by Meriel Lesseig | Oct 21, 2020 | Uncategorized
Obamacare open enrollment begins this year on November 1. If you’re in the market for comprehensive health insurance, open enrollment is your opportunity to shop for and choose a plan that meets your healthcare and budget needs.
Here are a few things to keep in mind if you’re shopping the health insurance Marketplace this year:
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Generally, open enrollment for 2021 is November 1 through December 15, 2020. Check with your state, though, as some states have extended open enrollment periods. Then, your new insurance will become effective on January 1, 2021.
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You can find most of the information you need about open enrollment and what’s offered at HealthCare.gov.
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Depending on your income, you may qualify for premium tax credits, which could lower your monthly premium payment.
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If you can’t afford Marketplace insurance, depending on which state you live in, you may be eligible for Medicaid or your children may be eligible for the Children Health Insurance Program (CHIP). You can enroll in Medicaid or CHIP at any time.
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Marketplace insurance is comprehensive medical insurance and must meet Affordable Care Act (ACA) requirements, which means it has to cover things like pre-existing conditions, mental health, and pregnancy.
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Make sure you shop around to compare prices and benefits offered. If you don’t qualify for premium tax credits, your best option may not be on HealthCare.gov or your state’s official exchange. You can also buy comprehensive health insurance “off-exchange” directly from the insurance provider.
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As of 2019, the federal tax penalty for not having qualifying insurance coverage was set to $0. However, California, Massachusetts, Rhode Island, Washington DC, and New Jersey do have penalties if you don’t have health insurance.
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You can apply for Marketplace insurance online, over the phone, by filling out a paper application, or through an insurance agent.
So, now you’re all set to apply for Marketplace health insurance, but what do you do if you don’t currently have any health insurance coverage?
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If you have what is called a “qualifying life event,” you may be able to enroll on the Marketplace outside of open enrollment. Qualifying life events include losing health coverage (for example, you changed jobs and are waiting for your new job’s insurance), changes in your household (for example, you got married or divorced), or you moved. These are only a few qualifying life events. You can contact HealthCare.gov to see if you’re eligible for a special enrollment period.
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You can apply for non-Marketplace insurance as a stopgap until your Marketplace coverage becomes effective. Short-Term Medical is one option with coverage similar to comprehensive health insurance, including deductibles, copays, and coinsurance. If you feel like you don’t need something that extensive, a limited indemnity policy may be sufficient until your Marketplace coverage begins. It’s important to keep in mind, though, that these types of insurance plans do not have to comply with ACA requirements and usually exclude pre-existing conditions, preventive care, and mental health care as well as other benefits included in Marketplace plans.
Regardless of what route you take, SGIC encourages you to have some sort of healthcare coverage rather than none at all. If you’re interested in learning more about Short-Term Medical or limited indemnity policies, please give one of our friendly Member Services representatives a call, (888) 912-4767, Monday through Friday, 8:00 a.m. to 5:00 p.m., and they’ll be happy to put you in touch with a licensed agent.
by Meriel Lesseig | Jan 14, 2020 | Uncategorized
Medicare is the U.S. government’s health insurance for people 65 and older, and it pays up to 80% of most healthcare expenses.
When Should I Start Looking at Medicare Options?
Start checking out Medicare options well before your 65th birthday. Figuring out the coverage you need can be a lengthy process and will depend on whether you’re still working or retired, or you have insurance through a different program.
Medicare.gov, the official U.S. government site for Medicare, provides detailed information about your options as well as what you want to consider when choosing your coverage, but you have two primary choices of Medicare coverage.
(1) Original Medicare, which includes Part A and/or Part B. Basically, Part A is hospital insurance, and Part B is medical insurance. Medicare provides the coverage; you can choose any doctor, hospital, or provider that accepts Medicare; and you usually have a deductible and coinsurance. For most people, Part A does not require a premium. Part B’s standard premium for 2020 is $144.60 or higher depending on income.
Medicare Supplement insurance works hand-in-hand with Original Medicare to pay for out-of-pocket expenses not covered by Medicare.
(2) Medicare Advantage (MA), also known as Part C, is provided through private insurance companies approved by Medicare and includes both Part A and Part B insurance. Your premium for an MA plan is in addition to your Part B premium, but it may have lower out-of-pocket costs than Original Medicare.
What About Prescription Drug Coverage?
If you have Original Medicare, and you also want prescription drug coverage, you have to join a Medicare Prescription Drug Plan (Part D).
