Cataract Awareness Month

DTS_hands_5 Glasses with notesWe cannot leave the month of June without noting that it is Cataract Awareness Month. Why is it so important? Over 24 million Americans over the age of 40 have cataracts. Cataracts are one of the leading causes of blindness both in this country and worldwide. A cataract is when cells build up on the lens of the eye causing it to cloud. Light has trouble passing through, and it becomes difficult to see.  While anyone, even children, can develop cataracts, most are age-related. Therefore they affect seniors the most.

Cataracts are also one of the simplest causes of blindness to treat. The clouding of the eye lens can be repaired in as little as 20 minutes with outpatient surgery. In fact, over 3 million Americans have this surgery each year. The treatment consists of removing the clouded lens and replacing it with an artificial one. The replacement, known as an intraocular lens, or IOL, has a 95% success rate. It is one of the safest and most successful surgeries in the country.

If you think you have cataracts see your opthamologist. In the meantime, avoid or delay cataracts by avoiding smoking, protecting your eyes from UV rays or injury, and eating healthy foods.

Cataract surgery with basic lens implants is covered by Medicare. There is even an exception to one of Medicare’s rules-after you have the surgery Medicare will cover one pair of eye glasses or contacts! Contact your Medicare representative for details to find out the specifics regarding your Plan, and make sure you get your glasses or contacts from a supplier that accepts assignment. Again, talk to your representative to avoid any pitfalls such as the possibility of having advanced implants not being covered, or having to pay for your glasses or contacts up front then submit for reimbursement (and then possibly having to appeal a denial.)

If you don’t have a representative, we always recommend having an agent to help you with those little bumps in the road and questions. Feel free to call us at 785-270-4593 or you can get a list of agents from your state insurance commission.

Questions? Please contact Century at 785-270-4593 or 1-800-227-0089 for assistance or to make an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

How Can I Explain

Insurance

Does your Explanation of Benefits (EOB) leave you scratching your head? Insurance companies and Medicare and Medicaid are required to issue an EOB to help you understand what claims they have processed, what they paid, what they didn’t, what portion you owe, and why. The problem is the number of terms can be staggering. Fortunately, your EOB usually comes with an explanation of how to use it (perhaps your carrier has something online to explain things in-depth). Keep reading to understand some of the basic terminology.

Provider – Your doctor, the lab who took your blood, a hospital, a pharmacy or a place that sells or rents durable medical equipment (wheelchairs, etc).

Date of Service (DOS) – Your Provider bills your carrier based on the day you actually received services. You may be scheduled for a “Plan” of repeat services, such as dialysis or chemotherapy, but each visit will be billed separately. One day all your services may be bundled, which will certainly help. For now, most are billed by DOS.

Service/Product – This could be anything from an office visit to surgery to rental of an oxygen tank.

Amount Billed – This is what the Provider is charging for your services before insurance pays.

Discount or Write-Off – The amount the Provider has privately agreed through contract not to collect. The carrier will not pay this amount, and you will not have to pay it either. The Provider will “write it off.” The amount is negotiated between the carrier and the Provider based on many factors, and why the carrier wants you to stay In-Network. Carriers do not have these agreements with Providers who are “Out-of-Network.” (See Here to learn about In and Out of Networks.)

Amount Paid – The amount your carrier paid your Provider.

Copay, Coinsurance, or Deductible – This is your share of the bill. (See Here for how these work.)

You may also find items such as the amount paid by another source if you have another insurance who is primary, or Notes which clarify why things were not paid or handled certain ways.

Questions? Please contact Century at 785-233-1816 or 1-800-227-0089 for assistance or to make an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

It’s the Max

DTS_kinckerbocker_6 SpoolsFor many years the insurance industry has had ‘Out-of-Pocket Maximum’ clauses in health care policies. The term included this and excluded that. It was very confusing, especially if you changed carriers to one who might have an entirely different set of rules for your Out-of-Pocket Maximum (OOPM). For example, some carriers included deductibles, but excluded copays. Other carriers included copays, but excluded deductibles.

