Who is eligible for Medicare?
Individuals who are 65 or older are eligible for Medicare, as well as some younger individuals with disabilities or End-Stage Renal Disease.

When can I enroll in Medicare?
There are four enrollment periods for Medicare.
1) Initial Enrollment Period – begins three months before your 65th birthday and ends three months after the month that you turn 65.

2) Annual Enrollment Period – begins October 15 and ends December 7 each year.

3) Open Enrollment Period – allows you to make a one-time change to your Medicare Advantage Plan from January 1 through March 31

4) Special Enrollment Periods – are available under certain circumstances throughout the year, such as moving out of your existing plan’s service area or retiring from a job that previously provided your benefits.

What is the difference between a Medicare Advantage plan and a MedSupp plan?
A Medicare Advantage plan offers coverage for Medicare Parts A and B. Some Plans include Prescription Drug coverage and may include additional benefits not included in Original Medicare. With Medicare Advantage, you will have copays, deductibles, and premiums. Medicare Supplement, or Medigap, is extra insurance that fills the gaps in Original Medicare to help reduce out-of-pocket expenses.

While Medicare Advantage and Medicare Supplement are sold through private insurance companies, they cannot be used together.

Our agents can help you determine which plan best suits your needs and budget.

How do I get my prescription at a lower cost?
Prescription costs vary based on each plan’s formulary. We can review your plan to determine if you have the most cost-effective strategy for your needs. Additionally, there are a variety of programs that can help reduce your out-of-pocket drug expenses. We would be happy to meet with you to discuss what options are available and best for you.

Can I delay Medicare Part B if I have other coverages?
Some situations allow you to delay Medicare Part B penalty-free, like having group health plan coverage through an employer or spouse’s employer or having TRICARE and being an active duty service member.

What is health insurance?
Health insurance is a contract between an individual and an insurance company. The insurer agrees to cover part or all of the individual’s medical expenses in exchange for regular premium payments. It helps reduce the financial burden of medical care by covering costs such as doctor
visits, hospital stays, medical tests, medications, and preventive services.

What are the different types of health insurance plans? The main types of health insurance plans include:

Health Maintenance Organization (HMO): HMOs require members to choose a primary care physician (or PCP) who coordinates the patient’s care and provides referrals to specialists for specific care needs. They generally offer lower premiums and out-of-pocket costs.

Preferred Provider Organization (PPO): PPO plans offer more flexibility in choosing healthcare providers and don’t require referrals, which generally increases the cost of care.

Exclusive Provider Organization (EPO): Similar to PPO, it covers no out-of-network care except in emergencies. Usually, it has lower premiums. These networks are often limited geographically.

Point of Service (POS): Combines features of HMO and PPO plans. Requires a PCP and referrals for out-of-network care but offers some coverage outside the network.

High-deductible health Plan (HDHP): These plans generally feature lower premiums and higher deductibles. They are often paired with Health Savings Accounts (HSAs) to help manage costs.

What is a premium?
A premium is the amount you pay for your health insurance plan, typically every month. Your premium is the price you pay for having health insurance coverage. It does not include additional out-of-pocket expenses like deductibles, copayments, and coinsurance.

What is a deductible?
A deductible is the amount you must pay out-of-pocket for covered healthcare services before your insurance starts to pay. For example, if your deductible is $1,000, you must pay the first $1,000 medical costs yourself. Deductibles can vary in size, from $0 to several thousand dollars. Money paid to satisfy your deductible also goes toward your maximum out-of-pocket expenses (MOOP).

What is a copay (or copayment)?
A co-payment is a fixed amount for covered healthcare services when receiving care. For instance, you might pay a $20 copay for a doctor’s visit. Copays are separate from deductibles and are usually required for office visits, prescriptions, and other services.

Copayments do not count toward your maximum out-of-pocket expenses (MOOP).

