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NHIA Blog2018-10-03T17:48:50+00:00

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3007, 2021

Medicare Part D: What is That?

By |July 30th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

If you or a loved one are on Medicare, you may be wondering what benefits apply and how they work. One such benefit that many people ask about is Medicare Part D. Commonly known as prescription drug coverage for Medicare, people seem confused about getting this coverage and how it works with other forms of insurance. This week, we are looking into Medicare Part D and how it may apply to you.

What is Medicare Part D?

Part D is a prescription drug benefit that went into effect in 2006. It is a federal program that private insurance companies administer. To put it simply, it is an insurance plan specifically for your medication needs. Much like your health insurance has a network of doctors they cover, Part D has a network of pharmacies. Check with your plan to determine which pharmacies and which prescriptions it covers. Medicare Part B, the part that provides general medical care, does not cover everything. The intention behind creating Part D was to alleviate some of the costs associated with prescription drugs. Unlike Part C, where a beneficiary has to be enrolled in both Part A and Part B to participate, beneficiaries of Part D only need to be enrolled in one or the other.

How does Medicare Part D Work?

Annual Deductible

Part D has a few stages that you should be aware of. To start, as with any insurance plan, you have an annual deductible. Much like your other insurance, you pay the in-network prices set by your insurance for all your medications until you reach your plan’s deductible for 2021. The maximum allowed deductible for Part D is $445. Plans may use the full deductible, a reduced or discounted deductible, or waive the deductible entirely. This is why it is important to check what your plan allows and determine if it is the best fit for your open enrollment. Once you meet the deductible, you enter what is known as Initial Coverage.

Initial Coverage

In Initial Coverage, you are responsible for a copay toward each of your prescriptions based on your plan’s formulary. The formulary is a listing of all the medications covered under the plan, with each medication filed under a particular tier based on criteria like name brand or generic as well as other criteria. The higher the tier, the higher the copay will be for you. Your Part D plan keeps track of all spending throughout the year for you and the insurance company. Once the total expenditures for both reach $4,130 (the maximum allowance for initial coverage in 2021), you reach the Coverage Gap.

Coverage Gap

In the Coverage Gap, you are only responsible for 25% of the cost of your medications. Your insurance plan will continue to track all spending for both you and the insurance company. However, to get out of the Coverage Gap and into Catastrophic Coverage, only your spending will apply. When your spending for the year reaches $6,550 (the maximum allowance for coverage gap in 2021), then you enter Catastrophic Coverage.

Catastrophic Coverage

Under Catastrophic Coverage, you are only responsible for 5% of the cost of your medications. Your insurance plan will be responsible for the remaining 95% for the rest of the year.

Exceptions

There are some additional stipulations under Part D, such as a requirement that you try a less expensive alternative medication before trying the more expensive counterpart. If the less expensive treatment does not work, you and your doctor will need to file an exception to have the more expensive medication approved.

2307, 2021

Flu Vaccine Myths and Misconceptions

By |July 23rd, 2021|Categories: Blog and News, NHIA Blog|0 Comments

Flu season is swiftly approaching. It hardly seems possible that the year is half gone, but so it is. With that said, you may be wondering about whether or not you should get the flu vaccine. Questions about its safety and efficacy abound every year. Many people wonder if the vaccine itself has not given them the virus. We have all heard stories of someone or other who swore the only time they ever got the flu was the time they got the shot. Today we are here to talk about that and many other flu vaccine myths and misconceptions.

Can I Get the Flu from the Vaccine?

We will start with one of the most common flu vaccine myths out there. The flu vaccine can’t give people the flu. Any anecdotal evidence from someone who swore they only got sick after the shot misunderstands some key facts about the vaccine.

First, the vaccine contains a dead strain of the virus. Therefore, it cannot infect you. All it does is give information to your body on how to fight the flu. The dead virus causes your immune system to identify and create antibodies against the flu. That way, if your body comes into contact with the virus, your body is already prepared with the information to destroy it.

Additionally, it takes a couple of weeks after receiving the vaccine for your body to fully build up its immunity. The flu itself takes a couple of days from exposure to the onset of symptoms. This is why many people think that the flu shot gave the virus. In reality, they had already been exposed to the flu by the time they got the vaccine.

Is the Flu Just a Bad Cold?

Unfortunately, this is not the case. The common cold and the flu share symptoms. They are not caused by the same infection. The common cold comes from rhinovirus, one of the most common viruses that is one of the smallest viral particles we have found at 30 nanometers. The flu comes from influenza, which is much larger at 80-120 nanometers. By comparison, COVID-19, a.k.a. Sars-Cov-2, is only about 100 nanometers. Not only are the particles of each very different, but the level of infection and lethality of each are also very different. So, it is a mistake to think of the flu as just a bad cold.

Do I Need a New Shot Every Year?

