CalCPA ProtectPlus

The following information is from Healthcare.gov:

How the Affordable Care Act will make Medicare stronger into the future

• The life of the Medicare Trust fund will be extended to at least 2029, a 12-year extension as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare. This will provide you with future cost savings on your premiums and coinsurance.
• Medicare will take strong action to reduce payment errors, waste, fraud, and abuse in Medicare. The President has made a commitment to reduce Medicare fraud 50 percent by 2012. The Affordable Care Act makes an historic, ten-year, $350 million investment to prevent, detect and fight fraud in Medicare, Medicaid and the Children’s Health Insurance Program—including criminal efforts to exploit the new law. Visit Stop Medicare Fraud for more information.
• In 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name drugs. Every year after, you will pay less for your prescription drugs in the donut hole until there’s complete coverage of the donut hole in 2020. Between now and then, you will get continuous Medicare coverage for your prescription drugs.
• The coordination of care between doctors and the overall quality of care will improve so that you will be less likely to experience preventable and harmful re-admissions to the hospital for the same condition.
• Hospitals will have new, strong incentives to improve your quality of care.
• Starting in 2014, the Affordable Care Act offers additional protections for Medicare Advantage Plan members by taking strong steps that limit the amount these plans spend on administrative costs, insurance company profits, and things other than health care.

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Our group plans require that you work a minimum of 20 hours per week in order to maintain your coverage. If you plan to retire before your 65th birthday (Medicare eligible age) you will not be eligible for coverage. You may be eligible for COBRA and/or CalCOBRA coverage depending on the size of your firm. Please contact Banyan Administrators, LLC at 877-480-7923 to discuss your options.

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The following information is from Medicare.gov.

Question: 2010 Part B Premium Amounts for Persons with Higher Income Levels

Answer:  Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less ($170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.

Social Security will use the income reported two years ago on your IRS income tax return to determine your premium (if unavailable, SSA will use income from three years ago).  For example, the income reported on your 2008 tax return will be used to determine your monthly Part B premium in 2010. If your income has decreased since 2008, you can ask that the income from a more recent tax year be used to determine your premium, but you must meet certain criteria.

The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty.

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The following information is from the Department of Labor’s website and is full of valuable information for all of us!

The Department of Labor’s Employee Benefits Security Administration (EBSA) administers several important health benefit laws covering employer-based health plans. They govern your basic rights to information about how your health plan works, how to qualify for benefits, and how to make claims for benefits. In addition, there are specific laws protecting your right to health benefits when you lose coverage or change jobs. EBSA oversees health care laws covering special medical conditions. For more information on the laws that protect your benefits, see EBSA’s Web site at www.dol.gov/ebsa. Or, call the agency’s toll-free help line at 1.866.444.3272 to reach a regional office near you. These 10 tips can help make your health benefits work better for you.

Realize that Your Options are Important

There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. If your employer offers a high deductible health plan, look into setting up a Health Savings Account to save money for future medical expenses on a tax-free basis. The more information you have, the better your health care decisions will be.

Review the Benefits Available

Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.

Read Your Plan’s Summary Plan Description (SPD) for the Wealth of Information It Provides

Your health plan administrator should provide a copy. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. (continue reading…)

Approximately 3 months before your 65th birthday you will receive a letter from Banyan Administrators, LLC outlining your options. ProtectPlus is not a Medicare supplement and in most cases we do not recommend maintaining your ProtectPlus coverage once you are eligible for Medicare. However, factors that may affect your decision include: the size of your firm, whether or not you have a younger spouse and/or dependent children and when you plan to retire. You may contact Banyan Administrators, LLC  at 877-480-7923 to discuss your options.

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The following information is from Medicare.gov.

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date.

You may refuse Part B coverage. However, if you decide to pick up Part B coverage at a later date, but before you turn 65, you may have to pay a 10% surcharge in addition to the Part B premium. Also, please be aware that you will automatically be re-enrolled in Part B when you turn 65, even if you previously refused Part B coverage. You may again refuse coverage, but if you keep it you will not have to pay a surcharge.

Note: A Special Enrollment Period is available if you waited to enroll in Medicare Part B because you or your spouse was working AND had group health coverage through a current employer or union. If this applies, you can sign up for Medicare Part B:

• While you are still covered by an employer or union group health plan, through your or your spouse’s employment, or
• During the 8 months following the month when the employer or union group health plan coverage ends or when the employment ends (whichever comes first).

The Social Security Office can answer questions about applying or appealing Social Security Disability benefits. They can also answer questions about when you will be eligible to receive Medicare.

Your 24-month waiting period will be waived if you have been diagnosed with ALS (Amyotrophic Lateral Sclerosis). This disease is commonly known as Lou Gehrig’s Disease.

The following information is from Medicare.gov.

Question: Will my Medicare Part B premium increase in 2010?

Answer:  Most Medicare beneficiaries will continue to pay the same $96.40 Part B premium amount in 2010. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2010.

For all others, the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium. The Medicare Part B premium is increasing in 2010 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $110.50 per month.  In 2010:

• New Part B beneficiaries will pay $110.50 (because they did not have the premium withheld from their Social Security benefit in the previous year).
• Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit will pay $110.50.
• Higher-income beneficiaries pay $110.50 plus an additional amount,  based on the income-related monthly adjustment amount (IRMAA).

