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The Medicare Modernization Act of 2003 created prescription drug coverage for all Medicare beneficiaries. This coverage went into effect January 1st of 2006. What is Medicare Part D and how do make the most of your prescription drug coverage?

As of January 2006, there are three components to Medicare. These components are Part A (Hospitalization Insurance), Part B (Medical Insurance), and Part D (Prescription Drug Coverage). Prescription drug coverage under Medicare works like any other Prescription drug insurance on the market today.

When you enroll in Medicare Part D you are signing up with a private insurance company appointed by Medicare to administer your plan. Part D providers and their plan offerings vary by region. There are dozens of providers and even more plans to choose from; all of these plans cover prescriptions differently and not all of them may cover the medicines you take.

How do you know which plan to sign up for? First, start by making a list of all the medication you take. List it by the medication?s name, brand versus generic, and how often you take it. Next, contact Medicare at their toll free number: 1-800-633-4227, and ask them for a list of Part D providers in your area.

You will receive a list of private insurance companies appointed by Medicare to administer Part D plans in your area. Finally, you will need to contact each of these insurance companies with the list of medications you prepared earlier. Read more…

Health Insurance; COBRA; OBRA; HIPAA; Medicare. If asked, could you state that you knew that all 5 of these topics had the same thing in common: medical insurance coverage for you and, perhaps, your family? Would you know the qualifications for each? Well, in this article, we will discuss them. For a timeline that depicts, graphically, the time relationship between them, please see the timeline in www.disabilitykey.com.

HEALTH INSURANCE Coverage from Work

If we are lucky, we, and/or our spouse, work for a company that provides, as a benefit, health insurance coverage for us and our family. If so, we are very lucky. Even if that is true, there are some key things that you might want to look at to see if you have ENOUGH coverage.

1) From your Human Resources Department (or wherever else you would go to get information about your health insurance) get what is called a “Summary Plan Description” (SPD). This document should be kept where you can always find it, as it contains all the information you will need about what your insurance covers and what it doesn’t.

2) Look up “Coverage” and “non-coverage” in your SPD.

These will tell you what your plan covers and doesn’t cover. You need to see if, perhaps, you or one of the covered members of your family has a condition or circumstance that might not be covered, where you need additional coverage. For example, let’s say that your family has a history of cancer; perhaps your plan restricts the number of hospitalization days for care; or, restricts the days per condition. In this case, (like my children) you might want to get additional “cancer insurance” (I think that AFLAC might provide this type of coverage).

It would be a good idea to contact a Health Insurance benefit Broker and ask him/her to read your SPD and see if you have any gaps in coverage. They then can help you supplement coverage BEFORE YOU NEED IT!

NO HEALTH INSURANCE COVERAGE

You might be one of the growing members of our society that, through one circumstance or another, does NOT have health insurance coverage for your family. In this case, I strongly encourage you to contact a Health Insurance Broker and get immediate coverage of what is called “catestrophic” (not sure if I spelled this correctly) coverage. In this type of coverage, you will generally have large deductibles, but will have coverage if, say, one of you has to go into the hospital.

CONTACTING A BENEFITS INSURANCE BROKER

Whenever you call or email a Health Insurance Broker, it is very important to prepare ahead of time. WHAT, specifically are you looking for; how much can you afford to pay every month; what circumstances do you want to make sure that your family is covered for. In this way, you can make sure to focus on your critical needs.

COBRA

COBRA is an acronym ( how can I spell acronym correctly, yet not be sure that I spelled catestrophic correctly?) that stands for: Consolidated Omnibus Budget Reconciliation Act. Basically, it is a federal law that allows you to pay for your Company-paid health insurance, as an active member, if you no longer work for that company for, generally 18 additional months.

1) COBRA is “triggered” (that is, you, or a covered member of your family, become eligible for COBRA) by events such as the following: resignation from the company; termination (FOR ANY REASON) from the company; divorce of a spouse; a covered chile’s birthday makes them ineligible for coverage. These are the main “triggering” events for COBRA.

2) Now, when eligible for COBRA, you will be asked to pay for 100% to 105% of the company’s employee/employee and family coverage amount. You should get a letter from your company explaining what that amount will be. BEFORE YOU DECIDE TO TAKE COBRA, there are some important things for you to consider.