Because influenza mutates and different strains are more prevalent each year, it is important to get a new shot every year to ensure that you have the greatest level of protection against the flu. Especially with COVID-19 still hanging around, influenza is a dangerous comorbidity to have should you also be exposed to COVID-19. Therefore, to keep yourself and those you come into contact with protected from the flu, it is best that you get a new shot every year.

1307, 2021

Hurricane Readiness Kit Preparation

By |July 13th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

Hurricane season is upon us here in Florida. That means that big storms could be rolling in any time. While there is usually at least a week of warning, you do not want to wait until you hear about a storm to get ready for it. One major reason is that natural disasters often limit supplies because everyone else is trying to prepare as well. Therefore, you are better off preparing now for a storm that may or may not come. As the saying goes, “Better to have it and not need it than need it and not have it.” As part of taking care of your health, today we are discussing some things that you should have on hand in a hurricane readiness kit to keep you and your family safe and protected in the event of a hurricane.

Hurricane Readiness Kit

The items listed below are by no means exhaustive. This is an essentials-only list to get you started in your hurricane readiness. This list also covers the bare minimums of each item. In the event of a storm, high winds may have caused damage to trees, houses, and other infrastructure, making it difficult for you to get out of your home. Flooding can also cause problems with evacuation. We recommend you plan for two weeks of sheltering in place. If you can evacuate, prepare a to-go hurricane readiness kit for at least three days. That said, here are some items you should have in a hurricane readiness kit.

Water

Humans cannot live without water. You must plan for at least one gallon of water per person per day. That means, for a family of four to shelter in place for fourteen days, you will need at least fifty-six gallons of water. It sounds like a lot, but you will be thankful for the stash if worse comes to worst.

Food

Only keep non-perishable food items that you can prepare easily. Remember that in the event of a storm, running water and electricity may be unavailable.

Flashlights & Batteries

We do not recommend candles as they can quickly become an additional safety hazard. Along the same lines, keep a solar-powered power bank that you can use to charge your phones. Having the ability to contact others, including family or emergency services, can be lifesaving. Your phone can also act as a weather radio to keep track of the storm.

First Aid Kit

In the event of a larger storm, window damage can cause injuries to those inside the home. For this and other possible injuries, you need a first aid kit on hand with some basic supplies like bandages and antiseptic. Make sure you also have enough reserves of any medications you or your family need.

Cash & Fuel

If you can evacuate, gas pumps and ATMs may not be operable. The same goes for electronic payments as power lines, or the internet may be down. This means that you will need to use cash for any transactions and have spare fuel available to fill up on the road. Only take what you need but remember to keep supplies covered and out of sight. After a storm, short supplies can lead to desperation and looting. Your only priority is to keep you and your family safe.

907, 2021

Telemedicine is Changing Healthcare

By |July 9th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

In 2020, many things changed out of necessity. Some changes were for the better; some decidedly not so. One of the big changes that happened was telemedicine visits. You may have even experienced one of these yourself. Instead of going to the doctor’s office when you feel sick, you had the option to stay home and speak with your doctor via video conference online. In this way, you minimized your exposure to others who may have COVID-19, and you potentially also prevented spreading the virus if you yourself had it. You even have the option of uploading files or photos prior to the appointment for your doctor to review. There are several pros and cons to telemedicine, so let us look at some of them in more detail below.

Pros

Faster Response Time

In many cases, scheduling a telemedicine visit can be much faster than scheduling an in-office visit. This is because a doctor’s office is not having to spread out appointments to limit the number of people who are in the building at any one time. Many times, you will have also uploaded all the pertinent information and any photos or additional documentation ahead of time, so your doctor is able to see all of that upfront. This makes the appointment itself much faster, and everything runs much smoother.

Access

While telemedicine was available before 2020, it became significantly more essential after COVID-19 hit. As a result, many insurance companies opened up access to doctors, hospitals, and patients to utilize this in their practice. Telemedicine is not solely helpful during COVID-19. Telemedicine is even being adapted to emergency treatment for things like stroke, where getting a rapid response is critical to recovery. Indeed, it is even being used to help train and further the education of doctors and nurses in their time outside of medical practice.

Convenience

Many patients are turning to telemedicine, even when they are not contagious. Largely, this is because they find it is easier to fit telemedicine into their schedules. When scheduling an appointment during a busy workday, patients no longer have to consider commute time in their schedule. Instead, they only have to plan for time to log in and have a conversation. This makes telemedicine very appealing in a fast-paced world.

Cons

Diagnostic Difficulty

As convenient as it is to send a photo and log in to a video conference, there is still something to be said for in-person doctor visits. Photographs can only show the object in two dimensions instead of three. And it is also difficult to show scale or proper coloration in a photograph. For this reason, some people still prefer an in-person visit.

Unreliable Technology

Another downside to telemedicine is the uncertainty of connection success. There is a little bit of a learning curve when it comes to telemedicine, so those who are not as well versed in technology may struggle to get connected. And any interruptions in internet connection can make telemedicine frustrating.

