Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts

Attorney General's suit against Premera ends in $10 million nationwide settlement

Friday, July 12, 2019

State Attorney General
Bob Ferguson

As a result of an Attorney General’s Office investigation, Premera Blue Cross, the largest health insurance company in the Pacific Northwest, will pay $10 million nationwide for failing to secure sensitive consumer data and for misleading consumers before and after a data breach affecting millions across the country. 

Attorney General Bob Ferguson led a coalition of 30 state attorneys general investigating the company’s practices.

The data breach affected the information of more than 10.4 million individuals nationwide, including more than 6.4 million Washingtonians. 

Under the consent decree, filed today in Snohomish County Superior Court, Premera will pay $5.4 million of the total recovery to the Washington State Attorney General’s Office, which will go towards continued enforcement of state data security and privacy laws, and nearly $4.6 million to the coalition of states that joined Ferguson’s legal action.

Premera’s $10 million payment to the states is in addition to any payment from the proposed class action settlement, which was filed in federal court in Oregon but not yet finalized by the court.

The consent decree also legally requires Premera to implement specific data security controls to protect personal health information, annually review its security practices and provide data security reports to the Washington State Attorney General’s Office.

“Premera had an obligation to safeguard the privacy of millions of Washingtonians — and failed,” Ferguson said. 
“As a result, millions had their sensitive information exposed. Premera repeatedly ignored both its own employees and cybersecurity experts who warned millions of consumers' sensitive health information was at risk.”

More details here



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Payment glitch interrupts automatic Medicare Advantage and Part D premium withdrawals

Thursday, June 13, 2019


From the Office of the Insurance Commissioner

Earlier this year, a federal government systems issue prevented Medicare Advantage and Part D premiums from being automatically deducted from the Social Security payments of some people with Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), affected people include those enrolled either in a Medicare Advantage plan or in a Medicare Part D drug plan for coverage that started Jan. 1, 2019 and chose to have their premiums automatically deducted from their monthly Social Security benefit, rather than pay the plan directly.

It's not yet clear how many people were affected, and of those affected, who have been made aware, or how much they might owe. The Social Security Administration (SSA) notes that “Plans will be sending premium bills to those affected. If you are affected and haven’t already received a bill in the mail, you will soon. The first bill will likely be for a larger amount than usual to make up for the unpaid premiums.”

Plans must offer enrollees a “grace period” to repay the missed premium payments, which must last at least as long as the delay in billing. Plans also have the option not to pursue these outstanding payments.

CMS advises beneficiaries to call their plan directly with any questions or concerns.

Statewide Health Insurance Benefits Advisors (SHIBA) is part of the office of the insurance commissioner.



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Insurance Commissioner: Washington now has strongest law in the country to protect against surprise billing for emergency care

Wednesday, May 22, 2019

Insurance Commissioner Mike Kreidler

On May 21, 2019 Gov. Jay Inslee signed Insurance Commissioner Mike Kreidler’s request legislation to end surprise medical billing, enacting arguably the strongest law in the country to protect consumers from this unfair practice.

The new law (www.leg.wa.gov) protects consumers from getting a surprise bill when they get either emergency services at an out-of-network emergency room or medical treatment at an in-network hospital or facility but are seen by an out-of-network provider.

“For more than a decade, we’ve heard from people hit with a balance or surprise bill,” said Kreidler. 
“They’ve shared their stories of receiving a bill on top of what they expected to pay, despite going to the hospital or facility their health plan covers. Many wanted to know how this could be legal. 
"This year, we learned of two consumers who received surprise bills of over $100,000 and who both faced losing their homes and medical bankruptcy.”

Kreidler added, “I think the breadth of these stories – and that no one was immune – finally provided the motivation needed for the sides to come together and find a solution.

"I’m grateful to Rep. Eileen Cody, D-West Seattle, and Sens. Christine Rolfes, D-Kitsap County, and Annette Cleveland, D-Vancouver, for their critical work on this legislation and to the other legislators who supported this important consumer protection."

