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Show Page 12 The Ogden Valley News Volume XXX Issue VII November 15, 2023 Is Health Insurance on Your Mind? By Kjirstin Mich’l Is health insurance on your mind? Tired of seeing the commercials, social media advertisements, and constant spam calling? Does it make you wonder if you could be getting more out of your health insurance? You probably can! Fall is the time of year for pretty colors, brisk cold mornings, warm afternoons, pumpkin spice everything, putting up Christmas too early, and health insurance commercials. Let me educate you if it may be a good idea to take a closer look at your health insurance. Let’s Start with Medicare. If you are currently on Medicare, you are probably getting bombarded with calls, mailers, and social media advertisements enticing you to change plans. This time of year is the Annual Enrollment Period (AEP) for Medicare, October 15 through December 7. Now is the time to review your current plan and see what the changes will be next year. Will your doctors still be in network? Will your prescriptions be on the formulary and how much will they be? What other benefits will your plan offer? Do not be swayed by the newest and best thing, or what your neighbor has. You must take your own health into consideration and make sure you are covered for the things that matter to you and your pocketbook. MAPD (Medicare Advantage Prescription Drug) plans vary quite a bit from carrier to carrier. You should look at the network, are you covered outside of Utah? What are the copays for primary care, specialists, lab work, surgery, or hospitalization? Is your plan an HMO? HMO is a limited network with no coverage outside of that network. Maybe you should look at a PPO option that would give you coverage at a higher coinsurance rate just in case you needed to go outside of your network. Look at the Max out of Pocket amount. Do you have expensive medications? The insurance carriers’ contract with specific pharmacies and drug companies and you may get better pricing if you change your plan or pharmacy. Do you have a pharmacy you love? Find the plan that is contracted best with that pharmacy to get the preferred pricing. Do you know what extras your plan offers you? Are you using them? Some plans have extras that are not widely known, such as money back to you for doing healthy things like getting your colonoscopy, mammogram, or going to the gym. Do you use your Over-the-Counter benefit? Would transportation to and from doctors’ appointments help you? Do you need extra Dental, Vision, or Hearing Aids? If you have a Medicare Supplement plan (Plan F or Plan G), you don’t need to do anything with that at this time of year. Your premiums will increase as you age, but the plan will stay the same. When you have a Medicare Supplement you have an additional Prescription Drug plan (Part D) that you should consider at this time of year. Same as above… if you have expensive medications, you should shop your drug plan every fall. If you don’t take any medications, you could save a bit of money and shop for the cheapest plan out there for the year to avoid the penalty. “The commercials on TV say that I can get money back on my Social Security and help with groceries and utility bills. I want that!” Those benefits are designed for people who are on Medicaid and Medicare. Medicaid is a low-income state assistance program. If you have Medicaid and Medicare, yes, you should search the Dual Eligible plans that will help pay for your Part B premiums and monthly benefits for food and utility payments. There are also benefits for Veterans. Medicare Advantage plans without the prescription drug coverage are designed for Veterans who get their prescription drug coverage through the VA, (Veterans Affairs). Some of these plans have a Part B giveback amount anywhere from $20-$100 a month that is credited to their social security benefits to help pay for their Part B. Even if you get all your healthcare needs taken care of by the VA, it wouldn’t hurt to look at the Veteran plans to see if you could benefit from the Extra Giveback, Dental, Over the counter, Meals after Hospitalization and other coverages offered, without messing up your VA coverage. The choices for Medicare seem very vast and confusing. It’s best to team up with a licensed broker to help wade through the choices and find what’s best for your health situation, income, and lifestyle. Now on to Under-65 Individual Insurance. If you are under 65 and do not have insurance through your employer, or you are self-employed, you must decide what is best for you and your family’s coverage. This depends greatly on your health and your income. If you are offered health insurance by your employer, you are supposed to take it. But if it is unaffordable for your family to be on that plan, you can stay on the employer plan and your family can opt to take another option. The individual or Self-Employed options are Individual ShortTerm Medical plans, Health Share plans, or the Marketplace plans—often called ACA (Affordable Care Act) or nicknamed Obama Care. Individual Short-Term Medical plans are not guaranteed issue and may exclude or have a waiting period for any pre-existing condition. You usually have a nationwide PPO