The ACA (current law) has eliminated much of the confusion. Have to pay a deductible? It applies to your max. Paying coinsurance on that hospital stay? It applies. Pay a copay for that office visit? It counts. Yay! Now you can budget for your health care because you KNOW absolutely how much you will have to pay at the most! Right? Well, not exactly.

There are still a few things that won’t count towards your OOPM:

  • Insurance premiums – whatever you are paying, whether you bought coverage at work, on the exchange, or some other method, the cost of having insurance does not reduce the OOPM for your share of actual health care costs. If you pay $5,000 per year for your health insurance, you will pay $5,000 plus your portion of your health care costs (deductibles, co-insurance and copays). The good news is that the OOPM limits how much you have to pay for the second part. Your carrier will have to pay 100% once you meet OOPM, unless you hit one of other exceptions listed below.
  • Out-of-network cost-sharing or balance billing does not apply.
  • Non-essential (medically unnecessary) health benefits do not count either.
  • Expenses that your insurance does not cover, like cosmetic surgery, cannot count towards your OOPM.

The OOPM in 2017 is $6,850 for individuals and $13,700 for family plans. This is the same as it was in 2016, though it can change each year. Also, be aware that lower income individuals/families can get help with their OOPM.

So read your policy carefully. Make sure you know what your policy will cover, and if you have to go to network health care providers, do so. Protect yourself by knowing more.

Questions? Please contact Century at 785-233-1816 or call Toll Free 1-800-227-0089 for assistance or an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information. (Updated from 07-10-15)

Deductible Copay for my Coinsurance

DTS_Dinner_damo_1 Potato ShoppingThe insurance industry uses standard terms to describe out of pocket expenses. These terms can be a little confusing to the average person. Do you know the difference between a deductible, a copay, or coinsurance? Hopefully, this article will help to shed some light and clear things up for you.

If you have car insurance, you are probably already familiar with deductibles. This is a fixed amount you must pay first before your insurance kicks in. Your deductible is not reduced by any discounts agreed to by your In-Network provider with your insurance company. Deductibles range from $0 to thousands of dollars depending upon your plan. Usually, a higher deductible means a lower monthly premium. One interesting thing about deductibles is that other family members with the same coverage can help you reach your deductible. If your deductible is $1,000 per person or $2,000 for the family, it is possible to reach the family deductible without any one person in the family reaching their personal deductible.

Copay is the amount you pay for a specific service every time to get that service during the policy year. The copay is a flat fee that can vary from policy to policy, and even from year to year, but will remain the same for the entire coverage period. Copays typically are $25 or less, but can be higher depending on the service or the policy. Examples of copays include $20 for a standard office visit to your doctor, $15 to fill a prescription, or $50 for an emergency room visit. This is the insured’s out of pocket costs to receive these services. The nice thing about a copay is that since the amount is fixed you always know what you will need to pay up front.

Coinsurance is very similar, but is based on a percentage of the cost of the service. Example: 80/20, 90/10 or some other number. In an 80/20 plan, insurance pays 80% and you pay 20%. Coinsurance usually applies to certain specific services. Like deductibles and copays, coinsurance applies to your total out of pocket expenses.

Finally, your policy may set these amounts/percentages at a lower amount for In-Network and higher amounts for Out-of-Network. (You can read about networks here.)

Questions? Please contact Century at 785-233-1816 or call Toll Free 1-800-227-0089 for assistance or an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information. (Updated from 07-03-15)

In-Network vs. Out-of-Network

Death_to_stock_Dinner_damo_7Health insurance can be confusing. Networks, deductibles, and out of pocket maximums are just some of the terms you should learn before you buy health coverage. Not knowing and understanding these terms can cost you hundreds, if not thousands, of dollars. One of the most important things to understand is the difference between In-Network and Out-of-Network.

Health insurance companies contract with a network of health care providers in order to keep costs down and assure better outcomes. Providers In-Network go through a credentialing process to affirm they are fully educated, licensed, insured and in good standing. The providers agree to offer a discount (write-off) for their services. The insurer agrees to pay claims quickly, and to send the provider people covered by their insurance. The provider cannot collect the write-off from the patient, but they make up for the discounts in increased volume.

