, remember to dress warmly. Wear layered, loose-fitting clothing and mittens. When possible, wear a hat to protect against heat loss since close to half of all body heat is lost through the head.
  • You can prevent many winter hazards simply by planning ahead. Before winter arrives, check all the windows and doors in your home for cracked or worn sealants. A new application of caulking may be needed; in a pinch, staple a sheet of plastic tarp over really old windows.
  • Talk to your electric or gas companies to see if you can be put on a level billing system that averages your energy payments equally over 12 months. This doesn’t save money, but it does help to budget during the heating season and prevent your heat from being shut off.
  • To avoid slips and falls, wear non-skid boots or other shoes with plenty of traction.
  • Cold weather can put extra strain on the heart. When doing winter chores such as shoveling snow, do some warm-up exercises first and take many breaks.
  • To conserve energy, heat only those rooms that you use. Close off the attic, garage, basement, spare bedrooms or storage areas. But don’t overdo your money-saving efforts: keep your thermostat set to at least 65 degrees to prevent hypothermia.
  • Shift energy use from peak to off-peak times. For example, do small things like running your dishwasher after 9 p.m.
  • When using a portable heater, plug the heater directly into an outlet, not to an extension cord. Make sure the outlet and wiring are in good condition. Keep the area around the heater clear of furniture, newspaper or other flammable materials and take special care to avoid tripping over cords.

Article from www.4elders.org

What is the Difference Between Companion Care and Personal Care?

When someone mentions Home Care, there is a wide range of services they may be offering and sometimes it can be difficult to figure out what those services are. This is intended as guide to give you more information about the names of the services and which one might be right for you.

It’s important to remember that home care is different than a Home Health Agency, these agencies primarily focus on skilled medical care at the home that a standard care provider cant give. Make sure to call and discuss with a company exactly what type services they provide, as well as research that they are a reputable company.

Home Care will basically fall into two categories: Companion Care and Personal Care. When you are talking about Companion Care this is usually a less intensive, non-medical type service. This often includes activities like taking care of a pet, driving to Doctors appointments or any errand for that matter, light household cleaning, preparing of meals, grocery shopping, washing dishes or clothes and watering plants. One of the most underrated services they can provide is simple companionship, whether that is playing cards, going on walks or simply a warm smile, it can make all the difference. We all have to deal with loneliness or isolation, but these problems can acutely affect us, as we get older.  Companion Care can be a great service to alleviate some loneliness, as well provide some basic help.

Personal Care is slightly different, they will generally provide all of the services covered by Companion Care, in addition to more hands on services like help with taking medication, bathing and dressing. Personal Care is usually for people who require a much higher degree of assistance rather than merely help with chores and appointments.

It is important not to expect more from a caregiver than what they have been trained to do. Make sure to have a frank discussion before hiring someone about what they are and are not able to perform in the execution of their job. It can be a little scary for some people to invite a stranger into their home, it is important to research any company you hire for Home Care to have a good reputation. However, it’s also important to remember that most of the time caregivers very warm, good people who love what they do and provide a lot of assistance, either for you or a loved one.

Article from seniordirectory.com

What is Respite?

Respite Definition: What is Respite Care and When Do I Need It?

The dictionary’s respite care definition is “a short period of rest or relief from something difficult or unpleasant” or “an interval of rest or relief”.  Respite care generally refers to care provided to offer such a break to a primary caregiver.  Respite might be provided full-time for a period such as a week or two (for example while a caregiver travels) or might be provided on an intermittent basis (such as every afternoon or once/week so the caregiver can run errands, rest or attend an activity).  You can find a good overview of respite care in Aging Wisely’s post, “Caregivers: Options for Respite“.

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