What is coinsurance?
Coinsurance is the percentage of the cost of covered healthcare services that you pay after you’ve met your deductible. For example, if your coinsurance is 20%, and you have a medical bill of $100 after meeting your deductible, you’d pay $20, and your insurance would cover $80. Coinsurance payments go toward your maximum out-of-pocket expenses (MOOP).

What are the maximum out-of-pocket expenses (or MOOPs)?
The maximum out-of-pocket expenses are the most you will have to pay for covered services in a plan year. This pre-determined amount consists of combined payments toward your deductible and co-insurance obligations. Once you reach this limit, your insurance plan covers 100% of the costs for covered services for the rest of the year. Copayments and insurance premiums do not typically count toward your maximum out-of-pocket expenses.

What does “network” mean?
A network refers to the group of doctors, hospitals, and other healthcare providers that have agreed to provide services at reduced rates for your insurance plan. Staying within the network typically costs less than going out-of-network, where you might face higher costs or no coverage. Medical networks are generally regional, especially for most small employer-sponsored and individual ACA insurance plans.

What is the Affordable Care Act (ACA)?
The Affordable Care Act (ACA) became law in 2010. It enacted a comprehensive healthcare reform law to expand access to health insurance, improve the quality of care, and reduce healthcare costs. It includes provisions such as mandatory coverage for pre-existing conditions, essential health benefits, and the creation of health insurance marketplaces.

What is a Health Savings Account (HSA)?
An HSA is a tax-advantaged savings account designed to help individuals with high-deductible health plans (HDHPs) save money for medical expenses. Contributions to an HSA are tax-deductible, and withdrawals for qualified medical expenses are tax-free. Ask your Agent of S.H.I.E.L.D. for details.

What is a Flexible Spending Account (FSA)?
An FSA is a tax-advantaged account that allows employees to set aside pre-tax dollars to pay for eligible medical expenses. Unlike an HSA, FSAs are usually offered by employers and have a “use it- or lose it” rule, meaning funds must be used by the end of the plan year, or they are forfeited.

How can I enroll in health insurance?
You can enroll in health insurance through various methods:

Employer-Sponsored Insurance: Offered by your employer during open enrollment periods or qualifying life events.

Directly from Insurance Companies: Health insurance can also be purchased directly from the insurance company. This option is generally for those who do not qualify for subsidies but are not offered insurance through an employer or do not qualify for a privately underwritten health insurance plan.

Health Insurance Marketplace: (AKA the Health Insurance Exchange) The Federal government designed HealthCare.gov, and some states created their sites to allow people to sign up for health insurance. (something we strongly advise against). Friends don’t let friends purchase health insurance on the internet! We recommend that you discuss your health insurance options with one of our S.H.I.E.L.D. agents. We will help you determine your subsidy and gauge what your plan will cost and look like.

Medicaid: A state-by-state program for low-income individuals. These programs, paid for by tax dollars, utilize the various insurance networks to provide at no cost to those who qualify. Networks and the availability of doctors on those networks are often limited.

Medicare: For individuals 65+ with specific disabilities or certain chronic or terminal illnesses. Eligibility is determined through the Social Security Administration (SSA.gov). (See the FAQ on Medicare for more details.)

Privately Underwritten Health Insurance: Some insurance carriers offer private insurance programs in which an individual’s health determines rates and eligibility. These underwritten policies generally require lab testing to help determine an individual’s eligibility.

What is a qualifying life event?
A qualifying life event (QLE) is a significant change in your life that allows you to enroll in or change your health insurance plan outside of the open enrollment period. Examples include marriage, divorce, the birth of a child, losing other health coverage, or moving to another
state/service area.

What should I consider when choosing a health insurance plan?
When looking at your health insurance plan options, consider factors such as:

Premiums: How much can you afford to pay monthly?
Deductibles and Out-of-Pocket Costs: Your potential costs for care.
Network: Availability of your preferred doctors and hospitals.
Coverage: Whether the plan covers the services and medications you need.
Flexibility: The plan’s flexibility in terms of referrals and specialist care.