The new law takes effect starting Jan. 1, 2020. Key protections include:
  • A consumer who receives emergency care in an out-of-network emergency room or who has a non-emergency medical procedure in an in-network hospital or facility cannot be balanced billed.
  • An insurer cannot balance bill a patient if they seek emergency care at an out-of-network facility in a state that borders Washington.
  • Insurers must pay the out-of-network provider or facility directly for care their enrollee receives.
  • If the insurer and provider or facility do not agree on a commercially reasonable payment for out-of-network services within 30 days, their dispute goes to binding arbitration.
  • A disclosure template will be developed and must be given to patients describing when they can and cannot receive a balance bill.
  • Insurers, providers, and facilities must include up-to-date network information on their websites.
  • Any provider who continues to illegally balance bill may be referred to the state Department of Health for enforcement.
Kreidler’s office will develop rules this summer for the new law. Sign up to get updates.
“There is much more that we need to do to address the challenges facing our health care system,” said Kreidler. “But to finally put this issue to rest lifts a weight for many and should give thousands of consumers more piece of mind. For now, we’ll settle for that victory.”


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Insurance Commissioner: What can I do if my health insurer denies my claim?

Monday, April 8, 2019

From the office of the State Insurance Commissioner

It’s not uncommon for a health insurance company to refuse to pay for medical treatment. If it happens to you, it doesn’t have to be the final word.

You can appeal to your insurer. If the answer's still no, you can appeal to an independent review organization. In addition to appealing a denial, you can also file a complaint with the Office of the Insurance Commissioner.

If you want to file an appeal with your health plan, contact them and ask: “What do I need to do to file an appeal?” After that, you’ll need to collect materials that support your appeal, such as documentation from your medical provider and information about your medical condition.

After you send your appeal materials to the health plan, be persistent. Most people don’t win at the first level of appeal, but the odds of winning increase as you reach higher levels of appeals. The chance of winning is highest when your health plan appeal reaches the final level, called an Independent Review Organization.

Read more information and find letter templates and other pointers in the appeals section of our website. If you need help, file a complaint with us.



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Joint statement on Affordable Care Act victory from AG Ferguson and Insurance Commissioner Kreidler

Thursday, March 28, 2019

The judge's ruling is available here.


OLYMPIA — Attorney General Bob Ferguson and Insurance Commissioner Mike Kreidler offered the following joint statement:

“Washington state secured its 18th legal victory against the Trump Administration this afternoon. Today’s ruling by the United States District Court for the District of Columbia protects the Affordable Care Act by blocking the Trump Administration’s attempt to undermine state health care exchanges. 
"President Trump’s Rule jeopardized state health care exchanges around the country, including Washington’s. The federal judge hearing our case correctly called out the ‘absurdity’ of the Administration’s reasoning, and ruled the Administration was unlawfully attempting an ‘end run’ around the ACA. Washington will continue to fight to protect hardworking Washingtonians’ access to affordable health care, and hold the Trump Administration accountable to the rule of law.”

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Get a CLUE: Little-known database can affect your insurance rates

Wednesday, March 6, 2019

From the office of the Insurance Commissioner

Most insurance consumers are not aware there’s a little-known database called CLUE —Comprehensive Loss Underwriting Exchange — that can affect consumers’ property and auto insurance rates without their knowledge.

What should consumers know about CLUE?

It’s a report generated by LexisNexis that contains up to seven years of your personal auto and property claims history. The data comes from insurance companies when they close claims you file.

Insurance companies review the CLUE data and use it to set the rates they charge you.

You have the right to request a free copy of your report:

LexisNexis, Consumer Center
866-312-8076
Request your personal report online

If you find mistakes in your CLUE report that you want to dispute, contact LexisNexis Consumer Center at 888-497-0011.

Read more about CLUE.

Questions? You can contact our consumer advocates at the Office of the Insurance Commissioner online or at 1-800-562-6900.



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Insurance Commissioner fines life insurance company $130,000 in December

Monday, January 28, 2019

Mike Kreidler, Insurance Commissioner
Topping the list of fines levies by the Insurance Commissioner Mike Kreidler in December 2018 was Accordia Life and Annuity Co., Des Moines, Iowa; fined $130,000, order 18-0250

Kreidler received 57 complaints about the company in 2016 and 2017 and started an investigation into its practices. The law violations included:
  • Failure to maintain full and adequate records of more than 8,600 customer accounts.
  • Underpaid interest on the death benefit of a policy and failed to correct the problem until the consumer complained to Kreidler’s office. State law requires that insurance companies pay 8 percent interest.
  • Failed to provide annual statements to 21 consumers.

Insurance Commissioner Mike Kreidler issued fines in December 2018 totaling $192,050 against insurance companies, agents and brokers who violated state insurance regulations.