Privacy Concerns

With telemedicine and the greater use of technology in the medical field, many people are concerned with the level of privacy being maintained with regard to medical records and personal information. There is something to be said for keeping certain information offline, as it is the only surefire way to avoid exposing information through an internet breach.

2706, 2021

Choosing Dental Insurance

By |June 27th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

Many people wonder if it is really worth it to have dental insurance. After all, how important is it to get a dental checkup and teeth cleaning? Can I just pay for services when I really need them, like when I actually have a toothache? The simple answer is, yes, you can. But you never know when that toothache is going to strike, and it could happen when your cash flow is already overwhelmed by something else like a broken-down vehicle or after storm damage. Not to mention, when your tooth starts aching, the damage is probably far worse than it would have been had you been getting your regular cleanings and checkups. More damage means more money out of pocket for you.

Savings

One of the biggest reasons to get dental insurance, as we have already touched on, is to save on dental procedures. When you have dental coverage, there are some routine services like cleanings and checkups that are fully covered. Other services are available at a significant discount. And who does not like to save money. Yes, dental insurance is optional. However, did you know that many dental insurance plan premiums are as low as $15 a month?

Cosmetics

Everyone feels better about themselves when they like how they look. One thing that can make you feel better about your appearance is having a bright, healthy smile. Having dental insurance enables you to get your smile looking its best through routine services and even specialty cosmetic services like whitening treatments and, in some cases, braces to straighten your teeth as well. Working with your dentist and your dental insurance, you can gain the confidence you want by improving your smile.

Health

The eyes are the window to the soul, and the mouth is the window to your health. Many times, what is going on in your mouth is a clue to what is happening in the rest of your body. For instance, gum disease can be an indicator of heart disease as well. Many other diseases, including diabetes, osteoporosis, and even Alzheimer’s have oral symptoms that your dentist can identify and diagnose. The earlier some of these diseases are diagnosed, the more can be done to treat them.

Emergencies

Dental emergencies happen. If you are playing sports and get hit in the mouth, for instance, dental damage can be quite painful and costly to repair. If you have children, dental emergencies are all but guaranteed at some point due to the rough and tumble nature of their play. With dental insurance, the cost of repairs to their teeth are greatly reduced. Plus, with dental insurance you will already have a relationship with a dentist, so you will not be left scrambling to find one who can squeeze you in when the emergency happens.

In Conclusion

All in all, dental insurance is optional, but it is something that is beneficial to you and your family. Taking care of your teeth is another way to maintain your overall health. And many plans are much more affordable than you may think.

2006, 2021

How to Choose an Insurance Plan

By |June 20th, 2021|Categories: Blog and News, NHIA Blog|0 Comments

President Joe Biden recently signed an Executive Order that created a special enrollment period for health insurance coverage. In addition, the American Rescue Plan Act (ARPA) provided additional subsidies for health insurance plans. Now many more Americans can find health insurance coverage with $0 or low dollar premiums. If you suddenly find yourself shopping for health insurance, here are a few things you should know before you choose an insurance plan.

Costs

There are a number of factors that come into play when looking at health insurance overall costs. Monthly premiums, copays or coinsurance, deductibles, and out-of-pocket maximums are all price points that you should weigh to determine which plan is right for you and your family. A monthly premium is like a subscription fee that you pay each month.

This cost does not go away if you do not use any health-related services for the month. As a general rule, the lower your premium, the higher your out-of-pocket costs. A copay is a set dollar amount that you pay to the provider at the time of service. Typically, this means a lower cost for a primary provider and a higher cost for a specialist. Coinsurance is a percentage of the overall medical costs that you pay. Coinsurance varies based on the provider and the services required. The out-of-pocket maximum is the highest dollar amount that you will pay in a calendar year. Beyond that dollar amount, your insurance provider must provide full coverage.

Determining Cost

Determining which plan is best for you and your family comes down to some basic information. If you find that you or anyone covered under your plan regularly requires medical care, medication, has a planned surgery, or is pregnant, then a plan with a higher premium but lower copays and deductible may be the better choice. If, on the other hand, you rarely need to see a doctor or specialist, then a plan with a lower monthly premium but higher out-of-pocket costs may be a better fit. Remember that there are subsidies available through the marketplace that may allow you to choose a better plan for you and your family at a cost that is much more affordable than it would otherwise be.

Network Types

Another important factor is the network type that your plan falls into. There are several different types, each with their own benefits and drawbacks. For instance, if you need to see a specialist and would prefer to choose your own doctor, then PPO or EPO would be a better fit for you. However, if you do not mind letting your primary care doctor choose your specialist for you, then and HMO or POS would work for you.

With an HMO or POS, you will likely need a referral before seeing a specialist. This could mean an additional copay or coinsurance before you receive a referral. In any case, if you have already established a relationship with a doctor that you like, make sure that your doctor is on the list of in-network providers for any health insurance plan that you choose. Most insurance plans charge more for out-of-network providers, so choose accordingly.

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