What will be your cost, and what will be the coverage for that cost?
Sometimes the cost is too much for the coverage. In these cases, you might want to select HIPAA coverage, instead (see HIPAA below).

Or, you might just want to get catestrophic coverage as was mentioned earlier, and wait for full coverage under your next job.

Part of this decision should be whether or not you or a member of your family has what is called a “pre-exisitng coverage” condition.

Here again, before automatically taking COBRA, it would be wise to contact a Benefits Insurance Broker and give him/her all of your options, and get their input. I have worked extensively with a Benefits Insurance Broker, and he is absolutely fantastic!

OBRA

What, you ask, is OBRA? I’ve never heard of it, you say, and no one I know has heard of it either! Well, that’s because, 99% of Human Resource or Benefit folks that I know have never heard of it! OBRA is a federal law that was passed that extends COBRA for an additional 11 months FOR DISABILITY PURPOSES ONLY!! Why, you ask, is this important? Thanks for asking, let’s see if I can explain.

If you are as nieve (did I spell this wrong too? sorry!) as I was when I first started looking to bridge my health insurance from working to Medicare, I assumed that when I got through all of the hoops to qualify for SSDI (Social Security Disabililty Insurance) I’d IMMEDIATELY be eligible for Medicare, RIGHT??? WRONG!!!!

When you FINALLY qualify for SSDI, you have to wait for 5 months Read more…

When you have a disability of any type, your time, energy, and emotions are all heightened as you begin the journey to learn all you can so that you can regain the best quality of life that you can, given your particular circumstances. And, if you are married, and/or if you have children, trying to communicate with them what is going on with you, as well as to your doctors, becomes a difficult chore also.

With all of this chaos in your life, the absolute last thing that you need to worry about is money! What if I can?t work any longer? How will the bills be paid?

Perhaps you are saying that you do not need any disability insurance. Consider the following.

Disability Statistics[1]

The odds of a person having at least one long term disability (LTD) that lasts three months or longer before that person reaches age 65.

DISABLED: (1999) According to the Disability Management Sourcebook, the number of folks between 17 and 44 with severe disabilities has increased 400 percent over the past 25 years. One in seven people will become disabled for five years or more before they reach 65.

ODDS, STATISTICS AND DISABILITIES: (1999) The chances of using your homeowners insurance are about 1 in 88. The odds of using your auto insurance at about 1 in 47. The chances of using your LTC insurance is about 2 in 5. One out of two women and one out of three men will spend some time in a nursing home. (Journal of the American Society of CLU, 1996) More than 12 million older Americans will require some form of long term care by 2020. (Health Insurance Association of America). 72% of residents in a nursing home are women 90% of nursing home residents are over the age of 65. 22% of the disabled population is under age 65. (Puget Sound Life Underwriters Journal 1996). Functionally disabled people between the ages of 18 and 64 represent 40% of Americans needing long term care services. (Life Insurance Selling 1995)

The likelihood of needing LTC (obviously) increases with age. In 1991, 29.2% if those age 45- 64 had a disability; 44.6% between 65 and 74 had a disability; 63.7% between the ages of 75 to 84. 15.3% and 41.5% respectively had a severe disability. (Employee Benefit Research Institute, 1995) 80% of disabled persons are cared for at home or in adult day care centers. 72% of caregivers are family or friends. (Puget Sound Underwriters Journal). The cost of home care can run from $4.25 to over $200 daily depending on the level of skill needed (SF Chronicle, 1995). Caring for each Alzheimers patient will cost more than $213,000- on top of other medical expenses- over the remaining five years of their lives. (American Journal of Public Health, 1994). Over 99% of nursing home care is either custodial or intermediate care, not skilled care, and is not covered by Medicare or Medicare supplements (Journal of the American Society of CLU’s, 1996).

