December Healthcare Forum

Using Your Insurance Most Effectively

This month we’ll discuss “insider” strategies to use your current health insurance most effectively to reduce your out-of-pocket costs, options you have if you missed the Medicare open enrollment period (ended December 7) and answer questions asked by two followers.

A. To take full advantage of whatever health insurance you have, we advise:

  • Make certain all medical/surgical procedures, tests (e.g. x-ray, blood) and post-hospital treatment (e.g. rehab) are “in-network” with your insurance.
  • Wait until your primary (and secondary) insurance has paid the full amount they are responsible for before paying your portion.
  • Obtain estimated costs BEFORE incurring them, including possible after-care services (e.g. rehab).
  • Before paying your portion, check carefully an itemized bill.
  • If you need assistance in understanding your bills, ask for help from a family member, friend, accountant and/or a professional billing arbitrator for assistance.
  • If you have a high deductible plan, and are eligible, consider starting a health savings account (HSA). Monies contributed are tax deductible, can be invested in various ways, and can be withdrawn tax-free if used for out-of-pocket medical expenses. It’s like having another IRA.

B. What if You Have Regular Medicare or Medicare Advantage Plan and Want to Make Changes After the Enrollment Period Ended December 7?

You may qualify for the Special Enrollment Period (SEP) from Jan 1, to March 31, if you

  • Moved to another part of the state or country.
  • Have lost your other insurance coverage (e.g. your other insurance from your employer ended).

If qualified, you can switch to another Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare. Make sure to avoid time gaps in coverage when making changes. On the Internet, go to Medicare.gov – Special Enrollment Period – for more details.

We appreciate the following questions posed to us:

Q #1 How do I obtain eye and dental insurance because it’s not covered by Medicare?

A #1 Dental is covered but only if required as part of an injury to mouth or jaw or side effects from radiation treatment for cancer. But, you can purchase a separate dental plan, like Delta Dental, that both authors have, but there is a waiting period before it can be used. So best to purchase insurance before some acute dental problem. Routine eye exams are not covered. Some Medicare Advantage plans provide a portion of the cost for routine dental, vision and hearing care. Check www.fairhealthconsumer.org.

Q #2 What do I need to consider while being the sole care provider for my aging, chronically ill father who lives nearby?

A #2 One of the most important considerations is to take good care of yourself because care providers can “burn out” and become depressed (high incidence). Try to enlist the assistance of other family members, nursing and social services in the community to give you essential “time off” and assistance with your father’s needs. You can carry out your obligations only if taking good care of yourself. Also, see if your insurance policies include respite care and if you qualify.

More information on this month’s topics can be found in our Amazon award-winning book, Insider’s Guide to Quality, Affordable Healthcare, on pages23-43, 51-56, 203-214.

We’ll be deciding soon the topic(s) for February’s forum.

Thank you for following our website – www.qualityaffordablehealthcare.net. Please send us your questions and encourage others to sign up.

Wishing you a healthy, peaceful and prosperous New Year.

Larry Lazarus and Jeff Foster

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