Wednesday, July 23, 2014

Do Marketplace Insurance Plans cover mental health and substance abuse services?

Yes.

All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.

Health insurance plans available in the Marketplace must cover ten categories of essential health benefits. One of these categories is mental health and substance abuse services, also known as substance use disorder.

These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.

Mental and behavioral health and pre-existing conditions

Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions.
Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage is in effect. There’s no waiting period for coverage of these services.

There are also no lifetime or yearly dollar limits for mental health services. Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits which includes benefits for mental health and substance use disorder services.

Parity protections for mental health services

Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:
· Financial, like deductibles, copayments, coinsurance, and out-of-pocket limits
· Treatment, like limits to the number of days or visits covered
· Care management, like being required to get authorization of treatment before getting it

(taken from HealthCare.gov)

Thursday, June 26, 2014

Ohio Celtic Fest is this weekend

If you're looking for something fun to do this weekend, visit 
The Ohio Celtic Fest at the Lake County Fairgrounds, on Mentor Avenue in Painesville Township.  There'll be six stages of non-stop musical entertainment - from Celtic rock to ballads and everything in between. Bagpipe band. Irish dancers from four local schools of dance. Lots of food. Shopping. And a kid's area with magicians, storytellers, petting zoo and bouncy things.

Stop by the Coffee House, sponsored by Mutsko Insurance Services, if you get a chance.

For more information, go to ohiocelticfest.com

Wednesday, June 25, 2014

Four ways to save big on prescription costs

1. Shop Around.
Prices at different pharmacies can vary dramatically, as much as from $4 to $250 or more within your neighborhood for the same prescription. Visit www.goodrx.com to compare prices and find coupons.  It pays to check.

Be sure to ask for the pharmacy’s lowest price because additional discounts may be available when you’re a member of a store’s loyalty plan. And don’t overlook your insurer’s “preferred” retail or mail order pharmacy when comparing costs. Some insurers and Medicare Part D Plans have negotiated deep-discounts to help you save.

2. Be wary of coupons.
Makers of brand-name drugs often flood the market with discount coupons in order to keep you as a customer. Even if a coupon cuts the cost you pay at the counter, your employer and insurance company are often paying the full price which will cost you in higher premiums down the road.

3. Cut the quantity 
Ask for a 14-day supply to get you started and see whether it help you without side effects. Once you're sure it works for you, you can refill a larger quantity.

4. Ask about OTC drugs, samples or a two week supply
Your physician may write prescriptions for drugs even after they are available over-the-counter. But, over the counter drugs are often cheaper so be sure to ask your doctor if your drug is available over the counter. 

Monday, June 23, 2014

What your doctor calls your visit can cost you.

Annual Wellness or Preventive Care Visit?

How your visit is coded by your physician’s office may mean the difference between your claim being covered or denied.
 
If you have Medicare Part B for longer than 12 months, you can get an annual wellness visit or update a personalized prevention plan on your current health and risk factors. 

This visit is covered once every 12 months.
 
Be sure your doctor codes it as an Annual Wellness Visit not a preventive visit to avoid any mix-ups or your claim being denied.
 

Friday, June 20, 2014

Getting Started with Medicare


Get the facts on Medicare. Attend one of our upcoming Getting Started with Medicare seminars. 

This class covers all the basics and is especially helpful for people turning 65, those going on Medicare for the first time or anyone who want to brush up on the most current Medicare information.

Preregistration is required. Please register by calling the phone number listed for the class you wish to attend. These events are only for educational purposes and no plan specific benefits or details will be shared. Some venues charge a nominal fee.

Tuesday, August 5, 2014
Lakeland Community College
6:30 pm – 8:30 pm
7700 Clock Tower Drive, Kirtland, OH 44094
440-525-7116

Thursday, August 7, 2014
Mentor Library
6:30 pm – 8:00 pm
8215 Mentor Ave., Mentor, OH 44060
440-255-8811

Monday, August 18, 2014
Morley Library
6:30 pm – 8:00 pm
184 Phelps St., Painesville, OH 44077,  Meeting Room B
440-255-5700

Thursday, June 19, 2014

Still Need Health Coverage?

Did you recently graduated from college?  
Have you aged off of your parent’s health plan? 
Are there events that left you without health insurance? 
Even though open enrollment is over, you may still have options to get health coverage this year. You may be qualified to sign up for private health insurance in the Marketplace right now, outside the Annual Open Enrollment Period.  
Anyone who experiences a qualifying life event is eligible to purchase private insurance in the Marketplace. Here are some examples of qualifying life events:
·         No longer covered by your parents’ plan
·         Get married
·         Get divorced
·         Death of a spouse
·         Have a baby or adopt a child
·         Move to a new area
·         Lost other health insurance including student health plans

Employment-Related Qualifying Events
You may also qualify for the Special Enrollment Period if your employment is terminated, your hours are cut back or your COBRA benefits expire. You will need to provide a letter from your employer on company stationary that verifies your termination or reduction in hours in order to qualify. For expiration of COBRA benefits, you will need a letter of documentation with your termination date.

Time Limits
You have sixty days from the date of any qualifying event to apply for health insurance coverage. In all cases you will be asked to provide documentation of the qualifying life event in the form of a birth or adoption certificate, marriage license, divorce decree or other legal documents.
Medicaid or CHIP coverage                                                                                 Enrollment to Medicaid or CHIP is open all year round. If you qualify, you (or a family member) can enroll immediately.
Call me to discuss your options.
If you or someone you know has questions on whether their circumstances qualify as an eligible life changing event, please contact me. I’ll do the checking and provide the best insurance choices for you and your budget.

There’s never a charge for my services.


Tuesday, May 20, 2014

Allergy Strategies

How to keep your spring allergies in check.

Suffering from springtime allergies?  Your first impulse may be to reach for allergy medicines. Instead, think about taking some practical steps to help reduce the pollen, dust mites and other allergens inside your home. 

1.  Windows: Wash curtain and wipe down blinds. Keep windows closed to keep pollen outside.

2.  Bedding: Wash pillowcases, sheets and blankets regularly - at least once a week or more. Cover your pillows, mattress and box springs with covers that are dust-mite-proof.  

3.  Stuffed Animals:  If you cannot wash your kids' stuffed animals, run them through an air fluff cycle in the dryer. Store stuffed animals in a plastic bin to keep dust to a minimum.

4.  Clothing:  Leave your shoes at the door, change your clothes and take a quick shower after being outside to reduce pollen inside your home.

5.  Flooring:  Replace carpeting with hardwood floors, tile and linoleum.  All of these harbor  fewer allergens than carpeting and rugs. If you cannot replace your carpeting, wash your rugs regularly and deep clean your carpeting.

6.  Smoking:  Allergies are simply one more reason to ask smokers not to light up inside your home.