All Stories

The Truth About Medicare Part B Coverage

Medicare coverage is based on the distinction of test, procedures, and services that are a medical necessity from those that are not. This means that the only services that are covered by Medicare are the ones that they-or the local insurance company that furnished the policy-deem to be necessary for your care. This is rarely a point of concern, as most services end up being covered.

Whereas Medicare Part A covers ongoing medical procedures, the primary purpose of Medicare Part B is to cover preventative health services. These include visits with your health care provider, immunizations, vaccinations, tests, and physical and occupational therapy.

Clinical Research

If you want to join a clinical study, Medicare Part B may cover the costs of that study, especially in cases where the treatment in the study takes the place of other treatments. In this situation, Part B covers only the routine charges, including hospital stays, operations required for the test, and the treatment of side effects that may result from the test. Part B does not cover the cost of the actual test treatment.

Mental Health Services

Part A covers inpatient mental health services, but Part B covers all outpatient mental care, as long as the services are furnished by a licensed mental health provider who accepts Medicare payments. This can include psychiatric visits, counseling with a certified therapist, help from social workers, and even midwife care.

Preventative Care, Immunizations, and Vaccinations

Flu shots fall under Medicare Part B, once a year, during flu season. Hepatitis B and pneumococcal (for infections like pneumonia) shots are also covered, if you are at risk for either disease. Most tests and visits that fall under the category of “preventative care” will also be covered. Tests like bone density screenings, cancer screenings, diabetes tests, and obesity counseling are all covered under Part B.

Your yearly “wellness visit” is also covered by Medicare, allowing you a check-up per year from the time you start Medicare until you leave it. Like any other check-up, during this visit, you can discuss current diseases, family medical history, medications, and treatment options. The main goal of these visits should be to maintain your health. Most doctors will have you fill out a health survey and use that information to create and implement a preventative health care plan. This plan may include further tests, lifestyle changes, and medications, but is ultimately designed to improve your overall health and extend that health into your later years.

Prescription Drugs

A number of specific drugs are also covered by Part B, including antigens, any drug used with durable medical equipment (a pump or nebulizer used for asthma), and most “injectable” drugs. Some prescription medications for osteoporosis, hemophilia, renal disease, and immune system deficiencies are covered if the disease and the person meets specific requirements. These requirements include the seriousness of the disease and how the drug is administered.

Networks Of Doctors And Hospitals Change With Healthcare Reform

Doctors across the nation have been voicing that they will not participate in the new Obamacare plan. Right from the start, it shows that many of the doctors are not educated on the new law. This ‘Obamacare Plan’ does not exist with the new Affordable Care Act.

The Affordable Care Act (ACA), commonly known as ‘Obamacare’, only changed how policies are sold and bought in the marketplace going forward. There is no government health plan that was attached to the law. When someone purchases a plan, on or off the Health Insurance Marketplace/Exchange, they are purchasing the plan from the insurance company that is offering the coverage. All the customer service, claims, and the invoices come from the actual health insurance company picked by the policyholder, not the government or anything called ‘Obamacare’.

With new restrictions for the health insurance companies, they had to do two things: Increase costs to cover the required expenses and anticipated claims experience; and control costs on the backend. In order to control costs on the backend, they had to reduce their network or completely change it.

In many states, in order to control the cost, the insurance companies had to change their network of doctors and hospitals. This forces some policyholders with a new ACA compliant plan to pick a new doctor. But why can’t you go the same doctor? It’s just dollars and cents.

In order for a doctor to be inside of a network with an insurance company, the doctor or hospital have to agree to the terms of the contract. Parts of those terms are the reimbursement schedule for seeing patients. Many doctors have seen a gradual decrease in the reimbursement schedule as time goes on. With the new law, many doctors decided it wasn’t worth the reimbursement schedule and did not sign the new contract. Therefore no longer being part of that insurance company’s network of doctors and hospitals.