When is health insurance open enrollment?
The open enrollment period for marketplace participants takes annually between November 1st and December 15th. Marketplace plans typically run from November to December. You can only make changes outside this period if you experience a qualifying life event.

What is a Summary of Benefits and Coverage (SBC)?
The SBC is a document that summarizes the coverage offered by a health insurance plan. It includes information on what the plan covers, the costs of services, and key features. It helps you compare different plans and understand your coverage options.

How can I appeal a denied health insurance claim?
If your claim is denied, you can appeal the decision by:
Reviewing the denial letter: Understand why your claim was denied.

Gathering documentation: Collect any necessary medical records or additional information.

Contacting your insurer: Follow the insurer’s appeal process, which typically involves submitting a written appeal.

Seeking assistance: You can also contact your state’s insurance department or a consumer advocacy organization for help with the appeals process.

If you have specific questions or need personalized assistance, we recommend consulting with an Agent of S.H.I.E.L.D.

What is life insurance?
Life insurance is a financial product that benefits beneficiaries when the insured person passes away. In exchange for regular premium payments, the policy guarantees a lump sum payout or regular income to the designated beneficiaries upon the insured’s death.

Why do I need life insurance?
Life insurance can provide financial security for your loved ones if you die unexpectedly. It can help cover funeral expenses, pay off debts, replace lost income, and ensure your family maintains their standard of living. Many plans allow you to use some of the benefits before you pass away if diagnosed with a terminal illness.

What are the different types of life insurance?
The main types of life insurance are:
Term Life Insurance: Provides coverage for a specific period (e.g., 10, 20, or 30 years). If you die within this term, your beneficiaries receive a pre-determined cash benefit. Term insurance is typically more affordable but doesn’t build cash value. Once the term expires, the benefit generally disappears, and a new policy will need to be purchased.

Whole Life Insurance: Offers lifetime coverage with a cash value component that grows over time. Premiums are generally higher, but it also provides a savings component you can borrow against or use for other purposes. These policies cannot be terminated, except if premiums are not paid.

Universal Life Insurance: A flexible policy that combines a death benefit with a cash value component. Premiums and benefit amounts are flexible, and the cash values grow based on market performance. These policies are often used in “private banking” scenarios.

Variable Life Insurance: includes a cash value component that can be invested in various sub-accounts. The policy’s value can fluctuate based on the performance of these investments.

How much life insurance do I need?

The amount of coverage you may need depends on various factors, including your financial obligations, income, and your dependents’ needs. A common rule of thumb is to have coverage equal to 10-15 times your annual income. However, it’s essential to consider personal circumstances and speak with an Agent of S.H.I.E.L.D. to determine the right amount for you.

How do I choose the right life insurance policy? Consider factors such as your financial goals, budget, and the needs of your beneficiaries. Term life insurance may be suitable for temporary needs, while whole or universal life insurance might be better for long-term financial planning. Evaluate your options and consult with an Agent of S.H.I.E.L.D. to make an informed decision.

What factors affect life insurance premiums?
Life insurance premiums are influenced by factors including:
Age: Younger individuals typically pay lower premiums because they’re considered lower risk.

Health: Health conditions and lifestyle choices (e.g., smoking, obesity, etc) can impact premiums.

Coverage Amount: Higher coverage amounts result in higher premiums.

Policy Type: Different types of policies have different cost structures.

Occupation or Hobbies: Activities with higher risks can increase premiums.

Can I change my life insurance policy?
That depends on the type of life insurance policy you have. Many policies allow you to make changes, such as adjusting coverage amounts or converting term policies to permanent ones.

However, changes can affect your premiums and benefits, so it’s essential to understand the implications before making modifications.

What happens if I miss a premium payment?
Missing a premium payment can result in a lapse of coverage. Most policies offer a grace period, allowing you to catch up on the missed premiums before the coverage lapses. If your policy has a cash value component, missed premiums may be deducted from your existing cash value. If your policy lapses, you might lose any accumulated cash value or face difficulty reinstating the policy.

