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Frequently Asked Questions

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Below are links to frequently asked questions about health insurance and supplement plans for individuals, families and small business.

Click on a topic below to view a list of related questions.

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MEDICARE

Original Medicare is a federal health insurance program for people 65 and older, as well as some younger individuals with disabilities or specific conditions like End-Stage Renal Disease. It consists of Part A, which covers hospital stays, and Part B, which covers doctor’s visits and outpatient care. Original Medicare covers 80% of the cost of Medicare-approved services. Drugs are not included with Part A or Part B.

Medicare Advantage, or Part C, is an alternative to Original Medicare. Offered by private insurance companies, it provides all of the same coverage as Parts A and B, and often includes extra benefits like vision, dental, and prescription drug coverage. There are deductibles, copays and coinsurance amounts up to a Maximum Out of Pocket annual amount. Typically, these are $0 premium plans. These plans are network based and are mostly HMO or PPO type plans. Some PPO plans have nationwide coverage as long as you stay within their network.

Also known as Medigap, a Medicare Supplement Plan, offered through private insurance companies, helps pay for the  costs not covered by Original Medicare. These plans are standardized, meaning every company offers the exact same service coverage, and they are listed by letters such as Plan G  or Plan N. As an example, with Plan G, you pay the premium, you pay the Part B deductible and then you are covered 100% for Medicare-approved services. These plans do not have a network. As long as the provider accepts Medicare, a Medicare Supplement plan is accepted.

Medicare Part D provides prescription drug coverage. You can purchase a standalone Part D plan to add to your Original Medicare or Medigap Plan or you can enroll in a Medicare Advantage plan that includes drug coverage.There are various stages in a drug plan – deductible (if your plan has one), Initial coverage stage (up to a $2000 threshold) and then catastrophic (where you are covered at 100%). 

IRMAA (Income-Related Monthly Adjustment Amount) is an extra charge some individuals pay on top of their standard Part B and Part D premiums based on their income. If your income exceeds certain thresholds, you may be subject to this additional cost. This link shows detailed IRMAA info. There is also an IRMAA appeal process that can be initiated should the IRMAA amount be based on an incorrect income (the last tax return filed). If there has been a retirement (work stoppage) or work reduction or divorce, etc. the IRMAA can be appealed.

UNDER 65

The Marketplace, also known as the Exchange, is where you can buy health insurance under the Affordable Care Act (ACA), commonly known as Obamacare. On-Exchange refers to health insurance plans that are purchased through Ask Carol B on the  Marketplace, where you may also qualify for subsidies to help with costs.

Yes, you can purchase private health insurance directly through Ask Carol B without going through the ACA Marketplace. These plans may have different rules and may not offer the same protections or subsidies available with Marketplace plans.

Typically, you need at least two full-time employees to qualify for a small business health insurance plan. The exact requirements can vary by insurer and state.

Short-term medical plans are designed to fill temporary gaps in coverage, such as during a job transition or waiting period for other insurance. They typically offer limited coverage for a short duration but can be a helpful solution in between major medical plans.

Medi-Share and other healthcare sharing ministries are Christian Health Care Sharing Programs where members share medical expenses. Unlike insurance, there are no guarantees of payment, and it’s not regulated like traditional insurance. It operates more like a community pool where members help cover each other’s medical bills. There are guidelines for each program that have to be followed. Pre-existing conditions are not covered. They are typically lower cost plans.

SUPPLEMENTAL INSURANCE

Dental insurance helps cover the cost of routine and major dental services by paying a portion of the bill after deductibles or copayments. A Dental Discount Savings Plan offers discounted rates on dental services in exchange for a membership fee, but it’s not insurance and won’t cover any portion of the cost.

A typical vision plan covers eye exams, prescription glasses or contact lenses, and sometimes discounts on corrective surgeries like LASIK. Specific coverage can vary depending on the plan. Implants are not covered on every plan and are limited by the plan to amount covered for the year or for the lifetime of the plan.

A Hearing Plan is helpful when you start noticing hearing difficulties or need regular checkups, hearing aids, or devices to improve hearing. It can help offset the costs associated with audiology exams and hearing aids, which can be expensive.

A Critical Illness Plan provides a lump sum payment if you’re diagnosed with a serious illness like cancer, heart attack, or stroke. It’s designed to help cover costs associated with recovery that traditional health insurance may not fully pay for.

If diagnosed with a covered illness, the plan pays out a lump sum benefit directly to you. You can use this money to cover out-of-pocket medical expenses, treatment costs, or even everyday bills.

The lump sum can be used for medical treatments, living expenses, travel for treatment, home modifications, or even replacing lost income while you recover.

An Accident Plan provides coverage for medical expenses related to accidents, such as ER visits, hospital stays, or physical therapy. It’s designed to help pay out-of-pocket costs related to accidental injuries.

This plan helps reduce the financial burden by covering costs like deductibles, copayments, and other medical bills that may not be fully covered by your health insurance after an accident.

A Hospital Indemnity Insurance Plan provides cash benefits for hospital stays. These benefits are paid directly to you, regardless of other insurance, and can be used to cover any expenses, including medical bills or household costs.

It typically covers hospital stays due to illness or injury, outpatient surgery, ambulance, physical therapy and sometimes intensive care stays. The exact coverage and amounts depend on the plan.

Yes, some plans may have a waiting period before benefits kick in, particularly for pre-existing conditions. Be sure to check the plan details for any exclusions or waiting periods.

Short-Term Recovery Care insurance helps cover the costs associated with rehabilitation or recovery after a hospital stay or surgery. It provides financial assistance for services such as nursing care or therapy.

This insurance pays out a daily or monthly benefit for a specific period to help cover recovery costs. Benefits can be used for in-home care, nursing facilities, or other recovery services.

It’s commonly used to help cover the expenses of short-term recovery from illnesses, surgeries, or accidents that require rehabilitation or skilled care but don’t qualify for long-term care insurance.

Long-Term Care Insurance helps cover the costs of extended care that you may need as you age, such as in-home care, assisted living, or nursing home care. It’s designed to help manage the high cost of long-term personal or medical care.

It covers services like help with daily living activities (bathing, dressing, eating), in-home care, nursing home stays, and sometimes adult daycare. Coverage can vary based on the policy.

Anyone concerned about needing extended care in the future should consider Long-Term Care Insurance. It’s especially helpful for those who want to protect their savings and assets from the high costs of long-term care.

Yes, there are final expense policies, sometimes called burial insurance, designed specifically to cover funeral and burial costs. Whole life insurance policies can also be used for final expenses.

It’s typically a good idea to buy final expense insurance as you get older or when you’re planning for end-of-life expenses. The earlier you purchase, the lower your premiums may be.

The advantages include peace of mind knowing your funeral costs are covered, and it spares your loved ones from financial stress. However, the coverage amounts are often limited and may not be sufficient for larger funeral costs.

Yes, travel health insurance typically covers you for medical emergencies that occur while you’re traveling abroad. It can cover emergency medical treatments, hospital stays, and sometimes evacuation.

Some travel health insurance plans may cover non-emergency conditions like minor illnesses or doctor visits abroad, but it’s important to review the specific plan details as coverage varies.

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