Most MA plans also offer prescription drug coverage, and if you have an MA plan and want prescription drug coverage, you must get it through your MA insurance provider.
When Do I Enroll in Medicare?
Applying for Medicare when you turn 65 is not the best plan. Your Initial Enrollment Period for Medicare is the 3 months before your 65th birthday, the month of your birthday, and 3 months after your birthday (7 months total).
If you miss your initial enrollment, you can apply during general enrollment (January 1 – March 31). However, your coverage does not go into effect until July of that year.
In specific situations (for example, you have coverage with an employer), you may delay enrolling in Medicare and enroll during a special enrollment period.
Medicare also has an open enrollment period from October 15 to December 7. This is when you can switch plans or join or drop prescription drug coverage.
Keep in mind, if you don’t sign up for Medicare when you’re eligible and you didn’t have other insurance, you can still apply, but you may face a penalty for late enrollment and see a 10% increase in your Medicare Part B premiums for every year-long period you're eligible but don’t enroll.
When it comes to your Medicare enrollment options, be thorough. Even If you think you’ll be enrolled automatically, still doublecheck to make sure well before your 65th birthday.
I Have Private Insurance…Do I Have to Sign Up for Medicare?
If your employer doesn't require you to sign up at 65, you don't need to enroll in Medicare, nor will you be penalized for not signing up during your initial enrollment period.
Once you apply for Medicare, it becomes your primary health insurance.
Does Social Security Impact Medicare?
It may. In some cases, you may be automatically enrolled in Medicare Part A and/or Part B when you turn 65. Once you sign up for Social Security (which can begin at age 62), it’s mandatory to enroll in Medicare Part A. Medicare Parts B, C, and D remain optional, and you can delay enrollment if you have other creditable coverage.
What if I Want Supplemental Coverage?
If you choose Original Medicare, and you want help paying for out-of-pocket costs not covered by Medicare, you can get a Medicare Supplement (also known as Medigap) policy from a private insurer, like SGIC. Medicare Supplement plans can help pay for:
- Coinsurance (what you are responsible to pay after your insurance has paid your benefit)
- Co-payments (the amount you pay when you have a doctor’s visit or otherwise seek care)
- Deductibles (the money you pay before your health insurance benefits apply)
Medicare Supplement Open Enrollment begins the first day of the month you are both 65 or older and enrolled in Medicare Part B; it lasts 6 months.
If you apply for Medicare Supplement after your Open Enrollment ends, you risk rejection or higher premiums based on your health history.
For more information on SGIC’s Medicare Supplement policies, please contact a licensed representative today at (833) 552-0828 for a benefits review.
Want to learn more about Medicare and your options? Check out these articles on our blog:
How Medicare Works with Other Insurance
How a Medicare Supplemental Insurance Policy Can Save You Money
Click here for more information on Medicare and Medigap. SGIC is not connected with or endorsed by the U.S. Government or Federal Medicare Program.)
by Meriel Lesseig | Feb 8, 2019 | Uncategorized
Do millennials need health insurance?
According to the Pew Research Center, you are a Millennial if you were born between 1981 and 1996, you’re considered a millennial. Ranging from as young as 23 years old to a very adult 38 years old, your cohort is cost-conscious (thanks recession) with buying habits that are drastically different than previous generations. You are actually financially savvy but, at the same time, tend to put off long-term financial planning, like saving for retirement and having health insurance. Overall, you also tend to pursue a healthy lifestyle, so it’s interesting that many millennials put off important health care needs. Today, SGIC answers the question: “Do millennials need health insurance and what are your options?”
Without health insurance, you are more likely to ignore preventive and minor healthcare concerns, until something really goes wrong. Unfortunately, because you’re young, the thing that “really goes wrong” could create a long-term, maybe even lifelong, financial impact.
That is why health insurance, along with your retirement savings, should be a priority for millennials. Investing a little bit upfront may save you a lot of money in the long run.
Must Know Health Insurance Terms for Millennials
First things first, we want to clarify some key health insurance terms that you may not know:
- Premium – amount you pay for your coverage, usually monthly.
- Deductible – amount you pay for covered services before your health insurance begins to pay.
- Copayment – fixed dollar amount you pay for your healthcare providers’ services or prescription drugs.
- Coinsurance – percentage you’re responsible for paying after your insurance pays its part of a covered service. For example, if your insurance pays 80%, you are responsible for the remaining 20% of the charge.
- Out-of-pocket maximum – maximum amount you will pay for covered services during a benefit period (usually, one year). Does not include premium or services not covered. May include copayments, deductibles, and coinsurance.