Reasons People Take STD and LTD

Leading the list of Top 5 causes of short-term disability (STD) workplace absence for 2001 was pregnancy (normal), followed by complications from pregnancy, injuries (excluding back), back conditions and digestive/intestinal conditions. The causes of claims and the percentage received for each cause were as follows:

LTD – 13 percent ? Cancer, 12 percent ? Complications from Pregnancy, 11 percent ? Back, 9 percent ? Cardiovascular, 5 percent ? Depression
(2003) every year 12% of the adult U.S. population suffers a long-term disability. One out of every seven workers will suffer a five-year or longer period of disability before age 65, and if you?re 35 now, your chances of experiencing a three-month or longer disability before you reach age 65 are 50%. If you?re 45, the figure is 44%

STD – 20 percent ? Pregnancy (Normal), 9 percent ? Pregnancy (Complications), 9 percent ? Injuries (Excluding Back), 8 percent ? Back, 8 percent ? Digestive/Intestinal

The primary sources of disability insurance are STD and LTD. It is important to see if your company offers these insurances. If they do, make sure that you are covered. If they don?t, you can get personal STD and LTD. By visiting the following website, you can get more information about disability insurances.

How Much Disability Insurance is “Enough”?

Research shows the following about employer-offered STD (short term disability) and LTD (long term disability).

Disability Insurance: ( 2003) In small private firms, fewer than one-quarter of workers have short-term disability coverage (22%), and just 13 percent have long-term disability income insurance, according to the Bureau of Labor Statistics.

Half of workers at large employers (100 or more employees) have short-term disability income insurance (47%), and more than one-third have long-term disability coverage (40%).

Disability coverage (American Council of Insurers 2004) 82% of employees are lacking in adequate coverage.

The Society of Actuaries says that only 2.5% of employees have individual disability coverage (i.e., paid for by the employee and not the company).

If you have already read the other blogs about Disability insurance, you know how important it is to know about what types of insurance you have, and how much each insurance will pay out, if and when you need it.

Now, you know how much your STD and LTD will pay out each month. The question is, how much SHOULD YOU HAVE?

There are some simple ways to determine just how much is “enough”, and it varies for each family.

1) Sick leave – maintain at minimum 5 days, and, at best, 10 days. In this way, you will be able to meet a usual time gap before your STD kicks in.

2) STD – most STD policies cover up to 26 weeks. To make sure that you have “enough” STD TIME coverage, the weeks should cover your LTD’s elimination period.

3) LTD – timewise, you will want your LTD plan to cover you until your retirement age. (Note, not all retirement ages are at 65. The retirement ages are increasing; make sure that you know your specific retirement age.)

Now, let’s talk about money. To calculate how much money is needed by you and your family, consider the following.

For each month, note the following.

1) OUTGO Your “must pay” expenses (including, but not limited to the following: house payment; utilities; car and gasoline; medical expenses; any child care; any loans, credit cards, etc.)

2) INCOME ON DISABILITY Add together any income other than yours (i.e., spouse’s income) plus whatever you will receive on a monthly Read more…

You have read the information about the need for disability insurances, and have checked out your company benefits to find that you DO NOT have short term disability (STD) or long term disability (LTD) plan coverage. If this is your situation, read the following. The time to do so is BEFORE you need to use that insurance!

The rest of you have checked out your company benefits and find that you DO have STD and LTD plans. Now you want to learn more about Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

(Note: a denial on behalf of an insurance company for LTD does not necessarily have an impact on your ability to successfully apply and be accepted for SSDI coverage.)

Social Security Disability Insurance

If you qualify for Social Security (i.e., if you have acquired at least 40 quarters of Social Security contributions) and are suffering from a disability, you may be able to receive monetary benefits from the Social Security Administration. Also, in some situations these disability benefits may be awarded to you and your dependents.

Social Security Disability Benefits or SSDI are paid to individuals who have worked in the recent years. Usually you have to work 5 out of the last 10 years. For individuals under 31 years old, the requirements are a little different since they have not been in the work force as long.
Under the federal Social Security Disability Act, “disability” means the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months or result in death.”

The Workbook described at www.disabilitykey.com contains a step-by-step ?How To? guide to assist you in documenting your illness/injury symptoms and their impact on your every day normal living activities.

Supplemental Security Income (SSI)

The Supplemental Security Income program is funded by the general revenues of the Federal Treasury and is intended to provide a minimum level of income to persons who are aged, disabled, or blind and demonstrate economic need. The SSI program is meant to supplement any income an individual might already have to ensure a certain level of income to meet basic living expenses. The dollar amount received in SSI on a monthly basis varies from person to person and is computed each month, taking into account an individual’s current financial situation.
For an individual to be eligible for SSI they must be disabled, or blind, or aged and have little or no income and resources. A person must fit into one of the following categories: Disabled, Blind (20/200 or less in your better eye with glasses or a filed of vision less than 20 degrees), or Aged (refers to be 65 years of age or older).

