Help for MS patients choosing health insurance for 2017

November 14, 2016 Alan Wittenberg, MSW

It’s that time of year again. Time for health insurance decisions. Many of our multiple sclerosis patients are probably reviewing their current plans, and considering whether they need to change plans or adjust the ones they have now. Here’s information and resources to help you make those decisions. 

Medicare enrollment

Medicare Health Insurance Open Enrollment began Oct. 15 and runs through Dec. 7, 2016, for Original/Traditional Medicare, Supplemental options and Part D-medications. This is the federal program. The Medicare Advantage plans are offered by private insurance companies. These plans offer the same coverage as Original Medicare, but most also offer more. Please note that Swedish does not accept all Medicare Advantage plans. To learn which plans we do accept, call Customer Billing Services at 206-320-4476 or the MS Center social worker at 206-320-3830. 

For a good overview about Medicare, there is a handbook called Medicare and You 2017. I would encourage you to contact the Medicare office at 1-800-Medicare or the state Insurance Commissioner’s Office at 1-800-562-6900 if you haven’t received this handbook. You can also find it online by searching for “Medicare and You 2017” on the federal Medicare website. This website also offers a “plan finder” tool that allows you to compare your plan with other prescription drug offerings and plans.

Private insurance enrollment

Open enrollment for plans on the Washington Health Benefit Exchange and plans outside of the Exchange began Nov. 1, 2016, and runs through Jan. 31, 2017. For more information about these plans, visit the Insurance Commissioner’s website and click on “Find individual health plans and premiums,” or call at 1-800-562-6900. To sign up for Exchange plans, you can either call 1-855-923-4633 or visit Washington Healthplanfinder. Please note that Swedish does not accept all Exchange plans. To learn what plans we do accept, please call Swedish Billing services at 206-320-4476 or the MS Center social worker at 206-320-3830.

Q & A

Here are answers to some frequently asked questions about health care insurance.
Choosing Medicare is complicated. What help is out there for choosing a Medicare plan? 
The National Multiple Sclerosis Society continues to offer free counseling to individuals with MS and related demyelinating diseases. The MS society can help choose the Medicare Supplement and Medication plans that will work best for you. If you want to choose a Medicare Advantage plan, the society will help with that as well. The MS society offers two resources:
  • A collaboration between the National Multiple Sclerosis Society and the Statewide Health Insurance Benefits Advisors (SHIBA) program, which is under the Insurance Commissioner’s Office. SHIBA has assigned a volunteer to specifically help people with MS and other conditions recognized by the National Multiple Sclerosis Society. To use this service, contact the National Multiple Sclerosis Society at 1-800-344-4867.
  • An MS society agreement with a licensed Medicare insurance broker. Brokers normally get paid by the insurance company. Unlike the SHIBA volunteer, who helps narrow down a person’s choices, the broker can actually help individuals with MS choose and sign up for a Medicare plan. To use this service, please call the MS Society at 1-800-344-4867.

If you prefer to not go through the National Multiple Sclerosis Society and want to talk directly with a SHIBA representative from your county, contact the Insurance Commissioner’s Office at 1-800-562-6900.
I am not eligible for Medicare so I need to purchase a private insurance policy. I understand that Swedish and Premera Blue Cross were still negotiating a contract. Any news?
Yes, a contract has been signed! However, it is important to know that only the Premera Heritage Plus plans are accepted. These are the “employer-supported health plans.” This means that any other Premera plan available on the Washington exchange (for example, Signature and Prime) are NOT accepted by Swedish.  

Important note: This does not affect Premera’s Medicare Advantage plan. 

Choosing a private health insurance plan is complicated and time-consuming. Is there any help?
Yes. If you don’t know anyone who can recommend a broker, you can go on the Insurance Commissioner’s Office website and scroll down to “Look up an insurance company or agent.” In the search box, type in the city you live in. Be prepared for many, many choices.

I have a low income. Are there any discounts for private health insurance policies? 
Yes. You can contact the Exchange directly or you can talk with a Swedish Patient financial advocate about your options. To talk with an advocate, call 206-386-6996.

My prescriptions are very expensive. What do I do if my insurance doesn’t cover all of my costs?
Pharmaceutical companies offer “patient assistance” for drugs they make. Contact the maker of your medications to see if you are eligible. There also may be foundations and other organizations that can help.  A good website to find more resources is NeedyMeds.

Does Swedish offer any financial assistance for medical expenses?
Yes. Eligibility depends on your household income. If your household income is below 400 percent of the federal poverty level, you would be eligible for either a 75 percent or 100 percent discount for the services Swedish covers. As an example, 400 percent would be $47,080 for a household of one and $63,720 for a household of two. Please note that Swedish does not cover things such as medication and lab work.

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