Have questions about health insurance and your options? Call SGIC at (888) 912-4767, and we’ll get you in touch with a licensed agent.
What kind of health insurance can I afford?
Millennials as a group carry a lot of debt (mostly student loans) and are frugal shoppers, using coupons and purchasing less expensive generic/store brands over name brands. They value convenience, price, and customer service.
If this describes you, you may believe there is no such thing as affordable health insurance. The truth is you have a number of health insurance options, depending on your current life circumstance.
Your health insurance options
Your parents’ insurance
If you are under 26, stay or get on your parents’ health insurance plan, if it covers dependents. This is your least expensive option, costing you nothing (unless your parents make you chip in). You can stay on that plan until you turn 26 even if you have a full-time job, get married, are in school, live at home, live on your own, or have children.
Your school’s insurance
If you’re a full-time student at a university or college and are not eligible for your parents’ health insurance, you may be able to enroll in a student health plan. Often, the cost of a school’s health insurance plan can be included with your tuition, room, and board, which means you can use your student loan to pay for it. The main downside is the plan may not be as robust as traditional health insurance.
The health insurance marketplace
Another option is the health insurance marketplace (Obamacare). Depending on your income level, you may qualify for a subsidy to help you pay for the premiums, and you will you have comprehensive, Affordable Care Act (ACA)-compliant healthcare coverage. The federal or your state’s marketplace offer a number of plans that have varying monthly premiums, deductibles, etc. Make sure you shop around to find the most affordable plan.
Off-exchange health insurance
If you don’t qualify for a subsidy on the health insurance marketplace, you can look for equivalent, ACA-compliant health insurance plans directly from the health insurance carrier or an outside broker or agent, usually referred to as an off-exchange plan. Again, shop around; you may find a plan with similar benefits at a cheaper cost than on the marketplace (if you’re not getting a subsidy).
Employer-provided health insurance
Working full time? Then, your employer may offer a group health insurance plan and pay for a portion of your premium. Keep in mind you are not obligated to enroll with your employer’s health plan. While it’s likely your employer’s health plan will be the best deal (if you’re too old to be on your parent’s insurance), it doesn’t hurt to check out your other options, whether on or off the exchange.
Short term medical insurance
Short term medical insurance may be a good option when you’re in-between being on your parents’ insurance and being able to enroll in either the marketplace or an employer-provided insurance, in-between jobs, a contract or freelance employee, or just find yourself without the type of coverage that fits your current lifestyle and budget.
Short term medical is considered comprehensive health insurance, but it is not ACA-compliant and may deny coverage if you have a pre-existing condition.
Supplemental health insurance
If comprehensive health insurance is not available or out of reach, but you know that some insurance is better than no insurance, take a look at supplemental health insurance plans.
While also not ACA-compliant, these plans are generally very affordable, easy to apply for, and pay benefits directly to you rather than to your doctor. A limited indemnity medical policy from SGIC can cover hospital stays, surgery, emergency room, doctor visits, and even wellness care. Other types of supplemental health insurance we offer include critical illness and accident insurance.
Catastrophic health insurance
Similar to supplemental health insurance, catastrophic health insurance can be attractive because it is so affordable. Only people who are under 30 years of age or that have a hardship or affordability exemption can purchase catastrophic health insurance on the federal or state exchanges.
Catastrophic health insurance pays benefits when you are very sick or in a terrible accident. It is also required by the ACA to cover the 10 essential health benefits but only after you meet your deductible, which could be as much as $6,000—which means, if you do need to use it, it’s going to cost you.
Medicaid
You and your family may qualify for Medicaid, which is free or low-cost coverage for you if your income is below a certain level, you’re disabled, or you’re pregnant. Visit your state’s Medicaid website to find out if you’re eligible.
As you can see, there are many healthcare options for millennials to make sure that you’re protected. Our goal at SGIC is to help you find a short term or supplemental health care policy that suits your budget and unique needs. Have questions about health insurance and your options? Call SGIC at (888) 912-4767, and we’ll get you in touch with a licensed local agent.
by Meriel Lesseig | Jan 28, 2019 | Supplemental Insurance
When you think of accident insurance, does a picture of a quacking duck pop into your head? What’s a duck got to do with accident insurance? Probably about as much as a lizard has to do with car insurance. But the real question is: what is accident insurance?
Accident insurance supplements regular health insurance by paying benefits when a catastrophic accident causes serious injury or death. An accident insurance policy can supplement not only your health insurance but your life insurance as well and give you some peace of mind for when life doesn’t go as planned.