How does life insurance payout work?
Upon the insured’s death, the beneficiary files a claim with the insurance company. The insurer reviews the claim and, if approved, issues the death benefit according to the policy terms. When structured properly, this payout can be tax-free for the beneficiaries.

If the insured is diagnosed with a terminal illness, they may opt to access and use the benefit before they pass away. This benefit is payable once the insurer verifies the diagnosis of the terminal illness.

Can I have multiple life insurance policies?
Yes, you can have multiple life insurance policies. This might be done to cover different needs (personal vs. business interests) or increase your total coverage amount. However, managing these policies effectively is essential to ensure they align with your overall financial plan.

What is a beneficiary?
A beneficiary is a person or entity designated to receive the death benefit from a life insurance policy. You can name multiple beneficiaries and specify how the benefit should be divided among them.

Can I change my beneficiaries?
You can change your beneficiaries at any time by updating your policy information. Reviewing your beneficiary designations regularly is essential to ensure they reflect your current wishes.

Are life insurance premiums tax-deductible?
Generally, life insurance premiums are not tax-deductible for individuals. However, there may be exceptions in certain circumstances, such as when the policy is used for business purposes or as part of an employee benefit plan.

How do I file a life insurance claim?
To file a claim, you must contact the insurance company and provide a death certificate and other required documentation. The insurer will review the claim, and if everything is in order, they will issue the death benefit to the beneficiaries.

Schedule an appointment with an Agent of S.H.I.E.L.D. to answer all your life insurance questions and explore which options would be best for your situation.

What is short-term disability insurance?
Short-term disability insurance provides income replacement for a limited period if you are temporarily unable to work due to illness or injury. Coverage typically lasts from a few weeks to up to two years. Waiting periods before benefits kick in will vary.

What is long-term disability insurance?
Long-term disability insurance offers income replacement for a more extended period if you cannot work due to a severe illness or injury. Benefits usually begin after short-term disability benefits are exhausted and can last several years or until retirement. Benefits can start in as few as 90 days.

What is an elimination period?
An elimination period is the amount of time you must wait after becoming disabled before your benefits start. Short-term disability policies typically have a 7 to 14-day elimination period, while long-term disability policies often have a 90 to 180-day elimination period.

Do I need disability insurance if I have paid sick leave?
Paid sick leave can help, but it might not be enough to cover all your expenses if you’re out of work for an extended period. Disability insurance provides additional financial protection if you exhaust your sick leave.

How is the benefit amount calculated?
Disability insurance benefits are usually based on a percentage of your pre-disability income, often between 50% and 70%. The exact rate and calculation method depend on your policy. Disability insurance is not intended to pay your entire wage. Instead, it is designed to sustain your basic needs until you can return to work.

Can I have both short-term and long-term disability insurance?
Yes, many people have both short-term and long-term disability insurance. Short-term disability can cover the initial period of disability, while long-term disability kicks in after short-term benefits are exhausted.

Are there exclusions in disability insurance policies?
Yes, most policies have exclusions, such as for pre-existing conditions, certain high-risk activities, or disabilities related to substance abuse. Always review your policy details to understand any exclusions.

How do I apply for disability benefits?
To apply for disability benefits, you must submit a claim form provided by your insurance company and medical documentation from your healthcare provider. Your Agent of S.H.I.E.L.D. Insurance can guide you through the specific process.

Can I get disability insurance through my employer?
Yes, many employers offer disability insurance as part of their benefits package. If your employer doesn’t provide it or you need additional coverage, you can also purchase individual policies through insurance providers.

What is supplemental health insurance?
Supplemental health insurance is a policy that helps cover costs not included in your primary health insurance plan. It can cover out-of-pocket expenses like copayments, deductibles, and services not covered by your primary plan. Claims for supplemental insurance policies are generally paid to the policyholder and not the healthcare provider. Benefits can be paid in lump sums or overtime for various diagnoses or treatments.

