Area Agency on Aging

800-852-7795   800-803-7174

Macomb County Deptartment of Senior Services

586-469-6313

Recipients of Medicare from Social Security can enroll  Medicare Part D (prescription benefit) which began January 1, 2006.    Low income persons below 150% of poverty (currently $1197 per month income for one, $1604 for two) can receive “extra help” from Social Security (800-772-1213), at reduced or no premium.  For advice about which provider to choose call the Area Agency on Aging’s Medicare/Medicaid Assistance  Program (800-852-7795 or 800-803-7174) or the Dept of Senior Services (586-469-6313) or Social Security (1-800-MEDICARE 800-633-4227), or see http://www.medicare.gov

Originally posted 2009-07-28 07:00:59. Republished by Blog Post Promoter

313-866-5333

email:info@worldmedicalrelief.org

www.worldmedicalrelief.com

For persons in Wayne, Oakland, & Macomb Counties age 18 and older who do not have prescription drug coverage and monthly income is below $1583 per month (single) or $2583 (couple)—add $25 per dependent—and not currently enrolled in Medicaid.  Prescriptions are mailed to your home.  There is an $8.30 co-pay per Rx.  Call for an application and information.

Originally posted 2009-07-28 07:04:29. Republished by Blog Post Promoter

Frequently Asked Questions

If you have a health insurance plan that states office visit copay: 20% after deductible, what is the cost of your office visit?

Great question. If your plan does not include office visits prior to the deductible, you are responsible for the full cost of the office visit. That is, until you satisfy the deductible.

Once you satisfy your deductible you would be responsible for 20% of the cost of the office visit.

Example:

• You have satisfied your deductible
• Doctors Office charges you $100 for an office visit
• The insurance company would pay $80 dollars towards the office visit
• You would be responsible for the remaining $20 dollars.

Frequently Asked Questions

What health care insurance covers lap band or gastric bypass surgery?  Depends.  Health care insurance covering the lap band surgical procedure is determined on a person-by-person basis.  Some policies only cover the procedure when/if medically necessary.  It may be covered if you meet the national guidelines for the care of morbid obesity.

Insurance Companies that cover Lap Band

These are companies that are known to partially cover or completely cover LAP Band surgery.  It does not guarantee that you will be covered.  Insurance companies cover surgery on a case-by-case basis.

• Cigna
• Aetna
• TriCare
• Blue Cross (some states)
• One Health
• Tufts Health Plan
• Medicaid
• American Family Insurance
• Humana
• Great West
• First Health
• Anthem BCBS

Verify Insurance

To determine if you insurance policy covers bariatric ( lap band ) surgery, refer to the insurance policy packet you would have received after paying your first premium.  For group coverage, it would have been provided by your employer.  If you don’t have a copy, contact your human resources department  or your insurance provider.  They will be able to provide a copy for you.

Most likely there are two sections that describe limits and the extent of your coverage.  Look for:

• Covered Expenses or What is covered (or similar) – This lists all the healthcare benefits for which the insurance company will pay.

• What is not covered” or “When the plan does not pay benefits”.  - cost that may not be covered by your plan

Look for statements  where the health insurance company excludes coverage for weith control, treatment for obesity, surgery for weith control, or exclude outright bariatric surgeries.

Look closely for statements such as “Surgery for the treatment of obesity is covered when deemed medically necessary”.   If bariatric or lap band surgery is excluded except when medically necessary, then if you meet the carriers guidelines, you may qualify.

Related Posts:

Cost of Lap-Band in Michigan

Financing Lap Band Surgery

Frequently Asked Questions

Yes.  Group insurance is medically underwritten. The entire gr0up, including the individual are reviewed by underwriting for group health insurance.

Let’s take a look at why one might ask this question.  Most often we hear this due to a concern about being denied for coverage.

The good news for those concerned is this.  Health Insurance companies in Michigan underwrite individuals to determine your rate.  The amount you pay monthly for health insurance.

When small group plans are medically underwritten, employees are asked to provide health information about themselves and their covered family members when they apply for coverage. When determining rates, insurance companies use the medical information on these applications. Sometimes they will request additional information from an applicant’s physician or ask the applicants for clarification. If a company is unable to obtain information necessary to accurately determine the risk of a particular applicant, it will underwrite more conservatively, meaning that the assumption relative to the missing information will be negative rather than positive.

Example: A person has a history of diabetes but it is controlled with medication and he is not overweight. If the company is unable to determine if that individual smokes or if he has normal cholesterol, it will assume that the missing information is negative and rate accordingly.

In most states the amount a company can vary a group’s premium rates based on medical underwriting factors is limited to a certain percentage of the average small group insurance rate. This is known as a rating band requirement, and the specifics vary by state.

If you have a pre-existing condition, a new insurance company can review your medical records for the last six months only and apply an exclusion of that condition from coverage for varying times according to the type of group plan you have. If you have maintained coverage of your pre-existing condition, without a break of more than 63 days, you are entitled to creditable coverage.

Please contact us at 888.320.5388 to answer specific questions not addressed here.  Or ask anonymously at http://www.formspring.me/michiganhealth

Make it a great day!

Billy

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Frequently Asked Questions

If you have a $0 copay for office visits after your deductible, how much does your office visit cost? That depends.

At first glance, without knowing what your copay before the deductible, all indications would be that you would pay nothing for your office visit. Of course assuming you have satisfied your deductible.

If you haven’t hit your deductible and you aren’t sure what your copay is before the deductible, a quick way to figure that out would be to look at your health insurance card.

Here is an example:

A quick review of the left side of the card shows your office visit copay is $25.  $35 for a specialist.  It also lists your X-Ray, Lab, and prescription benefits.  Your card may be different.

If you have questions please comment or feel free to ask us anonymously at http://www.formspring.me/michiganhealth

Make it a great day!

Billy

Section 125 Plans, also known as Cafeteria Plans, came about through Congress in 1978 and are named after their Internal Revenue Code. Such plans provide an employee benefit plan under which the employee makes an irrevocable decision to forego a portion of future income in exchange for receiving future benefits not subject to income tax at reception date. Essentially, Section 125 plans are created using pre-tax dollars, enabling the employee’s dollars to stretch farther. The employer deducts the cost of the employee’s future benefits from present income as a business expense.

These Plans Usually Provide Three Options:

• Premium Conversion – employee contributes a proportionate share of the family health care costs with pre-tax dollars.
• Medical Reimbursement Account – employee is able to use a Salary Reduction Plan to pay with dollars on a pre-tax basis for medical expenses not covered by insurance; a separate medical reimbursement account is established for each employee.
• Dependent Care Reimbursement Account – employee is able to use a salary reduction plan to pay with dollars on a pre-tax basis for dependent care expenses.

Section 125 pre-tax plans offer an opportunity for employers to save on their health insurance costs. However, implementing and administering the plan can be challenging:

1. The birth of your child or to care for your child after birth (the leave must be completed within 12 months of the birth).
2. The placement of a child with you for adoption or foster care (the leave must be completed within 12 months of the placement).
3. To care for your spouse, son or daughter, or parent who has a serious health condition.
4. In the event of a serious health condition that makes you unable to perform your job.
5. For a qualifying exigency arising out of your spouse’s, son’s, daughter’s, or parent’s being on active duty in the Armed Forces or being called up for active duty in support of a contingency operation.
6. To care for a child, parent, or spouse who has suffered an injury or illness during military service that makes the servicemember unable to perform his or her duties (in this case, the usual 12-week FMLA period is extended to 26 weeks within a 12-month period). If you are the nearest blood relative, you may qualify for this FMLA leave even if the injured servicemember is not your child, parent, or spouse.