It was an information-packed Saturday, as folks gathered for a resource fair and speakers on aging and caregiving. The Oct. 19 event took place at Warner Park Community Recreation Center, and was hosted by the North/Eastside Senior Coalition and sponsored by the Dane County Caregiver Support Program. Workshop titles included “How to choose senior housing,” “How to communicate with someone who has dementia,” “Practical skills: How to lift and position safely,” and “How to care for yourself.” Exhibits featured information provided by more than 20 community-based organizations that support caregiving in Dane County.
“Ask the Experts Sessions” offered folks the opportunity to discuss “All Things Legal” with Elder Law Attorney Julie Short of Haskins Law LLC, and “Untangling Medicare/Medicaid, plus the new Affordable Health Care Law and HIRSP,” with Donna C. Bryant, Insurance and Benefits Education Services.
Attorney Short, who has more than 20 years experience, was previously the Director of Aging and Disability Services for Easter Seals Wisconsin, and worked with CWAG (Coalition of Wisconsin Aging Groups.) She handles cases involving public benefits, guardianship, protective placement, long-term care, insurance, disability, and trusts and estates.
Short gave out a handout sheet highlighting five things everyone should know about health care reform, and listing covered services for adults (see sidebar.) One of the points of importance: “Starting on October 1, 2013, the Federal Government will operate a ‘Health Insurance Marketplace’ in the state of Wisconsin which will help those without affordable health insurance to buy health plans, with coverage taking effect as early as January 1, 2014. The Health Insurance Marketplace will be available to qualified citizens who are not offered health insurance through their workplace or are offered health insurance through their workplace that does not meet certain minimum standards.”
Donna Bryant provided the latest updates and information on medical coverage options. Prior to her retirement, Bryant was the lead counselor for the Medigap Helpline and helped coordinate the Wisconsin State Health Insurance Program (SHIP). Through her work with the Wisconsin Insurance Commission and auditing insurance agencies, she helped bring about key consumer protection regulations.
Bryant clarified some of the more confusing aspects of the new health care options, and emphasized key dates to take action. She began by stressing that people on Medicare are not impacted by the changes with the Affordable Health Care law, reviewing that “Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD)- permanent kidney failure requiring dialysis or a kidney transplant.”
“Medicare is not part of the Health Insurance Marketplace,” Bryant indicated.
Furthermore, there has been confusion surrounding the Oct. 1 sign up date, which is not for people on Medicare. As a result, she indicated, many people who get their medical coverage through Medicare “have been anxious, unnecessarily so.”
Timing is critical
For folks not on Medicare, it’s paramount to pay attention to the sign-up deadlines if the plan is to obtain health insurance through the Health Insurance Marketplace. The Health Insurance Marketplace began October 1, and it runs through March 31 of next year.
“If you want your insurance coverage to start January 1st, then you have to have that application in by December 15 (2013) in order for the insurance to start Jan. 1 (2014),” she said.
Bryant said that enrollment in the individual market closes March 31. “If you get an application in in March,” she explained, “your insurance will begin April 1.”
“If they do not get their application in by March 31, they will have to wait until the Marketplace opens at the end of 2014 for their coverage to begin,” she elucidated. Going forward starting in 2014, the annual open enrollment period starts October 15 and ends on December 7.
The Silver Plan is special
Another piece that’s critical when it comes to the Marketplace, Bryant asserted, is what’s referred to as the premium reduction factor. It’s very important to know that this is tied to a particular tier plan only, not to all four levels of coverage.
The cost-sharing reduction is based on incomes at or below 250% of the federal poverty level ($58,875 annually for a family of four in 2013) and those receiving the Premium Tax Credit, but applies only to people that pick the Silver-Level Plan. It does not apply to the other plan options (Bronze, Gold, or Platinum.)
“Eligibility for reduced cost premiums (based on income) only applies to the Silver (Level) Plan,” she reiterated. “It’s not just for any plan you choose.”
