Friday, July 8, 2016

Consider your options when you lose your employer-sponsored insurance

Finding out you are being laid off is stressful, and in addition to that, you have to make important decisions about health insurance that can save you—or cost you—thousands of dollars at a critical time. It’s important to consider all your options when deciding between COBRA or buying your own plan.

What is COBRA? COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, which is a federal law that allows you and any of your immediate family members to stay on your employer’s health plan under certain circumstances :
  • You lose or quit your job 
  • You get a divorce 
  • The employee dies 
  • You are no longer covered as a dependent due to your age
Only employers with 20 or more workers in the previous year are required to offer COBRA coverage. State and local governments fall under COBRA, but the federal government and certain religious organizations do not.

COBRA can be expensive. People who choose COBRA coverage must pay the entire premium, including the portion previously paid by the employer, plus a 2 percent administrative fee. Be warned, if you enroll in COBRA and later on want to switch to a health plan directly to an insurance company or through the Washington Healthplanfinder, you will have to wait until the next open enrollment period if you don’t qualify for a special enrollment.

Options other than COBRA
Before you decide to go with COBRA, find out if you can buy a health plan through the Washington Healthplanfinder and receive a subsidy to help pay your insurance premiums. You can also purchase coverage directly from an insurance company, broker or agent if you don’t qualify for any subsidies.

If you choose a health insurance plan, you likely will be responsible for a full yearly deductible. Generally, health insurance deductibles are not prorated for partial-year enrollees, no matter how few months are left in the plan year. Individual or family qualified health plans operate on a calendar year, from January through December. There is no way to transfer the money you spent toward another plan’s deductible when you switch plans mid-year.

Read more about losing your health insurance on our website. Questions? Contact our consumer advocates online or at 1-800-562-6900.

For COBRA- specific laws and questions, contact:

U.S. Dept. of Labor, Employee Benefits Security Administration
Seattle District Office
300 Fifth Ave., Ste. 1110
Seattle, WA 98104
206-757-6781

Tuesday, July 5, 2016

Learn more about Medicare at free event July 9 in Seattle

Are you new to Medicare? The Office of the Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) will be at the Seattle Central Library from 11 a.m. to 1:30 p.m. on Saturday, July 9.

You will learn about:
Medicare parts A, B, C and D
Your Medicare benefits and options
How to get help paying for Medicare if you qualify

Find registration and parking information for this event.

Other resources:
Find out more events on the SHIBA calendar.
Read more about SHIBA and how it can help you.
Do you have Medicare questions? Call 1-800-562-6900.

Thursday, June 23, 2016

Kreidler speaks to consumers in Shoreline about Medicare

Attendees to a Medicare birthday event on Saturday morning got to hear Insurance Commissioner Kreidler talk about why Medicare is important and what SHIBA does for Washington consumers. 
Commissioner Kreidler and Judy Ellis, SHIBA volunteer  with Sound Generations in Shoreline
Commissioner Kreidler and Judy Ellis, SHIBA volunteer
with Sound Generations in Shoreline 

SHIBA stands for Statewide Health Insurance Benefits Advisors. It’s a statewide network of nearly 400 highly trained volunteers who have been helping seniors and others understand their health insurance options for more than 35 years in Washington state. Washington was the first state in the nation to establish a SHIBA program, before the federal government offered assistance in reaching out the consumers who are or are about to be enrolled in Medicare.

Medicare provides health coverage for nearly 45 million Americans who are age 65 and older, and for 7 million younger adults with permanent disabilities. Medicare has been in existence for 51 years, which really isn’t that long ago. 
Shoreline Medicare event attendees
Attendees at the Medicare birthday event 
on June 18 in Shoreline 
Commissioner Kreidler recalled for the attendees a time before Medicare existed when his grandmother had to move in with his parents because she was ill and didn’t have health coverage. Her medical bills prohibited her from living on her own. If Medicare had existed, it would have provided a lifeline for her to have access to the health care she needed.

SHIBA offers free, unbiased assistance with health care choices, including Medicare, to more than 100,000 Washington residents each year. You can find more SHIBA events around the state at http://bit.ly/SHIBAevents.

