Comparing Life Insurance Products
One of the most common issues that faces people as they age is this question: how can I provide for them after I am gone? The answer for many has historically been by purchasing a life insurance policy. For many beneficiaries as they age, they take comfort in the knowledge that their families will receive a sum of money to cover things like funeral costs, any outstanding debts, and even life essentials like groceries while they are mourning. Agents need to be well versed in all the different options for life insurance in order to present their clients with a cohesive picture of their options.
Much of the time, people think of life insurance as two-fold: people are either able to purchase term life insurance or whole life (permanent) insurance. However, there are three different options for the type of policy that is available. The following presents a comparison of these three types: fully underwritten, simplified, and guaranteed issue life insurance policies. Each one has their benefits and drawbacks.
What are the Three Types?
Fully Underwritten – Comparing Life Insurance Products
Fully underwritten policies are typically for term life insurance, meaning that coverage is for a certain time frame, such as ten years, and then the beneficiary has to reinstate the coverage when that time is up. This is a policy in which the beneficiary’s medical history is completely disclosed, and most often requires a visit from a doctor, nurse, or other healthcare professional in order to have the application accepted. The approval process for fully underwritten policies is the longest; it can take up to several weeks to get approved. However, there is no specified maximum coverage amount. These policies are recommended for individuals in good health. They have no complex medical history.
Simplified Issue – Comparing Life Insurance Products
Simplified issue policies are also typically for term life insurance. The largest difference in the application process between simplified issue and fully underwritten is that the simplified issue application has far less medical history disclosure required. There is no visit or exam necessary by the medical professional, and, as a result, the premiums are often higher than fully underwritten policies. Approval of applications is quicker because of this, as well, with approvals in several hours to several days. The maximum amount of coverage differs by carrier, but is typically up to a million dollars in coverage.
Guaranteed Issue – Comparing Life Insurance Products
Guaranteed issue life insurance policies are for whole life, or permanent, policies. These are the most expensive premiums by far. No medical questions. (Hence the “guaranteed” part.) Approvals can come within a few hours. Because of the guaranteed aspect of the policy, the coverage is usually limited to between $25,000 and $50,000 per policy. These policies work best for people with a complex medical history. These individuals may not receive coverage otherwise.
Knowing the basics of which situations require which policies can help agents successfully enroll more clients and maintain more working relationships.
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Medicare and working after 65
As people approach the age of 65, many consider retiring and accessing their Medicare benefits. However, a growing number of individuals are choosing to continue working after turning 65.
Navigating Medicare and working after 65 requires an understanding of how these systems interact. By exploring your options, enrolling during the appropriate periods, and considering your retirement plans, you can make informed decisions that optimize your healthcare coverage and financial security. It is also be a good idea to consult with a licensed Medicare agent as well as a financial advisor to be sure you make the best choices for your unique situation.
Medicare Eligibility:
Most people become eligible for Medicare at age 65. If they or a spouse have worked and paid Medicare taxes for at least 40 quarters/ten years, they usually qualify for premium-free Part A. Enrollment in Part B has a premium for most people.
Here are the 4 parts of Medicare and what they cover:
- Part A: Is Hospital insurance and it covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services.
- Part B: This coverage is called Medical insurance and it provides coverage for doctor visits, preventative care, outpatient services, and medical equipment.
- Part C: Not everyone needs to have Medicare Part C. This is another name for a Medicare Advantage plan. These plans are offered by private health insurance companies and take the place of Medicare Part A & Part B coverage (although you still have to pay the Part B premium even with a Part C plan). In most cases, they include Part D prescription drug coverage.
- Part D: This is prescription drug coverage that helps pay for your medications. These plans are offered by private insurance companies.
Working After 65:
Many seniors choose to work past 65 for various reasons. These reasons may include; financial security, personal fulfillment, and maintaining social connections. If you continue working after 65, consider the following:
Employer Coverage vs. Medicare:
If you have health coverage through your employer or your spouse’s employer, you can delay Part B enrollment without facing penalties. You should look at the coverage and cost of each option before you make a decision. This is a perfect time to consult a Medicare agent so they can go over both plans and help you make the best choice. However, if your employer has less than 20 employees, Medicare becomes your primary coverage. This means you should enroll in both Part A and Part B to avoid potential late enrollment penalties.