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Fines from State Insurance Commissioner include Dental Health Services and American Pet Insurance

Wednesday, January 2, 2019

Mike Kreidler
State Insurance Commissioner
The Office of the State Insurance Commissioner monitors insurance related activities and responds to complaints about insurance providers which operate in the state. When there is fault, the office levies fines.

Two recent actions involved dental and pet insurance.

Dental Health Services, Seattle; fined $500,000, order 18-0437

Kreidler fined the dental insurer for:
  • Failing to identify and process 23 policyholders’ appeals.
  • Failing to identify and process 342 grievances from policyholders.
  • Erroneously canceling polices.
  • Double-charging 492 policyholders a total of $56,351. The company refunded the money with an additional $5,635 in interest. 
  • Failing to deliver enrollment materials to 76 policyholders. 
In addition to the fine, Kreidler will prohibit the company from selling new policies for at least 12 months. After the probationary period, the company can ask Kreidler to allow it to sell policies if it completes compliance and corrective action plans to the commissioner’s satisfaction. Kreidler is suspending $400,000 of the fine and will impose additional penalties if the company fails to comply with the terms of the order.

Kreidler previously took action against Dental Health Services in 2017 and 2018. Kreidler fined the company $400,000 for mishandling consumer complaints and other issues.

American Pet Insurance Co., New York City; fined $10,000, order 16-0127

Kreidler imposed $10,000 of a suspended fine against the pet insurance company for failing to follow the compliance plan it agreed to in July 2016. The plan includes a self-audit, which revealed that one policyholder was charged the incorrect premium and eight policyholders did not receive the required 30-day notice for a rate change. Kreidler previously suspended $100,000 of the $250,000 to ensure compliance with the terms of the order. This is the first portion of the suspended fine that Kreidler has imposed on the company.

If you have issues or questions about any kind of insurance, you can file a complaint at the webpage.

One caveat - the state only regulates medical insurance provided by insurance companies. Almost all the big companies are "self-funded" which means that they are acting as their own insurance company. As such, they are not regulated by the state. The companies contract with insurance companies to run their programs, so it's often impossible to tell if your insurer is self-funded (ask your Human Resources department).


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Health Insurance Application Assistance at Mountlake Terrace Library in January

Tuesday, January 1, 2019

Health Insurance Application Assistance 
Tuesdays Jan 8, 15, 22, 29 1:00-4:00pm
Mountlake Terrace Library, 23300 58th Ave W, Mountlake Terrace 98043

Sea Mar Community Health Centers will assist you with enrolling in Medicaid and low cost coverage health plans through the Washington Health Plan Finder as well as Food Stamps and/or cash assistance for those in need. 

For those who already have insurance through the state they will help you renew and answer any questions you might have about your coverage. 

Drop in anytime between 1:00 - 4:00pm to meet with a Certified Navigator who is available to help you free of charge.



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Birth control to be covered in Washington 2019 insurance plans

Tuesday, December 4, 2018

According to the state insurance commissioner, starting in 2019, health plans must cover all birth control with no out-of-pocket cost to you. 

Find a health plan by December 15 at Washington Health Plan Finder



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Medicare and Affordable Care Act insurance deadlines looming

Monday, December 3, 2018


Over 65? Disabled? Medicare open enrollment ends this Friday! Need help navigating your choices? Get free, unbiased help from SHIBA by phone or in person near you. More Medicare info on the Insurance Commissioners webpage is HERE. The government website is Medicare.gov


Low income or no income? Enrollment for Affordable Care Act insurance plans ends Saturday, December 15th. Subsidies make it possible for very low-income folk to have decent health care insurance. Get information and sign up at WashingtonHealthplanFinder.com



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Fraud: Tips to avoid Medicare card scams

Thursday, November 29, 2018

Medicare has been mailing new Medicare ID cards to Washington state beneficiaries since September and scammers are taking advantage of this opportunity to commit fraud.


The cards have a new look but, most importantly, they have unique numbers to replace the Social Security numbers previously used on the cards. 

Medicare created the new cards to reduce identity theft and fraud.