Friday, May 20, 2016

Department of Health looking for experts on patient out-of-pocket costs

During the last legislative session, Washington's Department of Health was charged with convening a task force on patient out-of-pocket costs. Senate Bill 6569 directed the task force to focus on two key areas:

1. Evaluating factors that contribute to out-of-pocket costs for patients and to the state.
2. Considering the health and economic impact of out-of-pocket patient costs to patients and to the state.

If you have particular expertise in this area and represent patient groups, insurance companies, pharmacists, pharmacy benefit managers, unions, business associations, or biotechnology representatives please consider joining this important task force.

Members of the task force will be asked to attend no more than four half-day, in-person meetings in the Puget Sound region between July 1 and Dec. 1, 2016.

To be considered for the task force, please respond to DOH Secretary John Weisman's letter by COB May 24, 2016 via email to C4PA@doh.wa.gov

Friday, May 13, 2016

Join telephone town hall to get answers to your questions about Social Security, Medicare

Join the King County Library System (KCLS) for a live telephone town hall meeting with specialists from the Social Security Administration and Washington Statewide Health Insurance Benefits Advisors (SHIBA)This free event will take place on Wednesday, May 18 from 10:30 a.m. - 11:30 a.m. 

Topics will include how to make the most of your Social Security benefits, health insurance and Medicare coverage. 

A telephone town hall is like a radio talk show, but you simply listen on your phone! Experts will take live questions from the audience. 

On the day of the telephone town hall you will receive a telephone call from the library between 10:25 a.m. and 10:40 a.m. Please answer the call and stay on the line, as it could take a few minutes before the call starts. You will hear some introductory remarks and then be connected.

Be sure to include your telephone number in the registration to receive a phone call! 

Brought to you by the Social Security Administration, Washington State Office of the Insurance Commissioner, the KCLS Foundation and AARP.

Register here for the telephone town hall. 

Tuesday, May 3, 2016

Need help with Medicare? Events being held around the state through summer

Consumers get help at a SHIBA event in Washington state
The Office of the Insurance Commissioner has a program that helps Washingtonians sign up for Medicare and other health care programs. It's called Statewide Health Insurance Benefits Advisors (SHIBA) and it offers free, unbiased and confidential assistance with Medicare and other health care choices.

SHIBA can help you:
  • Understand your health care coverage options and rights.
  • Determine your general eligibility for health care coverage programs.
  • Evaluate and compare health insurance plans.
SHIBA holds events around the state to help people who are just getting signed up for Medicare--called birthday events--and information sessions for people who are new to Medicare or simply have questions about it.

Upcoming events:
  • May 5: Lacey Community Center 
  • June 18: Shoreline Conference Center
  • June 23: Community Cultural Center of Tonasket 
  • June 24: Grand Coulee Senior Center 
  • July 9: Seattle Central Library
  • Aug. 6: Kent Senior Activity Center
Find out more about these events and other events on the SHIBA calendar

Read more about SHIBA and how it can help you. Do you have Medicare questions? Call 1-800-562-6900.

Friday, April 22, 2016

Gov. Inslee honors Cowlitz County SHIBA volunteer

From right: SHIBA Volunteer Coordinator Terri Osbourne,
volunteer Elouise Maahs and volunteer coordinator Sarah Clark
Congratulations to SHIBA Volunteer Elouise Maahs for receiving the Governor’s Volunteer Service Award in the health care category.

Elouise, who volunteers for SHIBA with Lower Columbia Community Action Council in Cowlitz County, was honored on April 11 at the Governor’s mansion, where she receive her award from Gov. Jay Inslee. A SHIBA volunteer since 2008, Elouise serves as a data specialist, where she records and processes client cases. In the past year she’s processed over 6,000 client cases. Eloise was nominated for her dedication and commitment to ensuring that seniors and people disabilities have their Medicare issues, complaints and appeals processed in a timely manner.

In addition to meeting the Governor on April 11, Eloise also stopped by the Office of the Insurance Commissioner/SHIBA and had the opportunity to receive congratulations personally from Insurance Commissioner Mike Kreidler.

Read more about SHIBA, which provides free, unbiased, and confidential assistance with Medicare and health care choices.

Friday, April 15, 2016

If I switch health plans halfway through the year, can my deductible be transferred or prorated?

