In a recent information session, Anne McGuire and Ginny Jamison from Healthcare Pathfinder met with the HTG team to discuss how they assist clients with healthcare insurance transitions, long-term care insurance claims, and related advocacy.
Below are key insights from their presentation.
LIFE EVENTS THAT TRIGGER INSURANCE DECISIONS
Q: What happens to my health insurance if I experience a significant illness or accident while still working?
A: If you become disabled due to illness or accident, you may become eligible for Medicare through disability. The timing is critical— applying for Social Security Disability Insurance (SSDI) promptly and coordinating with your employer coverage can make a significant difference in your healthcare costs and coverage.
Q: Is COBRA always the best option after job loss?
A: Not necessarily. While COBRA allows you to maintain your existing coverage, the Affordable Care Act (ACA) marketplace might offer more affordable options. Each situation should be evaluated individually, considering factors such as one’s preferred provider networks, existing treatments, and cost comparisons.
Q: What happens to my health insurance after divorce or the death of a spouse?
A: Surviving spouses or ex-spouses typically have COBRA as an option for up to 36 months or can pursue coverage under the ACA. COBRA provides valuable time to explore alternative coverage options without interruption in benefits and care.
Q: Does moving to another state affect my Medicare (?) healthcare coverage?
A: Yes, relocating to a different state triggers a special enrollment period. This is particularly important for Medicare Advantage, Medicare Part D and supplemental coverage, which may have different networks and benefits across state lines.
Q: What options do young adults have when they turn 26 and age off their parents’ health insurance?
A: Young adults can explore employer coverage if available, marketplace coverage through the ACA, or potentially COBRA through parents’ insurance. Some states (like New York) even extend coverage eligibility to age 29 under certain circumstances.
LONG-TERM CARE INSURANCE: KEY CONSIDERATIONS
Q: What typically triggers benefits under a long-term care insurance policy?
A: Most policies require the insured to need assistance with two or more Activities of Daily Living (ADLs) or to have cognitive impairments. Understanding your specific policy’s benefits, triggers, and elimination periods is crucial for planning.
Q: Is there a difference in claims processing between indemnity and reimbursement-based LTC policies?
A: Yes. While both types of policies typically require meeting certain ADL or cognitive impairment triggers, indemnity policies often send direct payments without requiring itemized billing. However, policy details can vary significantly, so reviewing your specific contract is essential.
Q: Can family members be paid as caregivers under long-term care policies?
A: It depends on your policy. Most plans explicitly exclude family caregivers, unless they work for an agency and the agency pays the family member. Reviewing these details before needing care can help you plan appropriately.
MEDICARE AND RETIREMENT PLANNING
Q: Does staying on COBRA beyond age 65 create Medicare penalties?
A: It can. COBRA is generally not considered creditable coverage for Medicare Parts A and B. Individuals who are eligible for Medicare but choose COBRA instead may face late enrollment penalties if they choose to enroll in Medicare later.
If your employer had fewer than 20 employees, Medicare would be considered primary coverage, and failure to enroll on time could trigger permanent penalties. Proper enrollment timing is critical based on your specific situation.
Q: Can Health Savings Plan (HSA) balances be used to pay for insurance premiums?
A: After age 65, you can use HSA funds to pay for certain coverage types, including Medicare Part B, Part D, Medicare Advantage and long-term care premiums, but details vary based on specific circumstances.
HTG maintains a network of trusted professional partners to enhance client support services. For clients navigating healthcare transitions, the HTG team can facilitate connections with these specialized resources. To learn more about Healthcare Pathfinder’s specific services, please visit their website.