Enrolling in Medicare While Working:
If you want to access Medicare benefits while working, make sure you sign up during your IEP or Initial Enrollment Period. The IEP begins three months before your 65th birthday and ends three months after your 65th birthday. Just be sure you understand how your Medicare coverage works with your employer plan if you have both. You may drop employer coverage and to join a Medicare plan. If you choose this option, you will need additional coverage such as a Medicare Advantage plan or a Medicare Supplement plan and a Medicare Part D plan.
No matter which plan you choose, be sure you have Creditable prescription drug coverage. If you do not, you can end up with a life-long penalty for late enrollment once you decide to purchase a Part D plan.
Medicare and Part-Time Work:
Even if you work part-time, you may be eligible for Medicare benefits. The rules for Medicare and employer coverage will vary. It all depends on your situation which includes the size of your employer. It is best to check with your employer’s HR department and your Medicare agent to see what your options are.
Click here for more information on working past 65
Medicare and Retirement Plans:
Working after 65 can impact your retirement plans, especially if you have retirement accounts like a 401(k) or an Individual Retirement Account (IRA). Check with your financial advisor for contribution limits and rules. You should also consider the following points:
The main rule for contributing to either a traditional or Roth IRA is, you or your spouse need to have earned income during that year.
Please be aware; IRA contribution limits apply based on your adjusted gross income amount.
- Earned income includes wages, salaries, tips, bonuses, commissions or earnings from self-employment.
- What is not counted as earned income cannot be deposited into your IRA include; dividends, interest, capital gains or distributions from retirement accounts.
Note; Social Security does not qualify as earned income, and can’t be contributed to an IRA.
Medicare and HSA Contributions:
If you have a Health Savings Account (HSA), contributing to it can provide significant tax benefits. However, once you enroll in Medicare, you can no longer contribute to an HSA.
RMDs and Retirement Accounts:
Once you reach either 72 or (73 starting in 2023) , you must begin taking Required Minimum Distributions (RMDs) from your retirement accounts. Make sure to plan for this additional income in retirement.
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Advanced Diabetes Supply: Agent Support Program
There are multitudinous programs available to agents through agencies and other partners that they work with. Some of these features come in the form of agent support programs. One of the organizations that works with Crowe and Associates is Advanced Diabetes Supply, a trusted supplier of diabetes supply products since 2002. They are a leading national distributor of Durable Medical Equipment (DME) and specialize in supplies for clients handling their diabetes diagnosis. Because of their national presence and range, they are able to provide efficiency, payor coverage, and flexibility.
In addition to this, Advanced Diabetes Supply provides a free agent support program. This is a personalized retention service in which they work with the agent to provide excellent care to their clients with diabetes. Nearly one third of the beneficiaries on Medicare are diabetic, and therefore this agent support program can help ensure retention of up to a third of an agent’s business book. Additionally, 26.4 million people over the age of sixty-five are pre-diabetic, which is a considerable 48.8% of that group. An account executive from ADS (Advanced Diabetes Supply) works with the agent to provide sales and retention support for their clients living with diabetes.
While working with the agent to provide retention, Advanced Diabetes Supply can also provide supplies to their beneficiaries. These supplies include blood glucose meters, test strips, lancets, lancing devices, and control solution. Also available are continuous glucose monitors, insulin pumps and supplies associated with those, including Medtronic and Tandem pumps, infusion sets, reservoirs, and cartridges. ADS is also in a position to supply clients with necessities that fall under Medicare Part D, such as Omnipod dash/5, insulin syringes and pen needles, and alcohol wipes.
Using the Service
It is very simple for an agent to take advantage of this free support service. The first thing to do is check if their client has diabetes. If they do have diabetes, the agent can then forward their client’s contact information to the account executive from ADS at point of sale – there is a secure “refer a client” link for this purpose. The account executive will then call the client and help them set up easy home deliveries for any supplies that they may need with free shipping. This makes the beneficiary’s life easier and helps the agent provide them with excellent service, increasing retention through ADS’ free agent support program.
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Medicare marketing ideas
Although Medicare agents play a crucial role in helping to guide Medicare beneficiaries in their search for quality healthcare, it can be a challenge to get in front of the people who need you. Because the Medicare market is so competitive, it’s essential for agents to advertise their services effectively and reach their target audience. In the next few paragraphs, we will discuss some Medicare marketing ideas that can hopefully put you on the path to success.