If you go to a physician not in your carrier’s network, the insurance company will not receive a discount for your services, and the provider may not have been through a credentialing process. Out of network providers can charge a patient whatever fee they want, even if the amount is twice what other providers in the area are charging for the same service. Insurance companies take steps to try to counter these high expenses.

Usual, Customary & Reasonable (UCR) is a term known in the health insurance field that relates to what a provider should charge for a specific service. If the average doctor charge in your area is $95 for an office visit, then $95 is the UCR amount. Your health insurance will only pay UCR. If the Out-of-Network physician charges $150, you may be billed for the difference.

Health insurance companies also may set higher deductibles, copays, coinsurance, and out of pocket maximums for Out-of Network providers. I will discuss these terms more in-depth in a later article.

When you buy a health insurance policy, it pays to check out the carrier’s network first. Is your regular doctor in network? If not, will they be willing to join? Are there many specialists in your area, or will you need to travel 50-100 miles to go to one? That $10 you save in monthly premium may cost you hundreds in Out-of-Network expenses. Know the In-Network and Out-of-Network provisions before you buy.

Questions? Please contact Century at 785-233-1816 or call Toll Free 1-800-227-0089 for assistance or to make an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information. (Updated from 6/26/15)

 

May the FAST be with You

CenturyE02May is National Stroke Awareness Month. It’s also Mental Health Month, National Osteoporosis Month, and Older Americans Month among many others.  These are all worthy subjects to write about, but this week our focus will be strokes.

Strokes can be devastating, and in the U.S., someone has a stroke every 40 seconds.  They steal our lives and our independence, but perhaps one of the toughest facts about strokes is that 80% are preventable.  To prevent strokes follow the same guidelines you would to keep your heart healthy.  On the University of Arizona’s website Dr. Gordon Ewy lists “10 Tips to Prevent Heart Disease and Stroke”. I believe the first one is the most important.  Here they are:

  • Take responsibility for your health.
  • Know your risks (age, genetics).
  • Don’t smoke or expose yourself to second-hand smoke.
  • Maintain a healthy blood pressure.
  • Monitor your cholesterol (blood lipids).
  • Limit your calories.
  • Make exercise a daily habit.
  • Pick your pills wisely (you can overdose on some vitamins or they may interfere with your prescriptions).
  • Reduce stress
  • Stay informed: Science changes constantly

If you cannot prevent a stroke, then taking action quickly is essential.  Getting treatment within 3-4.5 hours can increase your chances of recovery significantly.  Remember these 4 letters and ACT QUICKLY!

F – Face Drooping

A – Arm Weakness

S – Speech Difficulty

T – Time to call 911

In the end, your health is your responsibility. Keep informed. Monitor your numbers. Take care of yourself, and if something goes wrong, act FAST.

Questions? Please contact Century at 785-286-6402 or 1-800-227-0089 for assistance or to make an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.

Big Changes

Big Changes

Century has recently made two major changes. We have notified our clients of these changes through postal mail. However, just to be sure everyone impacted knows, we are making this announcement in our blog.

First, we have decided to concentrate all of our attention on our Medicare clients. We are your experts for Medicare Advantage, Medicare Supplements, and Medicare Part D (drug supplements). Our experience and knowledge will prove valuable to our clients in other ways too as we can help you obtain vision or dental insurance as well as health coverage.

The second big change involved moving our offices.  On January 13th we moved into shared offices with Health Connections, who are also owned by Stormont Vail Health.  The move gives us the advantage of using some of Stormont’s more modern technology.  There are many benefits for us in making this move. However, due to the security of the location we can no longer welcome walk-ins.  You must call ahead and make an appointment. We will be happy to see you.

Though we are no longer focusing on group products and the under 65 market, do not hesitate to call us if you have questions. We will be happy to steer you in the right direction or help you if we can.

Remember, we still have wonderful experts to help you. You can reach us at the same phone numbers and email addresses you have always used. We will continue to help you resolve issues and find the best coverage for you and your lifestyle.  The difference is you will have to make an appointment.

Questions? Please contact Century at 785-286-6402 or call Toll Free 1-800-227-0089 for assistance or to make an appointment.

Go to: http://www.centuryinsuranceagencyks.com or email info@century-health.com for more information.