This had nothing to do with where someone buys his or her new health insurance policy. It does not matter if someone purchased a plan on the Health Insurance Marketplace/Exchanges or outside of the Marketplace and directly with the insurance company or through an insurance broker. The networks are identical, generally speaking. There maybe some differences in certain counties or cities across the nation, but for the most part, this makes no difference.

Could doctors say they are not accepting the ‘Obamacare Plan’? Sure. However, it is very misleading to the patients, policyholders and the general public. It actually means that they do not agree to the new terms of the contract for the reimbursement schedule for seeing patients that have those plans.

Plus, there is no such thing as an ‘Obamacare Plan’. Each policy is still stamped by the insurance company, not the government. The role of the Health Insurance Marketplace/Exchanges is to control the tax credit. Those who apply and qualify for a tax credit can still finish the application with majority of the insurance companies on their website. This is done with a special connection between the Marketplace and the insurance company. It is still controlled by the Health Insurance Marketplace/Exchanges because that was where the tax credit qualification comes from.

This is no different from you buying a product from a store. You cannot make changes to that product or ask for a refund unless you go back to the store you purchased it from. This is no different.

You must be sure to look at the network of doctors and hospitals with any insurance company. Several major insurance companies have multiple networks to choose from. They will charge more to be part of a larger network of doctors and hospitals, or you can simply save money on premium dollars by choosing a smaller network and find a doctor within the network. It would be wise to seek professional help and guidance from a licensed professional, such as an insurance broker, to find the best option for you.

There Is No ‘Obamacare Plan’ – Just New Health Insurance Policies

The Affordable Care Act (ACA), commonly known as ‘Obamacare’, only changed how policies are sold and bought in the marketplace going forward. There is no government health plan that was attached to the law. When someone purchases a plan, on or off the Health Insurance Marketplace/Exchange, they are purchasing the plan from the carrier that is offering the coverage. All the customer service, claims, and the invoices come from the actual health insurance company picked by the policyholder, not the government or anything called ‘Obamacare’.

Policyholders can now receive a tax credit, if they qualify. The tax credit is based on a number of factors, such as family status, income and percentage of the premium. There is a little more to the equation, so please seek a tax professional or insurance agent to receive more information on qualifications. The amount of the tax credit will vary based on these factors. For this year, the tax credit is based on the estimated income for 2014. We are pretty much predicting the future on the income but it will be reconciled on the 2014 tax return, filed in 2015. Be very careful with this. You could end up owing the whole tax credit back when you file your taxes. Please seek a professional with experience on the Health Insurance Marketplace to get the best answer for your situation.

The policies inside the Health Insurance Marketplace and outside of the Marketplace are the same. No difference. The plans are exactly the same; the premiums are exactly the same. Even the network of doctors and hospitals are the same. The only difference is the amount of tax credit one may qualify for versus another policyholder. Otherwise, everything is the same.

Of course, this is assuming we are comparing the same policies, premiums and provider network.

The insurance companies have more flexibility selling plans outside of the Marketplace. In many cases, if they operate outside of the Marketplace, there will be more plan options available to you that are not available through the Marketplace. There are certain guidelines that must be met for policies to be sold inside the Marketplace and receive a tax credit.

The major confusion is that the plans sold inside the Health Insurance Marketplace are different from what is available outside of the Marketplace. This is simply not the case.

The only thing that makes the Health Insurance Marketplace so special is the tax credit. If you do not receive a tax credit, there is no incentive to actually purchase a plan inside the Health Insurance Marketplace. The plans are the same along with the network. If your friends and family claim they are paying less premium for their new plan they purchased than before, it only means one of two things: 1) they were paying a huge amount to begin with; 2) they received a good tax credit to reduce their premiums.

There is a lot of confusion and more to come with the changes in the healthcare law. Always use a health insurance professional that is familiar with these changes. This will help you choose the right plan for you and your family and keep it affordable.

Page 1 of 41234
© 2014 Travel Health Insurance. All rights reserved.
Powered by WordPress