In light of the confusion associated with the complexity of Health Insurance, we have compiled a list of frequently asked questions in an effort to help you better understand it. Contact or Email us for any further information.

Medicare

1. What is the eligibility for family members?

Under certain conditions, your spouse, divorced spouse, widow or widower, or a dependent parent may be eligible for hospital insurance when your spouse turns 65, based on your work record.

Also, disabled widows and widowers under age 65, disabled divorced widows and widowers under 65, and disabled children may be eligible for Medicare, usually after a 24-month qualifying period. (For disabled widows/widowers, previous months of eligibility for Supplemental Security Income (SSI) based on disability may count toward the qualifying period.)

2. What does the Primary Insurance status represent?
Sometimes, you may have other insurance that pays your health care bills first, while Medicare pays second. Medicare is the secondary payer when the following insurance is available: auto insurance, homeowners insurance, commercial insurance plans, group health plans under certain conditions, Black Lung benefits and Worker’s Compensation.

3. What is an Authorized Representative?
An Authorized Representative is a person you choose to assist you with Medicare-related matters. This is what Marc Insurance can do:

  • Choosing a plan to participate in;
  • Gathering more information about your insurance plan/policies for research and decision making purposes;
  • Handling claims and/or payments;
  • Receiving a notice in connection with an appeal on your behalf, and review/submit personal medical information when working with associated appeals.

4. What if you do not qualify?

Certain aged people who do not qualify for Medicare hospital insurance under these rules may be able to get it by paying a monthly premium. They also must always enroll in medical insurance (Part B) to get this coverage. Certain disabled people who lost premium-free hospital insurance because they work can get Medicare hospital insurance again by paying a premium.

 

5. What if you are under the age of 65?
Before age 65, you are eligible for Medicare hospital insurance if you:

  • Get Social Security disability benefits and have amyotrophic lateral sclerosis (Lou Gehrig’s) disease; or
  • Have been a Social Security disability beneficiary for 24 months; or
  • Have worked long enough in a federal, state, or local government job and you meet the requirements of the Social Security disability program.

 

Health Insurance and Health Care Reform

 

1. If you work at a company that has fewer than 25 employees and have adequate coverage already, will Obamacare help to lower your costs or improve your coverage?
Yes If your boss has fewer than 25 employees, and salaries at your firm average $50,000 or less, Obamacare could help.

If the firm fits this profile and your boss pays at least 50 percent of his employees’ premiums (most small businesses do), your employer will be eligible for a tax credit equal to as much as 50 percent of the amount that he lays out for insurance. If your boss receives the subsidy, he may well decide to lower the amount that he asks you to contribute.

2. Can small companies get a small business tax credit?
Small employers with fewer than 25 full-time employees and average annual wages of less than $50,000 are eligible for the tax credit. The maximum credit will be available to employers with 10 or fewer full-time equivalent employees and average annual wages of less than $25,000.

To qualify, the employer must contribute at least 50 percent of the total premium cost. In 2014, employers who qualify can receive a tax credit that covers up to 50 percent of their contribution for two years.

3. Who WILL NOT be eligible for Obamacare’s premium subsidies?
You won’t be eligible for government subsidies to help cover health insurance premiums if:

  • Your employer offers comprehensive, “affordable” coverage – which means that it pays for 60 percent of covered benefits and costs no more than 9.5 percent of your household income.
  • You are eligible for Medicare, Medicaid or another government program.
  • You earn more than 400 percent of the Federal Poverty Line: $45,960 for an individual, $78,120, for a family of three, $110,280 for a family of five.

People who earn just slightly more than 400% of the FPL will not qualify for a tax credit.

This will be especially true of older Americans buying their own coverage. Under reform, insurers in most states can charge an older customer three times as much as they would charge a 25-year-old for the same policy.

4. If you earn about $35,000 a year, but feel you cannot afford Health Insurance, will you be eligible for a premium subsidy?
Nearly 26 million Americans will be eligible for tax credits to help them buy insurance next year, but most don’t know it. (If you earn less than $45,960 ($94,200 for a family of four) you will qualify.

5. If you are under the age of 26, can you still be on your parent’s plan?
This year, you cannot enroll in a parent’s plan if your employer offers insurance. But beginning in January 2014, you can. You will be able to stay on your father’s plan until you turn 26.

 

Life Insurance

1. What is a beneficiary?
This is the person(s) or other party(ies) designated to receive life insurance or annuity proceeds upon the death of the insured. The beneficiary is named when a policy is taken out and can be changed at the request of the policy holder.

A contingent beneficiary is the party designated to receive life insurance policy proceeds if the primary beneficiary should die before the person whose life is insured.

2. What is cash surrender value?
This term refers to the amount payable to the permanent life policy owner upon surrender of the policy. It is equal to the current Cash Value, less any surrender charges that may apply, any monthly contract charges, and any outstanding loans and accrued interest.

3. What is surrender charge?
During the surrender charge period of a permanent life policy, an amount of money that is deducted from a policy’s Total Accumulation Value if you:

  • Surrender your policy
  • Decrease the face amount of your policy

4. What is Whole Life Insurance?
This is life insurance that remains in force during the lifetime of the insured, provided premiums are paid as specified in the policy. Whole Life provides a guaranteed premium, a guaranteed death benefit, and a guaranteed cash value. While a Whole Life policy is in force you may take out a policy loan against the cash value or receive the cash value (less any policy loans and accumulated interest) should you need to surrender the policy. In addition, a Whole Life policy can pay dividends, which may be used to enhance both the death benefit and the cash value or may be used to reduce your premium payment. Dividends are not guaranteed and policy loans accrue interest and reduce the death benefit.

5. What is Term Insurance?
This is life insurance, that pays a death benefit provided the insured dies during a specified period, and premiums are paid as designated in the contract. No death benefit is payable if the insured survives past the end of the term. Since premiums paid are used entirely to cover the cost of insurance, there is no cash value on a term insurance policy. Premiums may increase or decrease, depending on the type of term insurance owned.

 

Long Term Care

1. What is an elimination period/deductible period?
The elimination period is a specific number of days during which the Insured is eligible for benefits but for which no long term care insurance benefits will be paid by the insurance company. Some policies do not have elimination periods or the elimination period may apply only to specified benefits.

2. When are you eligible for long term care insurance benefits?
Each long term care insurance policy specifies the conditions under which benefits are payable. We can discuss the requirements of your policy and help you understand the conditions under which benefits are payable.

3. If you move to another state after buying a policy, will you still be covered?
Yes, however, your policy’s definitions of the places and people that provide LTC services may not match those in other states. For example, the assisted living facility definition in your policy is unique to each state, and may not accurately describe assisted living facilities in other states. Another more general definition intended to describe care in facilities outside Louisiana may limit the places where you can receive care covered by your policy if you move away. If you move, you should contact us to understand what services and facilities will be covered in your new home state.

4. What is the right age to buy Long Term Care Insurance?
This is an individual decision, based on many factors. Most people think about LTC insurance when they are close to retiring. Others buy it through an employer much earlier. Premiums are much lower for people in their 40s and 50s than for those over age 65. In addition, as people age, they are more likely to develop health conditions that may make them uninsurable. After age 60, premiums for LTC insurance begin to rise steeply. On the other hand, LTC services and places where people receive care are changing, and may not be the same services or places described in an LTC policy purchased 40 years earlier.