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(This News Article via California Healthline June 26th, 2009)

California clinics this week lost their court battle against the state’s plan to eliminate funding for adult dental care and several other services.

A Sacramento County Superior Court judge ruled that the state Legislature had the right to cut adult Denti-Cal and other benefits when it voted in February on various measures to reduce state spending. A lawsuit filed in April by the California Primary Care Association and two clinic groups argued that eliminating some Medi-Cal benefits, including adult Denti-Cal, violates federal law.

Denti-Cal is the dental benefit provided through Medi-Cal, California’s Medicaid program.

The suit, aimed at preventing the state from ending Medi-Cal payments for services at federally qualified health centers and rural health centers, claimed that state and federal law requires such centers to provide dental care and other services to all residents, regardless of income.

Reimbursements for dentistry, optometry, podiatry and chiropractic programs is scheduled to stop July 1, as is funding for other optional Medi-Cal benefits, including speech therapy and some mental health services.

Clinicas del Camino Real, a group of 10 clinics for low-income people in Ventura County, filed the lawsuit along with Southern Trinity Health Services in Northern California and the statewide California Primary Care Association, which represents hundreds of clinics throughout the state.

Officials for Clinicas del Camino Real said the loss of Medi-Cal reimbursements could result in layoffs of as many as 150 people and the closure of two of its clinics.

California lawmakers are taking a closer look at Medi-Cal spending as they work to address the state budget deficit. Here’s a look at other legislation under consideration in Sacramento.  Continue to original source.

Approximately 3 months before your 65th birthday you will receive a letter from Seabury & Smith outlining your options. ProtectPlus is not a Medicare supplement and in most cases we do not recommend maintaining your ProtectPlus coverage once you are eligible for Medicare.

However, factors that may affect your decision include: the size of your firm, whether or not you have a younger spouse and/or dependent children and when you plan to retire. You may contact Seabury & Smith at 800 824-1154 to discuss your options.

If You Continue to Work Past 65
For those who continue working beyond the age of 65, whether solo CPAs or in firms of fewer than 20 employees, the Group Insurance Trust strongly recommends subscribing to Medicare Parts B and D and purchasing a Medigap policy. Since Medicare will be your primary payer of claims, you will receive few if any benefits from retaining your group coverage.

However, if you are employed at a firm with more than 20 employees, the opposite generally holds true. Since your group plan qualifies as the primary payer, and thus is billed before Medicare, you should retain your group coverage. In this circumstance, you can also delay purchasing any optional Medicare and Medigap plans until you do finally retire. If your spouse has been covered on your group plan and you continue working, then for solo practitioners with ProtectPlus, the choice is simple. (continue reading…)

If You Retire at Age 65 For most people who retire on their 65th birthday, there are a set of choices to be made. Assuming you have contributed the minimum amount to qualify for Social Security, you will automatically receive hospitalization coverage under Medicare Part A.

Other medical expenses, such as doctors’ fees are covered under Medicare Part B. And though optional, subscribing to Medicare Part B is universally recommended.

The small premium for this coverage is automatically deducted from your Social Security payment, or will be billed to you if you have opted to delay collecting benefits. In addition to Medicare Parts A and B, the Social Security system gives you the opportunity to subscribe to prescription drug coverage under Medicare Part D. The complicated nature of this coverage has by now been well documented, so you should be sure to budget adequate time to determine the policy that will serve you best. (continue reading…)

Claims Procedures

Whether you have received treatment abroad in a hospital, clinic or doctor’s office, or filled a prescription, be sure to save your receipts. Also, try to get the doctor’s, or hospital’s, write-up in English. Anthem Blue Cross provides translation services, but having information about your treatment in English will speed your claim.

In addition, if you pay by credit card, the billing will be in dollars, making the process of reimbursement both simpler and at a better exchange rate.

Similar procedures apply for Delta Dental as well, plus Delta will make allowances for out-of-network treatment when abroad. When you return home, you can use the standard claims forms to get reimbursed.

Understanding the Medicare system that serves as the primary health insurer for almost everyone in this country who is 65 or older is vital in planning your health insurance needs. If you are approaching that age, you should start familiarizing yourself with the system before you retire.

You need to know how various parts of Medicare work, how they relate to the supplemental insurance policies (Medigap) and how they interact with your workplace group insurance plan.

In addition, understanding the relationship between Medicare and your group health policy becomes more important and more complicated if your spouse is covered under your plan at work. HIPAA, COBRA and CalCOBRA provisions may determine the availability of his or her coverage. (continue reading…)

It’s a haunting fear that most of us share in one form or another: You step off the curb in a foreign city, trip, and a sharp pain shoots up from your ankle. It might be broken. In another version, you’re enjoying a Caribbean cruise, and suddenly you have a high fever and feel nauseated. It could be something you ate or the flu, or it might be appendicitis. There are other scenarios too: you leave your carry-on bag with your prescription medicines in the taxi in Melbourne, or you crack a tooth chewing the ice in your drink in Puerto Vallarta.

All these scenarios share a common element—you’re abroad and you need medical help. Fortunately, friendly people guide you to the help you need. In addition, you are able to pay your bills with a credit card or a pile of traveler’s checks, or you arrange a wire transfer of funds from your bank. But now, you have a whole new set of concerns and questions: (continue reading…)