It is important to remember; honesty, transparency, and a commitment to help others are the keys to success in this industry. If you create a strong online presence, keep your audience engaged and build trust within the community, you will become a reliable resource for Medicare beneficiaries. Once you are established, you will be able to make a positive impact on the community.
Understand your audience:
When you know your target audience, you will have the foundation for a successful advertising campaign. Because Medicare beneficiaries are usually seniors or individuals with specific healthcare needs, you must tailor your message to address their concerns. Be sure you highlight the benefits your clients are asking about such as; dental, hearing, OTC, giveback amounts and plan costs.
Be sure your message is compliant:
Because Medicare is a highly regulated industry, it’s crucial for agents to adhere to all marketing guidelines set forth by the CMS. Before you do any advertising, make sure your materials are accurate, clear, and not misleading. It is imperative that you avoid making false claims or using deceptive tactics. These things can not only put your reputation at risk but they could also jeopardize your ability to sell Medicare products.
View the new Medicare Marketing rules for 2024
Create an Engaging Online Presence:
In today’s digital age, having a strong online presence is vital. Build a professional website that showcases your expertise and services. It is also nice to include customer testimonials. Incorporate search engine optimization (SEO) techniques to improve your website’s visibility on search engines, making it easier for potential clients to find you.
Social Media:
Social media platforms such as Facebook, LinkedIn, Twitter, Instagram or YouTube, to name a few, offer an opportunity for Medicare agents to engage with their audience and build relationships. Share informative content, answer questions, and provide valuable insights to position yourself as a trusted resource. Be cautious not to engage in direct selling on social media, as it may violate CMS guidelines.
Email Marketing:
Email marketing is a great tool to stay connected with both prospects and existing clients. You can use email to share updates on Medicare plan changes, educational content, and upcoming events. You should always get consent from recipients before sending marketing emails to ensure compliance with anti-spam laws. It is important to offer an opt-out button on all marketing emails.
Networking and Community Involvement:
Make sure you establish yourself as an active member of your local community. Whenever possible, participate in healthcare-related events, workshops, and senior expos. Anytime you have an opportunity to educate the community and let them know you are accessible is helpful. Community outreach programs are another way to show your willingness to help people with their Medicare coverage.
Think about traditional Advertising:
Although these days, digital marketing is essential, don’t underestimate the value of traditional advertising. You may need to try several approaches before you find what works best for you. Direct mail, newspaper ads, and radio spots can still be an effective way to reach older audiences who might not be as active online.
Word of mouth works well:
Happy clients can be your best advocates. If you provide great customer service, your clients will tell their friends and family members. Many people ask each other for recommendations when they are nearing time to enroll in Medicare. Positive reviews from real people can greatly influence potential clients’ decisions. Some agents use testimonials from satisfied customers on their website and marketing materials.
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What is MACRA?
There are many acronyms in the Medicare insurance industry. So much so, that it can be hard to keep them all straight. It is helpful to focus on the vitally important ones. MACRA is one of those acronyms that any informed agent needs to know about in order to best serve their customer base. What is MACRA stand for?
MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. This bipartisan piece of legislation was signed into law on April 16, 2015. It created what is known as a Quality Payment Program (QPP). The Quality Payment Program is an incentive program that replaced the Sustainable Growth Rate (SGR) formula that Medicare was using. The Sustainable Growth Rate would have made payment rates for participating Medicare physicians go down significantly, which would have caused problems in the industry. Instead, the Center for Medicare and Medicaid Services (CMS) is now using the Quality Payment Program.
There are two different ways that physicians can choose to participate in the Quality Payment Program.
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The Merit-Based Incentive Payment System (MIPS). This means that physicians would be reviewed and their payment would be based on how well they perform.
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Advanced Alternative Payment Models (APMs). For physicians who choose this route, they may earn Medicare Incentive Payments by participating in an innovative payment model rather than have their rate based on their reviewed merit.
Other things that MACRA accomplished, other than implementing the Quality Payment Program and doing away with the Sustainable Growth Rate, are as follows:
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It changed the way that Medicare rewards physicians, which puts the onus on quality of service rather than volume of service.
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Under the Merit-based Incentive Payment System (MIPS), many quality programs are streamlined.
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Rewards physicians for participating in Advanced Alternative Payment Models (APMs).
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MACRA also required CMS to remove social security numbers from Medicare ID cards by 2019, in an effort to prevent identity theft and increase security for their beneficiaries.