network, copays, coinsurance, and a deductible to meet. Preventative care is not covered 100%, and prescription drug coverage is not always included. Mental health and maternity are not included. These plans are a great fit for someone who is healthy, doesn’t go to the doctor much, is ok with meeting a bigger deductible, and just wants coverage for the bigger things. Health sharing plans - Healthcare Sharing Ministries (HCSMs) are programs where groups of people who share a common faith make monthly payments that are used to cover the cost of members’ medical care. Members’ monthly premiums create a pool the group can draw from to help cover out-ofpocket medical expenses. Health share plans are not required to cover anything and make their own rules about what they will and will not cover. This means there is no guaranteed payment of claims, and they are not legally mandated to do so. You often must pay for the services you need, keep all your receipts, and turn them in for reimbursement. These plans work beautifully for organized people, but for some it can be a mistake. Make sure to read all the fine print and know what you’re getting into. That brings us to the Marketplace—ACA— Affordable Care Act plans. The open enrollment period is November 1 through December 15 to start on January 1, and will be extended until January 15 to start February 1. Marketplace plans are subsidized by the federal government to help pay for your health plan. It is based on your age, family size, zip code, and estimated income level. The subsidy is reconciled when you do your taxes for that year. If the income on your application is lower than the amount on your tax return, you may owe additional income tax, if the income on your application is higher than on your tax return, you may receive an additional premium tax credit. The lower the income the higher the tax credit subsidy is to help pay for your plan. The higher your income is, the government expects you to pay more for your health insurance plan and max out the out-of-pocket amount. Marketplace plans are guaranteed issue. That means, no matter what health conditions you have. Preventative care, Maternity, and Mental Health are included and covered. Most Utah plans have an HMO network to stay in, copays and coinsurance, and often a deductible to meet. We are fortunate in Utah to have several plans that offer no deductibles. The Max out of Pocket amount for 2024 is up to $9,450 per individual and $18,900 per family on some plans and income levels. Pairing this type of plan with an accident or critical illness policy is a great idea for extra coverage and help paying that max out-of-pocket amount if something serious were to come up. If your income is too high for the subsidy tax credit, you will have to pay full price for the plan. This may be quite expensive; thus, you may choose one of the other options for your health insurance. But remember, if you have a preexisting condition or may want to have a baby, or you want your mental health counseling covered, you may choose to take a Marketplace plan. If you are currently on a Marketplace Plan, it’s good to do a review to see what will be changing for the new year. Many plans this year are ending and you will be automatically signed up for the closest one to your current plan. In doing several reviews, I have seen that this plan is not always the best one for you. It’s best to consult with a broker to see what else is available. There is a great number of people out there who do not have health insurance. People walking around 10 feet tall and bulletproof, thinking that they cannot afford health insurance, or they are healthy and don’t need it. No one plans to get sick, no one plans to fall and break a leg, but man what a bummer when they have no coverage! Medical debt is one of the top reasons why people file for bankruptcy. Now is the Open Enrollment period for anyone who does not currently have coverage to get coverage starting January 1. If someone says they cannot afford health insurance, they probably have an income level that will qualify for a subsidy to help pay for the plan. If they are healthy and “don’t need it,” they could get on a Short-Term Medical plan with a high deductible that would cover catastrophic events and not put them into major financial debt. Obviously, our health insurance and healthcare system are flawed. Improvements are continuously being made. But the problem is, not one system works for everyone. A plan that works for you may be horrible for your friend or neighbor. One thing we can do as we are planning for 2024 and our healthcare needs, is to consult with a licensed health insurance agent broker. A broker is contracted with many insurance carriers and many different types of plans. They can look at your situation and see what is best for you and your family year after year. If you call a 1-800 number, they will only sell you what they have in front of them with no regard to what is best for you. You do not pay additional money for a broker’s services. They are paid by the insurance carriers for helping you sign up. If you sign up directly with the carrier, you will pay the same amount without the broker’s expertise to help guide you. If you have an insurance broker, I suggest you contact them for a yearly