To be eligible for SSI a person must meet an income as well as resource test. SSI resource limits are set by statue and a person’s countable or real personal property, including cash, must not exceed the specified amount to qualify. The current resource limit is $ 2,000 for an individual and $3,000 for a couple. Income includes earned income (which refers to monthly gross earnings), and unearned income such as Social Security Disability Insurance (SSDI) or any other type of benefit or monetary support a person receives. A standardized formula, which takes into account earned and unearned income is used by SSA to compute the dollar amount of SSI cash benefit that a person qualifies for. This formula is applied during the initial eligibility determination and an individual must qualify for some dollar amount of SSI to meet the income test.

The specifics of qualifying for SSI are quite complicated.
The next time, we will talk about COBRA (and no, it is NOT a snake) OBRA, and their relationship to Medicare and/or another health insurance plan.

These are all of the traditional disability insurances. Now we will discuss what they are, and why you should care!

STD is an insurance that you are usually provided by your Employer. It is an Insurance plan that pays out a certain amount of money for a short period of time (normally, no longer than 6 months). There is usually a week of what is called “qualifying” time before the STD payment will kick in. Most folks can take sick leave, vacation time, paid time off, or some other sort of time for this qualifying time. This type of disability payment is for an illness or injury of a limited period of time. An STD payment ranges from a low amount that would equate to a state’s Unemployment payment, to a maximum of about 66% of base pay. To know about the specifics of your plan, ask the appropriate people for a copy of your STD plan’s Summary Plan Description.

LTD, or long term disability insurance payment usually results from a physical or mental illness that prevents an employee from performing the job that they occupied at the time the illness/injury occurred. To receive the disability benefits insurance payment, the plan participant must qualify, based on the particular plan requirements. There also is a qualifying period of time for LTD, just like for STD, only the average LTD qualifying period of time is usually 6 months. Again, like STD, the payment out of an LTD plan is plan-specific, and can range from a finite dollar amount to a percentage of base pay.

Key issues to research in your LTD disability insurance plan include, but are not limited to: pre-existing conditions; “own occupation” vs “any occupation” timeframes; whether or not the monthly benefit payment is taxable or tax free; etc. (Normally, the rule of thumb is that if the company pays for the LTD plan premiums, the benefit is taxable upon receipt; if the covered person pays for the plan premiums, the benefit is tax free.) Again, for specifics about your LTD plan, check out your Summary Plan Description.

Disability and Medical Insurance definitions. You have plans, and you have read about such things as: COBRA, OBRA, Own Occupation, Any Occupation, etc., and you REALLY want a simple definition. Read more…

Disability insurance is an important tool that every employee should make use of. It is an insurance policy that secures and provides protection for the workers who become disabled in the discharge of their duties or otherwise. The reasons for disability could be many such as prolonged illness or accidents. As per the terms and conditions of the policy, relief will be provided to the worker, when he has to live without pay and allowances from his employer.

Now, a person can buy a short term or a long term disability policy as per his needs. The range of short terms policies is generally two years, where for long terms policies, it is for longer periods, sometimes extending up to insurer’s full life.

There are many types of policies, as regards benefits and payment of premium. Policies provide many options, but for every additional benefit, additional premium need to be paid. Here is a list of benefits you may look for when purchasing the policy:

Purchases of additional coverage.

Cost of living adjustments (COLA).

Coordination of benefits with other policies.

Residual or partial disability rider permitting a return to part-time work with reduced benefit payments.

Return of premium after a specified period with no claims.

Waiver of premium payment after a specified period of disability.

Premium for disability insurance are based on many characteristics like age, occupation, health and the calculations of potential lost income. Occupation is very important, because some occupations by their very nature are more hazardous than the other.

The whole purpose of disability insurance is to provide the benefit to the insurer. Therefore while buying any insurance policy take written explanation from the insurance company Read more…

Disability can occur at any time. While many people take their body and health for granted, serious accident or injury can happen to anyone and if you find yourself disable, for a short period or long term, how will you cope?

Disability insurance is a sub set of health insurance that will provide the holder with income should they become disabled and thus unable to continue earning a living. If this were to happen to you, do you know what you or your family would do for income?

If you are aged 40, there is a higher chance that you will be disabled, and thus unable to work for a period of 90 days or more, than of you dying before the age of 65. There are three common ways of insuring against this risk.