Types of Accident Insurance
Insurance that covers accidents comes in different types, such as accident medical expense insurance and accidental death and dismemberment (AD&D) insurance.
SGIC’s Accident Insurance is a robust solution that includes multiple options, which allows you to customize a policy to fit your specific needs. With SGIC, you have the choice to purchase just an accidental death benefit or the more comprehensive AD&D benefit. Let’s explore more of the differences in these types of accident insurance coverage:
- The Accidental Death benefit pays your beneficiary a lump sum if you die as a result of an unforeseen accident.
- The Accidental Death and Dismemberment (AD&D) benefit pays you (or your beneficiary if you die) if you sustain a serious injury or die because of an unforeseen accident. Covered injuries for this type of supplemental insurance policy include loss of hands, feet, fingers, and toes; loss of hearing and sight; and loss of speech.
As part of your policy you can include an SGIC Accident Medical Expense benefit rider, which pays you a lump sum for ambulance, emergency room, hospital, doctor and nursing services, rehab, prescriptions, and even dental and vision services needed as result of that accident.
You can also add a Critical Illness benefit rider, which covers life-threatening conditions such as cancer, stroke, heart attack, coronary artery bypass graft, major organ transplant, paralysis, kidney failure, and coma.
Do I Need Accident Insurance?
Accidents happen. It’s not a bad idea to have accident insurance if you and your family live the adventurous life and travel a lot. If you have a high-deductible health insurance plan, SGIC highly recommends you add supplemental accident insurance.
If you’re interested in learning more about accident insurance, call (888-912-47670) or email SGIC at info@sginsco.com.
*Updated January 2020: Currently SGIC isn’t offering these plans.
by Meriel Lesseig | Jan 3, 2019 | Uncategorized
People are living longer. They are healthier. And they often work well past retirement age and well past when they are eligible for Medicare at age 65. As a senior, you may already have health insurance through your employer (or through your spouse’s employer) and might wonder whether you really need to or even should enroll in Medicare just yet. Well, it depends. Today, we’ll explain in general how Medicare works with other insurance.
First, if you are covered by your employer’s insurance (or your spouse’s employer’s insurance), you will want to consult with a benefits counselor to see if and how Medicare might impact that coverage.
However, you should probably go ahead and enroll in Medicare Part A (if you aren’t automatically enrolled), which is usually free and covers institutional care in hospitals, skilled nursing facilities, and certain home health care and hospice care services.
How Medicare Part B Works with Other Insurance
As for Medicare Part B, which has a monthly premium and covers general outpatient medical expenses like doctor visits, preventive care, and diagnostic tests, you are supposed to enroll during an eligibility period that begins 3 months before the month of your 65th birthday and continues the following 3 months. If you don’t enroll during that period, you might have to pay a 10% premium penalty for every year you don’t sign up.
Even if you’re working and have health insurance, you may still be required to sign up for Medicare Part B if your company has fewer than 20 employees. Medicare becomes your primary insurer and pays before your employer’s insurance. If you don’t have Medicare, your employer’s insurance may deny payment on services that would have been covered by Medicare.
On the other hand, if your company employs more than 20 people and has a group health insurance policy, you don’t need to sign up for Medicare Part B when you turn 65. If you do sign up for Medicare in this instance, your employee’s health plan would be the primary insurer, and while Medicare might make up some of the expenses not covered by the primary insurer, you will want to consider whether the additional premium is worth the additional benefits. Once you retire, you will have a special 8-month period to sign up for Part B, with no penalty.
About Medicare’s “Coordination of Benefits”
If you do end up with both employer-provided health insurance and Medicare, Medicare’s “coordination of benefits” rules decide who is the primary insurer and who is the secondary insurer.
- The primary insurer pays first, up to the limits of its coverage.
- The secondary insurer pays leftover costs, if any.
- Keep in mind the secondary insurer (which could be Medicare) may not pay all uncovered costs, and you may still have out-of-pocket expenses.
Even if you are not retired, you still can choose Medicare over your employee’s insurance (just keep in mind the enrollment period). If you have Medicare, you also have access to SGIC’s Medicare Supplement (Medigap) plans that work hand-in-hand with Medicare to help you cover some of your out-of-pocket costs for Medicare-approved services. Contact our Medicare Supplement Insurance Customer Service Center at (833) 552-0828 to get more information about how SGIC can help you find the best Medicare Supplement plan for you.