You can sign up for insurance online or by phone, with the Marketplace application available in English and Spanish electronically and on paper. If you choose the online version, you find out right then and there if you’re eligible for a reduced-cost and how much you’ll be paying each month for insurance coverage.
“The computer’s doing the computations as you put the information in,” Bryant said. “It’s looking at the information and your potential eligibility for other benefit programs.”
The way the system is set up in Wisconsin, when you apply online, it’s a live app that automatically screens you for eligibility for other social programs such as food shares, Medical Assistance/Medicaid, CHIP (health insurance for kids), etc.
The number to call is 1-800-318-2596 or HealthCare.gov/subscribe.
Beware: those on dialysis
With the new nationwide insurance law, one thing that’s happening is that the special high-risk insurance policy (Health Insurance Risk-Sharing Plan) that’s been available for people in Wisconsin is being lost.
“Theoretically, the thought is that you don’t need a high-risk plan if no one can be barred from receiving insurance based on their health anymore,” Bryant said. “The unique problem for individuals that are now on HIRSP along with Medicare is that the Marketplace was not designed for Medicare people, not designed with people on Medicare…” Medicare supplement policies are not subject to the Affordable Health Care Act, they can still have a pre-existing waiting period and they can still deny coverage.
The last day Wisconsinites will be covered under HIRSP is December 31, 2013. As a result, the folks who’ve been covered under HIRSP will have to sign up for some other insurance, or risk a penalty as well as huge medical expenses.
This is of particular concern for people that get kidney dialysis three times a week at a cost of about $1,000 each time.
Based on 30+ years in the insurance industry, Bryant advises those getting dialysis that are going off of HIRSP, do not sign up for coverage under the Marketplace. “A person on kidney dialysis is safer in the long run with Medicare and a Medicare Supplement Plan,” she attests. (In terms of particular Medicare Supplement plans, she does point out that, “If you’re on dialysis, you are not eligible to enroll in a Medicare Advantage Plan.”)
She helps ferret out the facts on this, using actual cost figures. For those on dialysis, “Medicare pays 80%, and the patient is responsible for 20%. This comes out to $600 per week, $2,400 per month the person pays. $28,800 out of pocket expenses (a year), just for dialysis, and that’s not taking into consideration anything else. So that’s the number a patient on kidney dialysis can use for comparing insurance plans and deciding…”
Typically, Medicare supplements will run anywhere from $250 to $660 per month, depending on what the insurance all covers. She gave an example of one Medicare supplement policy that costs $400 per month, or $4,800 per year “which will cover (the) $28,800, plus hospitalization, lab work, etc.”
Attained vs. Issued Age
She also recommends that people take out an Attained Age Policy rather than an Issued Age Policy, to pay the lowest price possible over time. This almost seems counterintuitive at first glance, however, it makes sense when Bryant explains it.
“An Attained Age policy, yes, it goes up a little every birthday. An Issued Age policy usually keeps you in the band/age you took out the policy. The reason that’s significant is, being under age 65, they’re in the higher premium rate (group) and being in the higher premium rate, once you go into the policy, you’re going to stay there (at that rate). “
For a person on dialysis that’s, say, 50 years old, the Attained Age insurance can cost almost half what the Issued Age type would be, for the same covered services.
Bryant also talked about the fact that because Wisconsin did not expand its Medicaid program, people who might otherwise have been penalized for not getting insurance may be able to have a waiver. She encourages people whose income falls between 100% to 133% of the federal poverty line that would have been eligible for health coverage under Medicaid had Wisconsin expanded its Medicaid program like other states, to ask questions.
In closing, she agrees that trying to figure out the best health care coverage can indeed be very confusing. Rather than sign up for something and later be sorry, she invites folks to call her and get questions about their particular situation answered.
Bryant is available at (608)833-1902, (608)535-9155, or (608)338-9800, or contact her via e-mail: email@example.com