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Things to do when you turn 65
If you are turning 65 in the near future, it is probably a good time to find a knowledgeable Medicare agent to provide insight into some of the things to do when you turn 65.
Decide if you want to retire or keep working
In most cases, you have thought about long before you turn 65. This is a good time to go over your financial health and see if you need to keep working or if you have had enough. You may have quite a bit of savings and are ready to travel the world. On the other hand, you may truly enjoy your work and couldn’t imagine what you would do without it. That is entirely up to you.
If you are considering retirement:
Check in with Social Security and see what your benefit amount will be if you retire and look at what it will change to if you wait a year or two. You should be aware of when you will reach your full retirement age and how much higher your benefit amount will be if you wait until then to claim it.
Take advantage of available catch-up contributions to IRAs & 401ks:
Once you are over 50, you are allowed to contribute an extra $1,000 to your IRA annually. If you have a 401k, you can contribute an additional $6,000 annually. If you opted to keep working, this is an opportunity to add to your retirement savings.
Important healthcare coverage decisions:
Before a person turns 65, their IEP (initial Enrollment Period) for Medicare starts. The IEP is a seven-month window around your birthday that you can use to sign up for Medicare coverage. It includes the three months before, the month of your birthday, and three months after.
Even if you have health insurance coverage through your employment or a spouse’s, you may want to sign up for Original Medicare during your IEP. Find out when to enroll in Medicare Part A & Part B. This is a great time to enlist the advice of a licensed Medicare agent who can explain all your options.
Do you have medical coverage through yours or your spouse’s employment:
If this is the case, you should speak with the employer several months before your 65th birthday to see what their policy for Medicare eligible employees is. Once you have an answer, you should go online or contact a licensed Medicare agent and learn about the Medicare options available to you.
You should contact Social Security and confirm your eligibility for Medicare Parts A & B. Even if you decide to stay on your employer plan, you may want to at least enroll in Part A. If you qualify for free Part A coverage. Because there is a cost to enroll in Part B, You might want to wait to enroll, as long as you have coverage through employment. Be sure you will not be charged a penalty if you do decide to wait.
If you do not have health coverage through an employer or spouse:
Make sure you enroll in both Medicare Part A & Part B before the month you turn 65. This will provide enough time have your enrollment processed and get your card to you. Normally your coverage starts the first day of the month you turn 65. If your birthday is on the first day of the month, your coverage starts on the first day of the previous month.
You will need to look at all the Medicare coverage options available to you. Again, this is a great time to get help for a licensed Medicare agent. The agent should take a list of your current doctors and medications. That will make it easier for him to find the best coverage for you. There are several choices available including Medicare Advantage plans, Medicare Supplement plans and Medicare Part D( prescription drug plans). Whatever plan you choose, be sure you have credible prescription drug coverage (Part D). If you neglect to purchase Part D coverage, you may end up paying a late enrollment penalty once you decide to add this coverage.
Learn about the Medicare Part B premium
If you have an HSA and enroll in Medicare:
Once you enroll in Medicare, you are no longer eligible to contribute to your HSA. However, you can contribute to an HSA after 65 if you chose not to enroll in Medicare Part A or Part B and maintained coverage through a high deductible health plan.
Click here to learn more about HSAs
Have a complete physical exam:
Because we all get busy and tend to put things off, we can forget to take care of ourselves. This is a great time to make sure you are in top shape so you can enjoy the years to come and address any concerns with routine exams and screenings.
Make sure your legal documents are in order:
I know this doesn’t sound fun, and in most cases at 65, you are in good health, but this is a good time to get this out of the way. Once this is taken care of, you can get it off your plate and move on.
Consider making a legal will. Be sure you make any health care choices known to family members. You can also make a living will or advanced medical directive. This can save family and friends a lot of stress later on if you become ill, they will not be faced with difficult choices. It can also protect any assets you have. You should also organize your finances and have important papers filed properly so they are easy to locate should the need arise.
Remember to have fun:
Do not forget to enjoy yourself. Take that trip or go out with friends/family. You have worked hard your whole life; now it’s time to stop and smell the roses.