Insurance companies are not required to credit money consumers already paid in cost sharing from prior plans but sometimes they do for employer-sponsored replacement policies. If you lose employer-sponsored insurance in the middle of the year, and you've already met your deductible the year, you may want to consider COBRA for the rest of the calendar year and get an individual or family plan during open enrollment.

If COBRA is not an option, you likely will be responsible for a new, full deductible. Generally, health insurance deductibles are not prorated for partial-year enrollees, no matter how few months are left in the plan year. Individual or family qualified health plans run from January through December. There is no way to recoup the additional money you may spend towards your health insurance deductible when you switch plans mid-year after paying the first plan’s deductible. However, sometimes medical and dental expenses like deductibles, co-pays and coinsurance can be deducted from your federal taxes, which will lower the taxes you pay that year.

When you choose a health insurance plan, it will be important to understand what your insurance company covers without requiring you to pay your deductible. Then you can decide whether you want a plan with lower monthly premiums and higher deductible or one with a higher monthly premium and a lower deductible. Many health plans cover some services such as emergency room or routine doctor visits such as preventive care without requiring you to pay toward your deductible. 

Deductible amounts vary by plan and can be separated into individual or family deductibles. Some health plans also cover other benefits like doctor visits and prescription drugs even if you haven’t met your deductible. 

Your best course of action is to read your policy and contact the insurance company to find out more about the health plan’s benefits. 

If you have questions about your plan or your rights as a consumer, you can contact our consumer advocates online or at 1-800-562-6900.

Friday, March 11, 2016

Most colonoscopies should be covered 100% by your insurance

The Affordable Care Act (ACA) requires that insurance companies cover 100 percent of the cost of preventive colonoscopies for adults older than age 50. Of course you’ll need to see a provider who is part of your plan’s provider network.

However, despite this new reform, we do hear consumers who’ve had a routine preventive colonoscopy only to have their insurer process their claim as “cost-shared diagnostic care,” which is subject to their annual deductible and coinsurance.

We also sometimes hear from consumers who receive a substantial surgical bill when a polyp is discovered and removed during a preventive colonoscopy. The Affordable Care Act and other federal guidelines protect consumers from extra charges for polyp removal during a preventive colonoscopy. If you receive a bill for polyp removal, you should file a complaint with us and we’ll help you get those charges reversed.

If you are diagnosed with colon cancer, any previous related symptoms may result in your provider processing the cancer screening as diagnostic and not preventive. In that case, your treatment would not be covered as preventive care and you’ll likely have additional costs. If you have any questions, check with your doctor.

Be aware that if a procedure or treatment is not a recommended preventive service, it may be subject to your plan’s deductible and cost-sharing. Also, if a medical recommendation or guideline regarding a preventive service does not specify the frequency, method, treatment, or setting for that service, your insurer may limit your coverage.
Here are some important tips to remember:

Thursday, March 10, 2016

Protect yourself from Medicare fraud

The Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) program is Washington state’s Senior Medicare Patrol (SMP). A federally funded and volunteer-based program, SHIBA/SMP volunteers provide education on how to prevent, detect and report Medicare fraud.

Medicare is the national health care plan for all U.S. citizens age 65 and older. It also covers people younger than age 65 who receive Social Security Disability Income and people who are diagnosed with certain medical conditions.

In Washington state, SHIBA/SMP volunteers help protect seniors and fight health care fraud, leaving more money in the system for everyone. Our state’s volunteers educate beneficiaries on how to avoid becoming victims of health care fraud, and how to report abuse or fraud, related to their Medicare benefits.

We all pay a price for Medicare fraud, waste and abuse, which contributes significantly to rising health care costs. There are three things you can do to help fight Medicare fraud:

  1. Know your rights. As a person with Medicare, you have certain rights and protections designed to help protect you and make sure you get the health care services the law says you can get.
  2. Protect your identity. Identity theft happens when someone uses your personal information without your consent to commit fraud or other crimes. Keep this personal information safe:
    • Your name.
    • Your Social Security Number (SSN).
    • Your Medicare number (or your membership card if you’re in a Medicare Advantage or other Medicare health plan).
    • Your credit card and bank account numbers.
  3. Get involved with other seniors with the Senior Medicare Patrol (SMP). The SMP educates and empowers people with Medicare to take an active role in detecting and preventing health care fraud and abuse.
You can find more Medicare fraud tips on our website. If you suspect Medicare fraud or have questions about your bill: