Dr.Copay & Associates ™

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803-567-1180. Visit CarolinaLifeAndHealth.com for additional information.

Client Communication

​"Dr.Copay - The Most Mentioned Name In Health Insurance Plans" ™

8/31/23

Prisma Hospital Systems has recently sent letters to all UnitedHealthcare insured clients advising Prisma would not be in-network with UnitedHealthcare as of 1/1/24. Prisma and UnitedHealthcare are in the midst of contract negotiations which we feel will be settled amicably for all parties before the start of 2024. We will keep you informed as these negotiations progress. 

​​​Affordable Care Act Information

INDIVIDUALS ENROLLING IN HEALTH INSURANCE FOR THE FIRST TIME 

Open Enrollment is the only time during the year that everyone under the age of 65 (who is not covered under a qualifying employer group plan) is eligible to apply for major medical health insurance.​ If an individual does not enroll during this time period, they will not be able to get health insurance for the remainder of the calendar year unless they qualify for a Special Enrollment Period which is granted by the Center for Medicare & Medicaid Services. All Affordable Care Act (ACA) plans are designed on a calendar year basis requiring all individuals to enroll annually for the plan of their choice. Individuals can apply for coverage ON or OFF the Federally Facilitated Marketplace Exchange depending on their ability to get an advanced premium tax credit (APTC) to help pay the monthly insurance bill. This APTC can only be given on plans offered ON the Exchange. The amount of the APTC is determined by the total household income for all individuals shown on their federal tax form. Incomes that fall below 250% of the Federal Poverty Level will also qualify for additional cost reductions on medical care which is only offered on Silver tiered level plans.

ACA Re-enrollments
For any APTC eligible individual whose information has changed (#household members and/or income, residence or tobacco use) the Center for Medicare & Medicaid Services (which administers the Affordable Care Act) has recommended that agents "actively" re-enroll those individuals so a correct tax credit can be applied to the client's account. Even for clients whose information has not changed, CMS recommends those clients actively enroll as well to insure your subsidy will be based on correct family details.

Client Open Letter On ACA

During the last two weeks of October, you should receive a letter from your insurance company showing the changes to your health insurance plan for the next year. The letter will show changes in the benefits as well as the monthly cost of the plan which will reflect any advanced tax credit (subsidy) you are qualified to receive. Those subsidies are based on your family’s household information that was used to enroll you in the current plan year. As your health insurance agent of record I recommend we schedule a time to discuss the health insurance options available to you. Since I have your information on file, your enrollment in the plan of your choice should be very fast and convenient. There are a number of plans offering a $0 cost monthly premium that you may want to consider before you make a final decision. As in past years, my associates and I will be enrolling individuals at multiple Columbia locations by appoinmtent. I will be enrolling individuals in the Sumter area by appointment on each Tuesday during open enrollment at the Tandem Family Health Center located at 1278 N Lafayette Dr. If you don’t live in the greater Columbia area please call my cell at 803-567-1180 to discuss your plan options and how we can complete your enrollment over the phone or online.

If you are approaching Medicare eligibility either by celebrating your 65th birthday or completing 24 months of SSDI payments, we want to make sure you transition from the ACA plans to Medicare on a timely basis. If you don’t get on Medicare when you are first eligible, you may face penalties on Medicare that may never go away. We will be able to review all your Medicare plan options and review other credits you may receive once you are on Medicare.

Client Open Letter On Medicare
Medicare Eligible Individuals ANNUAL ELECTION PERIOD
During the Annual Election Period, all Medicare eligible individuals can choose how to receive their Medicare benefits for the following calendar year. They may decide to stay in original Medicare for Part A (in-hospital benefits) and Part B (out-patient benefits) but will need to add Part D for prescription drug benefits. (Individuals not needing a prescription drug plan should still enroll in a plan when they become first eligible to avoid a late enrollment penalty.) They may also want to add a Medigap plan which supplements the estimated 20% that is not covered under Original Medicare. Medigap plans do not utilize networks of providers which allow you to see any medical provider that accepts Medicare. In general, Medigap plans cost more on a monthly basis than other options (see below) but they reduce your exposure to annual medical expenses.  

The fastest growing segment of the options available to Medicare eligible individuals is Medicare Part C known as Medicare Advantage. Although Medicare Part C is administered by insurance companies it is actually a part of Medicare providing the same benefits of Medicare Part A and Part B, and in some cases, offer Part D benefits as well. Plus, some of the plans contain benefits not offered by Original Medicare such as dental and vision benefits. Medicare Advantage plans use provider networks so it is very important individuals stay within the network of providers. In some cases, benefits are reduced or eliminated entirely if medical services are received out of their approved network. Unless individuals qualify for assistance through the SCDHHS, individuals enrolled in a Medicare Advantage plan are responsible for copays and coinsurance up to an out-of-pocket maximum expense of approximately $7000 annually for medical care. Costs for these types of Medicare Advantage plans range in price from $0/month up to $80/month depending on your county of residence.

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Medicare Re-enrollments
Medigap Plans

Individuals enrolled in a Medigap (Medicare Supplement) plan are not required to enroll again during the Medicare Annual Election Period. Since a Medigap plan is simply an insurance product and not a part of Medicare, it is exempt from the enrollment rules required of Medicare parts A,B,C & D. You can change Medigap insurance plan levels or carriers anytime during the year but you may have to go through underwriting if required by your chosen insurance carrier. Some insurance carriers are more lenient than others in their underwriting requirements and I would be happy to assist you if you think underwriting may be a challenge to you being accepted. If your current plan is offered by your insurance company, you can allow the plan to rollover to the following year. Most individuals with Medigap plans also have prescription drug plans which are described below.

Medicare Part D Prescription Drug Plans

Prescription drugs plans are a part of Medicare (Part D) and require enrollments to be completed on a calendar year basis. That enrollment can be accomplished by either (1) enrolling in a NEW plan during the Annual Election Period, or (2) simply letting your current plan rollover to the following year. The type and cost of drugs covered (and participating drug manufacturers) can vary depending on the plan's formulary. A review of your current medications as well as the eligibility requirements to receive assistance through the Social Security Extra Help program may be beneficial during this Annual Open Enrollment Period.
Medicare Part C Medicare Advantage Plans
Early in the month of October, all individuals enrolled in a Medicare Advantage or a Medicare Prescription Drug plan receive a publication entitled, "Annual Notice of Change" (ANOC) which details any changes being made to their Medicare plans for the following calendar year. After you receive the ANOC, I ask you contact me to discuss the changes to your plan and should you consider enrolling in a new plan during the Annual Election Period. I will be able to discuss the details of all the Medicare Advantage Plans as well Rx drug plans after October 1st so please contact me with your questions.

I thank you for your business.