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Medicare SEP Rules – Medicare Part B Special Enrollment Period Rules
Every agent knows about the Annual Enrollment Period (AEP). It’s often the busiest time of the year and it is when the majority of prospective clients are enrolled in insurance plans. There are, however, exceptions. Special Enrollment Periods, often known as SEPs, are periods of time outside of the AEP when someone can enroll in health insurance. These SEPs are usually prompted by a specific change in personal circumstances. For Medicare Part B, or medical insurance, SEPs are necessary because Medicare Part B is optional, while Part A (hospital insurance) is not. What are the Medicare SEP rules?
When Does It Start?
The Part B Special Enrollment Period starts when a person has coverage from their employer (called job-based insurance) and is simultaneously in their first month of eligibility for enrollment in Part B. The SEP ends eight months after the person loses coverage from that employer, either by end of coverage or unemployment. If they enroll in Part B coverage during their Special Enrollment Period, then the beneficiary can avoid paying the Late Enrollment Penalty (LEP), as well.
In most cases, it would be recommended to enroll in Medicare before the person loses their job-based coverage in order to avoid gaps in healthcare. It is important to understand the SEP rules.
How Do I Enroll? – SEP Rules
There are two steps to enrolling in Medicare Part B during the SEP.
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Contact the Social Security Administration (SSA)
The SSA can be reached at 800-772-1213. The prospective beneficiary can then request forms. The forms they will need to fill out are CMS 40B (application to enroll in Medicare) and CMS L564 (request for employment information). Both of these are needed to complete the process. However, the beneficiary should fill out CMS 40B and their employer should fill out CMS L564. If there are multiple employers, each one should receive a copy of the CMS L564 to fill out.
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Submit all forms to the SSA
Once all the information has been gathered, the forms must be dropped off either at a local SSA office or they can be sent to the mailing address. Locating a local SSA office or their mailing address can be done at their website.
Licensed Agents – Medicare SEP Rules
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Sign up for Medicare Part D
Once you enroll in Medicare, it is very important to Sign up for Medicare Part D. A skilled Medicare agent can make choosing the best Medicare Part D (prescription drug plan) reasonably quick and easy. Anyone who does not have credible Part D coverage when they are eligible for Medicare is subject to a lifelong penalty.
What does Medicare Part D cover:
Medicare Part D plans are prescription drug coverage. This coverage is available to eligible Medicare beneficiaries. Part D coverage is provided by private insurance companies that are contracted with the federal government. There are 2 ways to enroll in Part D coverage. First, beneficiaries may enroll in a PDP, stand-alone prescription drug plan, in addition to traditional Medicare. The second choice is to enroll in a Medicare Advantage plan, MAPD these plans include Part D coverage.
Who is eligible for Medicare Part D:
If you are enrolled in either Medicare Part A or Part B and live in the Part D plan’s service area, you are eligible to enroll in a plan. Additionally, certain individuals with limited income and resources are eligible for “extra help”. Extra help provides help paying for drug plan premiums, deductibles, coinsurance and other costs. Click here to learn more about “Extra Help” and how to apply.
When can you enroll in Part D:
To avoid late enrollment penalties, timely Medicare Part D enrollment is imperative. There are two primary enrollment periods.
The IEP or Initial Enrollment Period is a 7-month period. It starts three months before you turn 65, includes your birth month, and ends three months after your birthday. Please note; if you qualify for Medicare due to a disability, you may have different enrollment periods.
AEP or Annual Enrollment Period occurs each year from October 15th to December 7th. During the AEP, you can make changes to your existing Part D coverage, such as switching plans or adding coverage.
How to choose a Medicare Part D Plan:
This is an extremely important part of your Part D enrollment. If you choose the wrong plan, it can be a very costly mistake. Each plan offers different coverage options. Selecting the right Part D plan is crucial, as each plan may have different premiums, coverage options, and their own network of pharmacies. Please consider the following when making a plan choice:
Make a list of all the medications you are currently on. You may want to add in anything that your doctor will prescribe in the following months. Be sure to include the dosage and the frequency that you take them. This helps to find plans that cover your medications.
An insurance agent can show you a comparison of the best plan options for your needs. If you do not have an agent, use the Medicare Plan Finder tool on the official Medicare website. Be aware of all costs including; premiums, deductibles, copayments, and coinsurance costs. You need to consider the total cost of each plan option.
Look at the plan’s formulary. This is a list of drugs covered by each plan. Double check that your medications are on the list and make a note of any restrictions on your prescriptions.
Be sure the pharmacy you use is a preferred in-network. If it is not see if there are alternative pharmacies close by that are preferred in-network so you can receive the best pricing.