review. If you do not, or simply have questions you’d like answered, I am happy to assist you with your health insurance planning. I am an Ogden Valley Local! Enjoy this beautiful fall, as winter is fast approaching! Cheers and Good Health! LETTER TO EDITOR cont. from page 3 9. Denying the proposed Eden Crossing does not infringe on anyone’s property rights. Since, per the general plan, this proposed development does not follow the general plan’s guidelines as to where commercial development should be located. In fact, the development runs contrary to the guidance for growth and development as outlined in the general plan. Arguments currently being made by our county commission in favor of the proposed development are misplaced and, I would argue, are biased by, what I call (according to my personal opinion) a long, incestuous relationship between the county and the developer. For instance, millions of dollars in federal ARPA funds have been garnered by the county, specifically acquired and earmarked to assist one particular developer cover the cost of a multi-million sewer line project so he could move forward with several of his lucrative developments. Since a private individual or private company cannot qualify for ARPA funds, the county applied for the funds, but specifically to benefit the developer, allowing him to move forward with his multi-million-dollar sewer project, naming this developer as the contractor in the project. To legally cover their actions, the county then utilized additional available tax dollars to undertake expensive water and sewer studies in an effort to show the need for the expansive sewer project. More insulting to the public, who has no desire for the central sewer project, they allowed the contractor/developer to take an expensive detour of the line out and away from the direct route to the Wolf Creek Water and Sewer District Sewer treatment plant in order to accommodate the needs of the newly proposed Eden Crossing. Then, the county commission had the nerve to state, in public meetings, that they should approve Eden Crossing, because this is where the sewer line runs! Amazing! 10. The proposed Eden Crossing development would place high-density commercial development directly in the middle of, and next to, large-lot single family residential properties and agricultural lands. This goes against all good land use planning directives as taught in even the most basic land use planning classes. Highdensity commercial should be placed in the center of urban centers with lower density development radiating outward toward the edges of developments until it returns to low residential development then rural lands. Say no to Eden Crossing. Note: This article was provided by insurance broker Kjirstin Mich’l. You may contact her at 801-928-9701 or by visiting www. KMEDInsurance.com. Eden have a difficult time remaining economically viable. Time after time we see commercial businesses open in Eden, only to close shop down the road. The Ogden Valley News is always running ads advertising commercial property available for rent. The Valley Market has delayed construction of a new store for many, many years because of a lack of adequate commercial traffic to support a new store. 4. Because there is so much already-existing, untapped commercial space in Eden, by creating even more those who already have made investments in existing commercial real estate will see their investments further compromised as they now have to compete with even more commercial space. To add insult to injury, the additional highdensity commercial space being proposed at Eden Crossing, unfairly, isn’t even called out as a commercial node in the Ogden Valley General Plan. Which leads to the next reason Eden Crossing should not be approved: 5. The proposed Eden Crossing development is situated in an area that is not targeted as a commercial village node in the OV General Plan. 6. Were the county to approve the proposed Eden Crossing development, it would create urban sprawl, encouraging commercial development from the top of Powder Mountain, down through Wolf Creek and spattered all the way between Wolf Creek, Old Town Eden, and New Town Eden. 7. The approval of the proposed Eden Crossing development would be the “straw that broke the camel’s back” when it comes to following the OV General Plan, which calls for planning and zoning that supports our community’s rural, quaint, bucolic atmosphere. The general plan does not call for Eden to become one massive commercial, tourist center. 8. The county claims that we should expand Eden’s commercial zones to take development rights/density off the hillsides… curing the “measle map” syndrome of residential sprawl. The problem with this claim: Eden Crossing would not take residential development off of the Valley floor, as Eden Crossing is being proposed as a commercial center with hotels, commercial space, and, yes, apartments. However, Moose Hollow, which the same developer built several years ago, at that time, claimed it should be approved because it would provide “affordable housing” for the community—less expensive apartments! Did that happen? No. The vast majority of “apart- Shanna Francis, ments” or condos at Moose Hollow are now Eden expensive, lucrative short-term rentals. |