CalCPA ProtectPlus

(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…)