Check the plan’s star ratings. This is system based on overall service and coverage.
How to enroll in Part D:
Once you choose the best Medicare Part D plan to meet your prescription coverage needs, you have a few ways to enroll.
1. Online: A licensed Medicare agent may be able to enroll you using an enrollment link from their quoting engine or you can enroll by going to either Medicare.gov or the website of the carrier of the plan you selected.
Click here to view a demo of how to use Sunfire to run a quote
2. Fill out a paper application. If you are working with an agent, they will help you fill out the necessary paperwork and send the application in for you. If you do not have an agent, you can submit the application using the instructions provided by the carrier.
3. Enroll over the phone. You can call the plan carrier or call 1-800-633-4227 (1-800-Medicare).
Beware of late enrollment penalties:
If you miss your Initial Enrollment Period or do not have creditable prescription drug coverage for over 63 days, you may wind up with a late enrollment penalty. This penalty is added to your Part D premium and remains in effect for as long as you have Part D coverage. Please note; if you receive extra help, this penalty does not apply.
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Medicare Part B Premium 2024
Although the Medicare Part B premium 2024 has not yet been announced, it is projected to increase to $174.80. That is an increase in cost of almost $10 per month compared to the 2023 standard monthly cost of $164.90. This amount is based the Medicare trustees report released in March 2023. Click this link to learn more about Medicare costs for 2024.
In 2024, both the Part B, Medical coverage and Part D, prescription drug coverage premiums are expected to increase by 6%.
In some cases, Part B premiums may be higher or lower than the basic Part B premium:
Certain low income beneficiaries qualify to have their Part B premium paid for by their resident state DSS.
These individuals must apply for LIS in order to qualify. Medicaid recipients are also eligible to receive the Part B benefit at no cost.
In some cases, Medicare Advantage plans offer a Part B give back. This amount varies but reduces the amount you pay for Part B Medicare premiums.. When this is the case, the private insurance company assumes responsibility for a portion of your premium and provides coverage for your medical benefits.
Medicare charges some beneficiaries an IRMAA in addition to the basic Part B premium.
An IRMAA is an income-related monthly adjustment amount. The IRMAA applies to certain higher earning individuals and is determined by income reported (MAGI) on your income tax returns two years prior. In other words, your 2021 tax return is used to determine your 2023 Medicare premiums. The Social Security Administration will send you a notice to inform you if you will receive an IRMAA. The IRMAA applies to both Part B and Part D premiums as well as Medicare Advantage plans.
If your financial situation has changed, you can file an IRMAA appeal
Click here to download an IRMAA appeal form.
Take a look at the chart below to view the 2023 Part B premiums including the IRMAA amounts:
| Part B Coverage | |||
| Beneficiaries filing individual tax returns with modified adjusted gross income: | Beneficiaries filing joint tax returns with modified adjusted gross income: | IRMAA amount | Total Monthly
Premium |
| Less than or equal to $97,000 | Less than or equal to $194,000 | $0.00 | $164.90 |
| Greater than $97,000 and less than or equal to $123,000 | Greater than $194,000 and less than or equal to $246,000 | $65.90 | $230.80 |
| Greater than $123,000 and less than or equal to $153,000 | Greater than $246,000 and less than or equal to $306,000 | $164.80 | $329.70 |
| Greater than $153,000 and less than or equal to $183,000 | Greater than $306,000 and less than or equal to $366,000 | $263.70 | $428.60 |
| Greater than $183,000 and less than $500,000 | Greater than $366,000 and less than $750,000 | $362.60 | $527.50 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | $395.60 | $560.50 |
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Life Insurance for Lupus Patients
Some diagnoses carry more weight than others, particularly for those patients who are concerned about providing for their families. Lupus is one of those diagnoses. While whole life and term life insurance policies can be difficult to get for patients with a history of lupus, it is possible. Because there are increased risks associated with the disease, it may cost more for people with lupus to get coverage. Realistically, most lupus patients will pay more in premiums for their life insurance, but coverage is out there. Here’s how to find it:
First, patients will need to determine which of the two types of lupus they have. There are two main types of lupus.
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Discoid Lupus
Discoid Lupus is a chronic autoimmune disease affecting the skin. It can lead to scarring, hair loss, and hyperpigmentation of the skin. It can go and return, although it is chronic. It is more common in women than men, and it is most common in women between ages 20 and 48. In about 10% of the patients with discoid lupus, it will progress to systemic lupus. Early recognition and treatment can improve the prognosis significantly.
