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FAQs and Helpful Tips
Introducing Nicole Creamer Insurance Services - the perfect solution for all your health insurance needs. Whether you're self-employed, unemployed, or just overwhelmed by Medicare and Medicaid questions and understanding Medicare Advantage, Nicole Creamer Insurance Services has got you covered. Let us provide the expert help you need to ensure your health and financial wellbeing
Medicare Tips
Source: Making the Most of Medicare, published by Blue Cross and Blue Shield of Nebraska
1 - You can still work and get Medicare. If you’re 65 or over, still on the job, and work for an employer with 20 employees or fewer, Medicare must provide primary coverage for you.
2 - Enroll in Medicare when you’re first eligible, even if you have other health coverage. Even if your former employer provides some retiree health benefits, you should sign up for Medicare when you’re first eligible to avoid penalties and coverage gaps. Then, employer-provided benefits provide a secondary layer of coverage.
3 - Don’t think because you have Medicare, your coverage and costs won’t change. If your plan’s cost and coverage remain the same, your health or finances may change. Review your plan each year to make sure it still meets your needs.
4 - If you have Medicare or will soon enroll, you may be eligible for a Low-Income Subsidy or Extra Help. But you must apply. Millions of dollars are left unspent each year because Medicare beneficiaries don’t know help is available (see pages 18 and 19).
5 - Original Medicare doesn’t cover everything. You’ll have gaps in care with Original Medicare, but in rural areas, your coverage will extend to doctors and hospitals outside a Medicare Advantage network that accepts Medicare.
Individual ACA Market Basics
Source: Nebraska Department of Insurance
What is an Advance Premium Tax Credit (APTC)?
A tax credit you can take in advance to lower your monthly health insurance payment.
-APTC is based on your estimated expected income for the year.
-This matters because your payment is a percentage of what you earn–not a percentage of the total premium price.
-APTC is based on the premium for the second-lowest-cost silver plan, not the plan you select.
What are Cost Sharing Reductions (CSR)?
CSRs provide lower dollar amounts for copayments or coinsurance, paid at the time of service for things like doctor visits or prescription refills, or deductibles, which must be paid before the plan begins paying toward the service.
For people who earn between 138% and 250% of FPL and purchase a Silver plan, the ACA gives them a discount on cost sharing.
How are premium subsidies calculated?
People over 400% Federal Poverty Level (FPL) pay 8.5% of the benchmark.
If household income is more than 400% of FPL, the premiums are 8.5% of the second-lowest-cost silver plan available in their area.
If 8.5% of the household’s income is more than the premium for the second-lowest-cost silver plan available in their area, then the household pays the full premium.
Losing Medicaid?
Source: Blue Cross and Blue Shield of Nebraska
What is Medicaid Redetermination?
Medicaid redetermination is the process through which states assess the ongoing eligibility of Medicaid enrollees. This evaluation is required by federal law for certain groups, such as low-income families, qualified pregnant women and children, and individuals receiving SSI.
What is the unwinding Period?
The Unwinding Period refers to the process of resuming regular eligibility and enrollment operations for Medicaid and Children's Health Insurance Program (CHIP) coverage after the continuous enrollment condition, which was implemented to keep people in coverage during the COVID-19 Public Health Emergency (PHE), ends on March 31, 2023. States will be able to begin terminating Medicaid coverage on April 1, 2023, for consumers found ineligible for that coverage after the continuous enrollment condition ends on March 31, 2023.
What should consumers do if they receive notice of termination?
Consumers who receive notice of termination may start applying and enrolling immediately in other coverage, such as on the Marketplace or employer-sponsored coverage, to ensure continuity of coverage.
How long do consumers losing Medicaid coverage have to enroll in new coverage?
Consumers have until July 31, 2024, to enroll in an individual ACA plan (60 days from when they start their application). They have 60 days from the loss of coverage to enroll in an employer-sponsored health plan.
What plans may be the best option for those losing Medicaid coverage?
A Silver plan will likely be the best fit for those losing coverage because they not only qualify for Advanced Premium Tax Credits (APTC), but they also offer cost-sharing reduction options. Consumers may also have access to employer-sponsored health coverage.
When will coverage begin for those enrolling in ACA coverage?
If a member chooses to enroll in an ACA plan, their coverage will begin the first of the month following the completion of their enrollment. For example, if someone enrolls and selects a plan on June 15, their coverage would be effective as of Aug. 1. If the applicant isn’t fully subsidized, meaning they need to pay all or a portion of their premium, the first payment must be made to effectuate their coverage.