Health Insurance Changes for 2013
By Tucker Thompson, Collin County LIVING WELL Magazine
This article summarizes many changes to health insurance laws for 2013.
The Affordable Care Act expands access to affordable health insurance for individuals under age 65, covering illness, injuries and preventive benefits such as immunizations, cancer screenings, well woman exams, and more as outlined by the federal government. Infants to age 19 are “guaranteed” issue regardless of pre-existing conditions. If covered under a parent’s plan, children can stay on those until age 26.
Medicare Insurance. There are separate parts that people generally “call” Medicare insurance. People aren’t “automatically” enrolled, and must sign up for Medicare by age 65 or face financial penalties. Once signed up, there’s annual Open Enrollment if you want to change Prescription and/or Advantage Plans. This year’s runs from Oct. 15–Dec. 7, 2012. Medicare Supplement (Medigap)Plans can be purchased all year.
At press time for this publication, the 2013 premiums and deductibles for Part A, Part B, as well as any COLA increases haven’t been announced. I’ll be notified when the 2013 figures are announced and you may call me to inquire about updates.
(1) Hospital Insurance – (“Part A“) Hospital coverage is the basic coverage you’ll get when enrolling in Medicare. Part A will partially cover approved medical bills for hospital stays, skilled nursing inpatient care, minimal home health care, as well as hospice. Most people don’t pay monthly premiums for Part A but will have co-pays. The 2012 co-pays for hospital stays are $1,156 per “benefit period” for the first 60 days, $289/daily for days 61-90; $578/daily for days 91-150. Skilled Nursing Facility has no co-pay for the first 20 days, then $144.50 per day for days 21-100 for each benefit period.
(2) Medical Insurance – (“Part B“) When signing up for Medicare, you’ll be asked to enroll in Part B, which covers Medicare approved doctor’s office visits, preventive care, approved outpatient care, as well as some physical or occupational therapies. Most people pay $99.90/month for their 2012 Part B, plus an annual deductible of $140. People over preset annual incomes will pay slightly higher premiums for both Part B and Part D coverage. If you choose not to enroll in Part B, but later want to enroll, the federal government will penalize you 10% for each year you didn’t sign up, and this added percentage will remain on your monthly premium until death. While Part B offers more comprehensive health insurance when combined with Part A, please know it was not designed to cover 100% of a person’s medical bills.
(3) Prescription Drug Coverage – (“Part D“) If you decline initial enrollment but later sign up, you’ll also be charged an additional premium annually. Annually review all prescription drug plans, looking for:
ü new formularies making sure they cover YOUR prescriptions
ü all deductibles (that could be as high as $325), premiums plus co-pays
Doughnut Hole (2013). Once you and your Part D Plan have spent $2,970, you enter the doughnut hole (monthly premiums do not count towards this deductible). You then pay 47.5% of brand-name drug costs and 79% of generic costs until your total out-of-pocket reaches $4,750. Example: Your drug costs $100 in the doughnut hole, but you pay $47.50. The total cost, however, goes towards meeting the $4,750 doughnut hole limit. You then qualify for “catastrophic coverage,” with brand name drugs $6.60 or 5% of the cost and generics $2.65 or 5% of the drug cost.
(4) Medicare Advantage Plans – (“Part C“) You’re still enrolled in Medicare when you have an Advantage Plan, but Advantage Plans combine the benefits of Part A and B. You’ll continue to be charged the government’s monthly Part B premium, in addition to your Advantage Plan’s premiums, deductibles and co-insurances. Before enrolling, call your doctors’ billing office to make sure they’ll accept payment from any plan you’re considering! As HMO, PPO and PFFS plans, they each have their own defined networks, hospitals and geographical zip codes that will accept their plan. For example, Southwest Medical Center and M.D. Anderson won’t accept any Advantage Plans. If you travel outside your zip code to visit family or to vacation, make sure your plan is accepted in those zip codes! When out of a “service area,” most will only pay for emergency care.
(5) Medicare Supplements – Not restricted by networks, you can choose any doctor or hospital that accepts Medicare, anywhere. The most popular Medicare supplement is Plan F, which pays for everything that Medicare bills, with no co-pays or deductibles
Tucker Thompson, the author, has worked in the insurance field for over 20 years. In addition to serving clients throughout Texas and Oklahoma, he is often a guest speaker on topics related to the ever changing landscape of insurance for people of all ages. You may reach him directly at 972-548-1629.