Benefits in Action

Choosing the right health insurance plan becomes more and more important as we age. With many companies selling policies in Colorado, it is important to fully understand what each plan entails and how it pertains to your current situation.

Benefits in Action is a non-profit organization whose mission is to provide understanding, access, and utilization of health-related benefits to enhance your health and wellbeing. Benefits in Action is certified by the State of Colorado to provide counseling and application assistance with Medicare, Medicaid, and Connect for Health (the state insurance exchange). Additionally, we assist individuals in understanding their benefits and in accessing other public and private benefits necessary for good health. One such benefit in Supplemental Nutrition Assistance (SNAP).

To understand how to choose a benefit plan that best fits your health and financial situation, there are some vocabulary words important for you to know. That is the subject of this month’s column.

  • Plan Premium – The monthly cost that you will be required to pay for your health insurance.
  • Deductible – This is the amount you will have to pay before the insurance company starts to pay a percentage of the costs of your care.
  • Coinsurance – After you have met your deductible, the cost of your care will be split between you and the insurance company. Often, the insurance company pays 80% up to a maximum amount, and you pay 20%. You may also have to pay coinsurance for your prescription medication.
  • Out-of-Pocket-Maximum – The maximum amount that you will pay for covered services. Once this amount has been met the plan will pay for covered services at 100%.
  • Co-pay – Once you have met your deductible, the co-pay is the amount that you pay every time you see a health care provider and for prescription drugs.
  • HMO – Health Management Organization is a type of insurance that usually requires you to stay in a provider network. You may also see all your providers in one location regardless of the service. This type of plan will require you to receive a referral for a specialist.

GREAT! Now you know the necessary terms that deal with how you pay for your health care. Let’s move on to learn about all the different parts of Medicare and why each is important for you to know about.

  • Medicare Part A – This covers you when you are admitted to the hospital, skilled nursing facility, hospice, and sometimes receiving care in the home. • Medicare Part B – This covers doctor visits, services received on an out-patient basis, diagnostic testing, durable medical equipment, and ambulance rides. There is no out-of-pocket-coinsurance -maximum with this coverage.
  • Medicare Part C “Advantage Plan” – This covers hospital, prescription drug, and medical coverage and is provided by the same insurance company. These plans are offered in HMO and PPO style. (see definitions above) Not all plans are offered in each service area but will have an out-of-pocket-maximum.
  • Medicare Part D – Prescription drug coverage offered through a private insurance company. You may be responsible to pay a percentage or flat price for each medication.
  • Original Medicare – This is Medicare Part A and Part B. You will have to choose a Part D plan as well. Check with your health care provider – not everyone accepts original Medicare.
  • Medicare Supplement “Medigap” – Additional coverage that can pay remaining balances for services received under Original Medicare parts A and B. The policy will only cover Medicare approved services and cannot be added to a Medicare Part C “Advantage Plan.” Again, check with your health care provider – they must accept original Medicare for you to use this type of Medicare plan in their office.ALWAYS remember – there is a deadline for enrolling in Medicare – it is 3 months before and 3 months after your birthday month in the year you turn 65. If you miss this window, you will pay a penalty every month for the rest of your life.

ALSO, please call Benefits in Action every October to check to see if your current Medicare plan still meets your prescription, health care, and financial situation.

Benefits in Action understands how important choosing the right health insurance plan is. We have state certified Medicare counselors that provide unbiased Medicare information and a team devoted to Connect for Health Colorado – The Colorado Marketplace plans. An additional staff team can help you find ways to make your Medicare more affordable for you if you meet certain income and asset requirements. Appointments are available over the phone and in person.

Call to make your appointment today. 720-221-8354 or email info@benefitsinaction.org.


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