Coverage through an employer or other entity that covers all individuals in the group.
Health insurance coverage on an individual, not group, basis. The premium is usually higher for an individual health insurance plan than for a group policy, but you may not qualify for a group plan.
What are Covered Services?
These are medical services which would be covered under your medical plan. When shopping for medical insurance, ask specifically what medical services would be covered under your plan.
What is a Deductible?
The deductible refers to the amount of money that the insured has to pay before any of the health insurance benefits can be used. This is usually a yearly amount and would start over again, usually after a year. Normally, there are separate individual deductible amounts and total family deductible amounts.
What is co-insurance?
This is a percentage amount that is the insureds responsibility. For example, an 80/20% split means that the insurance company will pay 80% of the procedure and the insured is required to pay the other 20% after the deductible.
What is a co-payment?
A co-payment is a fixed amount that the insured is required to pay at the time of service. It is usually required for basic doctor visits and when purchasing prescription medications.
What is out-of-pocket expense?
This is the amount you as the insured would pay out of your own pocket. This term can also refers to the deductible, co-insurance, and co-payment amounts. The term annual out-of-pocket refers to the maximum the insured would have to pay yearly out-of-pocket, excluding premiums.
This is the most amount of money the insurance company will pay for the entire life. Individual lifetime maximums and family lifetime maximums can be different so pay close attention to those.
This is a health condition that someone had before obtaining the insurance policy. Some policies will cover pre-existing conditions, while other plans will not. Some plans may cover pre-existing conditions only over a specific amount of time.
Exclusions are anything the insurance company will not cover.
What is Cobra?
If you recently lost your job, had health insurance through that employer, and your former employer had at least 20 workers, you have the right to stay in the health plan you had at the job under a federal law called COBRA. Family members who were covered as your dependents can also continue the coverage. Your former employer will send you a notice to elect COBRA and then you will have 60 days to sign up for COBRA. COBRA coverage usually is guaranteed for 18 months, but under special circumstances you may be able to obtain 29 months of coverage.
The most important fact about COBRA is that you pay the total premium yourself and this can be very expensive.
What is Michigan Short-Term Disability?
An injury or illness that keeps a person from working for a short time. The definition of short-term disability (and the time period over which coverage extends) differs among insurance companies and employers. Short-term disability insurance coverage is designed to protect an individuals full or partial wages during a time of injury or illness (that is not work-related) that would prohibit the individual from working.
What is Michigan Long-Term Disability Insurance?
Long-Term Disability pays an insured a percentage of their monthly earnings if they become disabled. Long-Term Disability picks up where short-term disability leaves off. Once your short-term disability benefits expire (generally after three to six months), the long-term disability policy pays you a percentage of your salary, usually 50 to 60 percent, depending on your policy. You will then receive benefits for two to five years or until you turn 65.
Medicare Insurance
When should I enroll in Medicare?
If you are not receiving Social Security, Railroad or disability benefits, you can enroll in Medicare and a Medicare drug plan up to 3 months before your 65th birthday and no later than 3 months after the month of your birthday. This is called the initial enrollment period. You will need to submit an application to the Social Security Administration.
If you already get benefits from the Social Security Administration or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month that you turn 65. You do not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If you wait until you are 65, or sign up during the last three months of your initial enrollment period, your Medicare Part B start date will be delayed.
Do I need to enroll in Medicare if I have other health insurance?
You should sign up for Part A when you turn age 65 regardless of whether you plan on retiring or not. Signing up for Part B and Part D depends on your other health insurance you have and your personal preference. Talking to your insurance agent is advised.
Are there penalties for not enrolling in Part B or Part D once I am eligible for Medicare?
This depends on your situation so getting expert advice is recommended. If you have creditable coverage (this is coverage that is as good as the Original Medicare) there is no penalty.
What are the penalties?
If you do not have creditable coverage and you miss your enrollment period for Part B or Part D, a late-enrollment fee will be added to your monthly premium once you do enroll and this fee will continue for as long as you have Medicare.
For Part B, your monthly premium may go up 10% for each full year that you could have had Part B.
For Part D, you will pay a fee based on: 1% of the national base premium for that year for every month you were eligible but did not enroll. (about 32 cents a month for 2012)
What do I need to know if I have the Original Medicare Plan (Medicare Part A and Part B) and I don't have prescription drug coverage?
If you want Medicare to help pay for your drugs, you must join a plan that provides Medicare prescription drug coverage. You can choose from different plans to best fit your needs.
Should I join a Michigan Medicare Drug Plan even if I don't use many prescription drugs?
Even if you do not use a lot of prescription medications, you should still consider joining a Medicare drug plan. As we age, most people require prescription drugs for health reasons. If you wait to join after your initial enrollment in Medicare, your next available time to enroll will be between November 15 and December 7 each year, and you will have to pay a penalty. This in turn will result in higher monthly premiums.
What does a Michigan Medicare Drug Plan cover?
Most plans will have a list of drugs called a formulary, that will tell you what drugs are covered by the plan. Medicare drug plans will cover brand-name and generic drugs. This list must always meet Medicare's requirements, but it can change when plans get new information. If a drug is to be removed from the list or if the costs are changing, the plan must let you know at least 60 days before hand. In most cases, if you are actively taking a formulary medication, you will be able to continue on it for the full calendar year. If your doctor thinks you need a drug that isn't on the list, or if one of your drugs is being removed from the list, you or your doctor can apply for an exception or appeal the decision.
When can I switch my current Medicare Advantage Plan or prescription drug plan?
The annual election to sign up or switch to a different plan or health insurance provider is from October 15th through December 7th, 2011. New plan benefits will take effect on January 1st.
How do I get a replacement Medicare card if my card is lost, stolen, damaged or I change addresses?
You can ask for a new Medicare card via the Social Security Administration website or call Social Security's toll free number at: 1-800-772-1213. Your red,white, and blue Medicare card will be mailed to the address they have on file for you within 30 days. If you need proof that you have Medicare sooner than the 30 days, visit your local Social Security office.
Michigan Life Insurance
What is Life Insurance?
Life Insurance is a contract between an insurance policy holder and an insurance company. Upon the death of a policy holder, the insurance company pays a cash amount or death benefit to the beneficiary(s) named in the policy.
What is the purpose of Life Insurance?
Some of the main purposes of life insurance include providing financial security for loved ones, help in funding business continuation and help in satisfying estate tax requirements.
How do I determine how much coverage I need?
The amount of coverage needed will vary according to each individuals circumstances. Some of the factors that should be taken into consideration include: living expenses for your surviving spouse and/or family members, any anticipated final expenses including medical and burial costs, outstanding balance on your mortgage, educational costs for children, business continuation expenses and estate taxes.
Some insurance companies recommend 10 times your annual income as a starting point. Please keep in mind that your needs will likely change over time and what may seem like enough coverage now, may not be adequate enough coverage in 10 years time.
Most insurance companies will only allow a certain multiple of your annual income based on your age, but they can be flexible if you demonstrate other needs. For the most part it is up to you.
How do I choose the length of coverage?
Your individual circumstances will help you determine the length of coverage needed. Things such as your age, your spouse and children's ages, financial obligations such as a mortgage and student loans, and the number of years until retirement are some of the factors you will need to take into consideration.