Employer?s Insurance

The first is to receive insurance from your employer. This is required by law in many states. It comes as a form of short or long term paid sick leave. Larger employers can have even more generous terms. For example, a common policy might offer you 60% of your salary for five years, or maybe even all the way up to retirement. While not everyone is lucky enough to work for such a company, it is worth checking with your employer to find out what your protection is and whether or not its something you wish to provide for yourself.

Long Term Disability

The second common protection against this type of risk is social security and disability benefits. This usually only covers employees whose disability lasts for a period of 12 months or more. It also must be shown to be so severe that you cannot find gainful employment. Therefore there are Read more…

The role of a disability policy, whether individual or group, protects a certain amount of the employees’ salary. The insured may collect a portion of their salary once they become ill or injured, as long as their elimination period has been sufficed. Once the individual is able to return the work full time the benefits will end completely in all likelihood. It should be noted that injuries or sickness arising out of the job are protected by Workers Compensation.

The stereotypical model for a person labeled as disabled is someone in a wheelchair. However sickness can be just as debilitating as injuries from an auto accident. Some people are unaware that disability claims can include sickness, but they can.

Get up to Five Free Disability Insurance Quotes Today!

There are two types of disability policies, short and long-term. Short-term policies last less than two years, while long-term can last to age 65 or older. Both serve their purpose but be aware of the difference.

Group Disability Insurance is often the only way for employees to qualify or pay for disability insurance. The medical history of some employees may cause them to be turned down for an individual policy. Yet depending on the size of the company for Group Disability Insurance, simplified or little underwriting may occur. While others may be stretched to the limit with other debt or bills to pay for another policy.

An Individual policy Read more…

Many individuals struggle to understand what disability insurance covers. There are two basic forms of disability insurance, short-term and long-term disability. Short-term as its name implies is for a short period of time usually less than a year. Group short-term disability is more prevalent in the work place than long-term. One of the failures that individuals make is assuming that their policy covers 100% of their income. The policy usually covers up to 66 2/3%, it may be only be 50% for 13 weeks only. (Check your employee handbook) Uncle Sam allows you to get the benefit tax free, but you cannot get more in benefit than your pre-tax salary. It is very important that people read their employee benefits carefully.

The two main definitions used to define if benefits under a disability insurance policy are paid include own occupation and any occupation. Own occupation disability means you are unable to perform the substantial duties of your current position in a nutshell. Any occupation includes the duties of a job that you have been trained for through education, training, or experience.

Individual disability policies cover a percentage of your income based on your occupation, the hazard of your responsibilities, and your income. The elimination periods for disability policies usually range from 30-365 days. If you become sick or Read more…

The topic of insurance is not sexy by any means. Perhaps that’s why so many people avoid addressing it. Another reason may be a bit more subconscious–the avoidance of future, indeterminable events, in favor of present-day issues with more certainty.

You are probably aware that many Americans are vastly under-insured. Home and auto insurance are important, and most people have that covered. What I am referring to, more appropriately, is your (1) life insurance, (2) long-term disability insurance, (3) liability insurance, and (4) long-term care insurance.

It is almost amusing to see someone walking around with a $60 cell phone that they have paid to insure, while their multi-million-dollar body is completely unprotected!

I said almost! Before addressing a client’s investment situation, I always ask them to first consider the following four questions:

If you were to die, would your family have enough money to both pay off the house and live off the earnings from your savings?

If you were Read more…

Disability insurance covers you for an extended period of time. Should you be injured or take ill and as a result be unable to perform the duties of your employment, you will be covered under short term disability, then long term disability insurance will cover you. The coverage can be for a period ranging up to five years or until the disabled individual turns sixty five.

Long term disability insurance is often provided by your employer as part of your benefits package. If you purchase it on your own, the benefits are tax free.

Disability insurance on an individual basis makes great sense as if involved in an accident you are more likely to be disabled than die. Therefore it can be argued that it makes more sense to buy long term disability insurance than life insurance.

Disability insurance policies differ from one provider to the next. It is important that you do your research and find the disability insurance policy that best meets your needs with the insurance company that you trust the most. Insurance companies, through an independent insurance broker, will gladly offer you disability insurance quotes free of charge. You can get quotes online now which is the easiest way as Read more…