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Systemic Lupus
Systemic Lupus is a chronic autoimmune disease in which the immune system attacks its own tissues. While the symptoms do tend to come and go, this can cause widespread tissue damage and inflammation. Some typical signs of lupus can be painful joints, rash, major fatigue, and loss of circulation.
For patients with discoid lupus, finding a life insurance policy will be significantly easier than for those patients with systemic lupus. If a beneficiary has discoid lupus, or has lupus that has been dormant for many years, they can apply for a fully underwritten life insurance policy. This is a policy with the lowest premium rates, but discloses the applicant’s full medical history.
For patients with systemic lupus or lupus with other health concerns, a simplified issue or guaranteed issue life insurance policy is a reasonable way to go. Simplified issue life insurance policies ask far fewer questions about medical history, and guaranteed issue policies do not require any disclosure of medical history. Simplified issue premiums are more expensive than fully underwritten, and guaranteed issue policies are the most expensive overall. Despite having to pay higher premiums, access to these three different options for life insurance policies means that patients with lupus and their families do have the opportunity to benefit from a life insurance policy.
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Losing Medicaid benefits
Because of the recent Medicaid redetermination, many people are losing Medicaid benefits.
During the last 3 year period, Medicaid benefits have been automatically renewed for individuals who became eligible because of the public health emergency caused by COVID-19. During this time, beneficiaries were not required to recertify annually for Medicaid coverage.
Because the public health emergency has ended or “unwinding” as of May 11, 2023, the requirement to recertify for Medicaid coverage is back in place. This means there will not longer be any automatic renewal and Medicaid beneficiaries must prove the need for benefits.
In other words, beneficiaries will go through redetermination.
This process takes place each year and reviews each person’s need for health care assistance through their state government. It is important to reply to any valid communication you receive from your state’s department of Social Services or DSS. If you fail to respond, you may lose your coverage even if you do qualify.
Each state has 1 year to begin the redetermination process starting on March 31, 2023. All states must finish processing renewals within 14 months. In other words, beneficiaries may lose Medicaid coverage as soon as April 2023.
Millions of people will lose Medicaid coverage:
Although we do not know the exact number of people slated to lose coverage, it may be over 15 million. For many employment is a main factor in their loss of Medicaid coverage.
Some individuals will lose coverage due to not confirming eligibility with their state’s DSS offices before the expiration of their coverage. There also may be problems with a backlog of paperwork and a processing system that is simply overwhelmed. This can cause delays and coverage loss. This backlog has the potential to effect millions . That is why it is best to be proactive and go into your Medicaid account to ensure you are still eligible and covered.
Click here to learn more about the unwinding of Medicaid’s continuous enrollment
What if I no longer qualify for Medicaid:
If you reapply for Medicaid and do not qualify, there are other low cost or even free healthcare choices available to you. The choices depend on your personal circumstances.
- If either you or your spouse/partner has an employer that offers health insurance coverage, you may qualify to join during either their open enrollment period or with a special election period.
- In the interim, if you are not yet eligible for employer based coverage, you can enroll in a short-term insurance plan while you wait to qualify. There are several options for these types of plans.
- You can also access healthcare through the healthcare marketplace. In many cases, beneficiaries may qualify for a subsidy and pay a low monthly premium. If you lose health coverage, you have a special enrollment period or SEP you can use to enroll in coverage. To find the market place for your state go to healthcare.gov/marketplace-in-your-state.
- College students may be able to purchase health coverage directly through a campus health plan. Students can get details from their registrar’s office.
- If you are either 65 or older or have a qualifying disability, you may be eligible for health coverage through Medicare. Contact a licensed Medicare agent for help going over all your plan options.
- Anyone who is either a veteran or an active duty service member may qualify for Tricare. Use the following link to get more information: Tricare healthcare coverage.
It’s important to note that if you believe you qualify for Medicaid, you should reapply. We’ll discuss that next. But even if you do apply, you may need to explore some of the options above while you wait to be approved.
How do I reapply for Medicaid benefits:
If you have limited income/funds, you may be eligible to retain your Medicaid coverage. If this is the case, Click here to for information on how to apply for Medicaid. Contact your state DSS office for applications and guidance.