Types of Health Insurance Plans

Affordable Care (ACA or Obama Care)
Affordable Care Act (also kwown as ACA, under 65 plans, or Obamacare) was signed by President Obama in March 2010.  The purpose of ACA was to make health care affordable to more people.  There are a few ways to obtain health insurance coverage.  If you have an employer, you may be eligible to sign up under your employer's group coverage.  If you are not eligible for group coverage, you can apply for an individual plan through ACA.  You can no longer be turned down for coverage due to pre-existing conditions.  If you are eligible for tax credits called APTC or cost sharing reductions called CSRs, you're premiums and out of pocket expenses (like deductibles, copayments, and coninsurance) will be reduced.  If you qualify for credits, then you will apply through the exchange and if you do not qualify for credits, you will apply off-exchange (directly through an insurance company) and your premiums will have a higher cost.  The Affordable Care Act also had provisions to expand Medicaid.  Anyone under 65 that has less than 133% of federal poverty level (FPL) of modified adjusted gross income (MAGI) should apply for Medicaid.  

Medicare

Part A
 Part A most people get coverage with no additional out of pocket expense (if an employee worked 40 quarters).  If the employee worked less than 40 quarters, then the premium cost will be based on the quarters worked. 

​Part A covers inpatient hospitalization, skilled nursing care, hospice, home health care needs, and nursing home care (but not long term care-also called custodial care).  Medicare Part A has a hospital deductible of $1,408 (for 2020) for each occurrence (unless it's for the exact same illness within a 60 day period).  

Part B
Part B has a premium that is collected monthly through the social security or railroad retirement benefit check.   If you are not collecting these benefits yet, then you will receive a monthly bill for the Part B premiums.  The amount of the Part B premiums are related to your income.  If you receive a large income, then you will pay an Income Related Monthly Adjustment Amount (called IRMAA). 

​Part B covers doctor services, diagnostic testing (such as MRI, CT scans, X-rays, lab work),  outpatient services, preventive services, and durable medical equipment.  There is a Part B deductible of $198 (for 2020).
 
What doesn't Part A & B cover:    
Long term care, cosmetic surgery, foot care, acupuncture, dental care & dentures, hearing aids and fittings, eye care including eye exams and glasses.  There are certain coverages for dental, hearing, and vision, if related to a medical condition.  Long term care, dental, vision, and hearing plans are available separately.  Long term care is subject to underwriting. Dental plans may have a waiting period.   

Part C
 Part C is also called Medicare Advantage.  A Medicare Advantage plan has both health coverage and prescription drug coverage all in one plan.  The plan costs start at $0 premium and can go up to $139.00 per month.  When you sign up for a Medicare Advantage plan that plan acts as your Medicare and whatever benefits are in the plan are what you will have.  The benefits can be different than what is under Part A and Part B.  The plan can also offer additional services that are not covered under Medicare Part A and Part B such as preventative dental, vision and/or hearing (the benefits offered depend on the plan), a gym membership through Silver Sneakers, nursing hotlines, over the counter benefits (for items like band-aids, vitamins, etc.)  A Medicare Advantage plan will have a maximum out of pocket, and have co-pays and co-insurance amounts that will be charged when services are acquired.  These plans have a network involved so be sure that your doctors are covered.  You will also want to make sure that your medications are on the plan formulary and know what your out of pocket expenses will be at the pharmacy.  

Part D
Part D is your prescription drug coverage.  It is a stand alone plan that can be paired with a Medicare Supplement plan.  Plans in our area in Kentucky start at $13.20.  There are several companies that offer Part D plans and I represent all of them that are in our area.  We look at what plan will fit your current medications at your chosen pharmacy at the lowest out-of-pocket for you.  Plans can be reviewed during the annual enrollment period (called AEP) from October 15-December 7 each year.  This review will help you determine if your medications are covered for the next plan year.  If not, then you can change your Part D plan and move to another company that will save you money.  If you decide not to change to another plan, then you will stay on your current plan without having to do anything 

Supplement
​Supplements are also called Medigap plans because they fill in the gaps that Original Medicare doesn't pay.  The Plans that I sell are Plan F,  Plan G, and Plan N.  Plan F is subject to MACRA and only those that were on Medicare prior to 01/01/2020 are eligible to purchase that plan.  Plan G is almost identical to a Plan F.  The difference is on a Plan G you will be responsible to pay the Part B deductible each plan year.   The Part B deductible for 2020 is $198.00.  Supplement premiums are dependent on age and carrier.  
Are you lose your job or are you retiring?  Then you definitely need to sit down and have a discussion about what benefits that you are losing.  There is much more to consider than just health insurance coverage for you and your spouse.  Did you lose dental, vision, and hearing coverage?  Did that big life insurance policy terminate when you left your job?  Do you still have a cancer plan (or maybe you didn't have one to start with)?   Have you thought about long term care yet?  Also if you have a 401k, what do you plan to do with those funds now?  Did you get a large severance package that you would like to invest?  These are all things to consider.  Contact me and we can sit down and put a plan in place that will work for you and your budget.  

Short Term

Short term medical is available to individuals who need medical coverage for a short period of time (less than 1 year) because you missed your annual open enrollment period or you do not have access to insurance through a group employer plan or through Affordable Care.  If you are between jobs, or starting a job where you have to wait a period of time before your coverage will start, then a short term medical plan could be right for you.   You can apply for coverage on any day.  No need to wait for an open enrollment period or the need to have a special enrollment period.  Coverage can be for one month or for just under one year.  Short term plans are underwritten so you will have to answer health questions.  The plans are are subject to pre-existing condition exclusions.  

If you are interested in finding out information on a plan or getting a quote for the state of Kentucky, follow the link below:

https://www.uhone.com/shop/#/census/shortterm?brokerid=AA5201985​