What are some common types of supplemental health insurance policies?
Common types include:
Critical Illness Insurance: Provides a benefit if you are diagnosed with a covered critical illness like cancer, heart attack, stroke, or kidney failure.

Accident Insurance: Offers coverage for injuries and medical expenses resulting from accidents.

Hospital Indemnity Insurance pays a set benefit amount for each day you are hospitalized. Some plans also cover tests or surgeries that occur in outpatient facilities.

Dental and Vision Insurance: Covers routine dental and eye care. Dental and vision insurance are not included in standard health plans.

Cancer Insurance: Specifically covers cancer diagnosis, treatment, and care expenses.

Are there waiting periods for supplemental health insurance policies?
Yes, many supplemental health insurance policies have waiting periods before coverage begins. This period varies by policy and type of insurance. For instance, critical illness insurance might wait 30 days before a claim can be filed.

Will supplemental health insurance cover all my out-of-pocket expenses?
Supplemental health insurance is designed to help cover some of the costs not paid by your primary insurance, but it may not cover all expenses. Reviewing the policy details to understand what is and isn’t covered is essential.

Can I purchase supplemental health insurance if I already have primary health insurance?
Yes, you can purchase supplemental health insurance even with primary health insurance. These policies are meant to complement your existing coverage. Your primary health insurance carrier cannot reduce their coverage because you have a supplemental health insurance plan.

How much does supplemental health insurance cost? The cost varies depending on the coverage type, age, health status, and insurance provider. It’s essential to compare policies and fees to find one that fits your budget and needs.

Are there any exclusions or limitations with supplemental health insurance?
Yes, each policy has its own set of exclusions and limitations. Standard exclusions include preexisting conditions or specific types of treatments. Speak with your Agent of S.H.I.E.L.D. Insurance for details about what may be excluded from these policies.

How do I file a claim for supplemental health insurance?
Your claims experience will vary from one carrier to another. However, you will need some universal things to make a claim.

Proof of Illness or Injury: This can be a doctor’s note or medical records associated with the claim.

Healthcare Provider’s Contact Information: The insurance company may need to contact the attending doctor or facility to verify your claim.

Bills: Most supplemental insurance providers will reimburse expenses you have already incurred for associated treatment or transportation—your Agent of S.H.I.E.L.D. Insurance can help you with your claims experience.

Can supplemental health insurance policies be customized?
Some insurers allow you to customize your supplemental health insurance coverage based on your needs. You may be able to choose different levels of coverage or add optional benefits, but this will depend on the insurer’s offerings.

Is supplemental health insurance worth it?
Whether supplemental health insurance is worth it depends on your personal health needs, financial situation, and the gaps in coverage of your primary health insurance. It can be beneficial if you want additional financial protection against unexpected medical expenses.

Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs)

• These are programs that allow employees to save money tax-free for medical. Money in these accounts is intended to be used to cover:
• Medically related costs such as copayments or coinsurance
• Prescription drugs
• Chiropractic or Physical Therapy related care
• Dental or Vision expenses
• Vitamins and Supplements
• Over the Counter Medications (like pain killers, antacids, cold and flu medications, etc.)
• Medical Equipment
• and more

In addition, FSAs may also be used for:

• Transportation Expenses (such as money for tolls, public transit fares, and parking)
• Childcare Expenses
• Smoking Cessation Programs

Always check with your plan administrator or consult IRS guidelines, as eligibility can vary based on your plan and any updates to regulations. Additionally, it’s necessary to keep receipts and documentation for any expenses you intend to claim through your account.

Health Reimbursement Arrangements (HRAs) are employer-funded plans that reimburse employees for out-of-pocket medical expenses (premiums if the employee has a plan through the healthcare exchange are not eligible expenses). Funds can be set aside to help employees who have high-deductible plans or may need help with large medical expenses.