Here’s what a scammers may say when calling Medicare beneficiaries (note: none of these is true!):
  • Ask for your bank account information so you can pay for your new Medicare card. 
  • Ask you to confirm or give your personal information to get your new card. 
  • Ask for your old Medicare number (which was your Social Security number) to prevent your Medicare coverage from being interrupted. 
Facts about the new Medicare cards
  • They are FREE! You do NOT pay for your new card and you don’t have to do anything to get it. Medicare will automatically mail your new card to you. You can sign up to get an email from Medicare to know when to expect your card in the mail.
  • You do NOT need to give any personal information to get your new card. The cards are mailed to the address you have on file with Social Security. You can update your address online, call 1-800-772-1213, or visit your local Social Security office. 
  • Your Medicare coverage will NOT be interrupted or stopped because your new card is being mailed to you.
  • In general, Medicare will never call you uninvited and ask for your personal information, or to get your new Medicare Number and card. 
What to do if you get a call 

If you receive a call or email that seems suspicious, do not share any information. Hang up and call Statewide Health Insurance Benefits Advisors (SHIBA) at 1-800-562-6900 to report the incident.

In addition to providing free, unbiased help with your Medicare options, SHIBA is Washington state’s Senior Medicare Patrol project. We help clients prevent, detect and report Medicare and Medicaid fraud and abuse.



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King County Executive Dow Constantine testified before U.S. Senate Committee

Wednesday, November 28, 2018

King County Executive Dow Constantine testified before the full U.S. Senate Committee on Health, Education, Labor and Pensions, chaired by Sen. Lamar Alexander, R-Tenn. Sen. Patty Murray, D-Wash., who serves as Ranking Member of the committee, invited Executive Constantine to the hearing.

Executive Constantine described the success and challenges of moving toward a more affordable, high quality, and prevention-oriented health system before a U.S. Senate Health, Education, Labor and Pensions committee hearing, “Reducing Health Care Costs: Improved Affordability Through Innovation.”

Video of Executive Constantine’s testimony can be viewed here.

Here are Executive Constantine’s remarks:


Chairman Alexander, Ranking Member Murray, and members of the Committee, thank you for the opportunity to speak to you today.

I am Dow Constantine, the elected Executive of Martin Luther King, Jr. County, in Seattle, Washington. King County delivers vital regional governmental services including…
─ housing,
─ transit,
─ criminal justice, and…
─ public health for nearly 2.2 million people.

King County reduced health care costs and also worked upstream to prevent those costs in the first place, through our work as the public health provider and our early childhood initiative, Best Starts for Kids.

My written testimony provides more detail of our unique vantage point as both a purchaser of health care for our 15,000 workers, and a provider of public health services.

Our story illustrates that to succeed in moving toward a more affordable, high quality, and prevention-oriented health system, you need partnerships…
─ between patients and providers,
─ between management and employees,
─ between employers and health plan administrators, and…
─ between the public health system and the health care delivery systems.

Managing the rising costs of employee health care is an ongoing challenge. Today, King County spends over $235 million each year.

In the early part of this century, as employers around the nation faced skyrocketing health care costs, King County
responded with two key actions:

First, we convened our region’s purchasers, health plans, and providers to jointly tackle cost and quality problems. We founded what it is now known as the Washington Health Alliance, whose vital work to increase transparency you heard about in this committee last month.

Second, we approached our labor partners, with whom we negotiate benefits. Together, we designed a high-quality, lower-cost health plan with a local HMO that is about one third cheaper than our traditional plan.

We also put in place a wellness initiative called Healthy Incentives, where participating employees enjoyed lower out-of-pocket costs.

Over a five year period, we saved about $46 million; and our approach earned us the 2013 Harvard Innovations in Government award.
That alone was not good enough.

By tracking the data, we realized savings from this approach had plateaued.

So we sharpened our focus on achieving value instead of volume, building off lessons learned from private sector leaders like Boeing.

This year we added a new value-based plan choice for employees – accountable health networks. Enrollment in value-based plans has grown from 21 percent of our employees in 2011, to 37 percent today. We are now working to double enrollment in the next five years.

King County also overhauled our wellness program this year, disconnecting participation from what employees pay for their coverage.

Our new approach focuses on building an overall culture of health, going beyond the typical calls to exercise more and eat better. Most important, we’ve taken a public health approach to employee healthcare by tailoring efforts to our diverse workforce.

An example of our more tailored approach is with our 4,000-plus transit employees. As it turns out, compared to other County workers, this group was much less likely to have had a recent dental check-up – nearly 1 out of 3 had not visited a dentist in the past year.

So we worked with the transit union and our dental carrier to design a six-month pilot in which we are reducing cost sharing, going to bus bases to offer scheduling help, and taking other steps to help our workers find a dentist that’s right for them. This will help avoid not just cavities but future costs for both us and our employees.

As we look ahead, I’d like to highlight three areas where Congress’ attention would help foster continued innovation to manage health care costs:

- First, the federal government should continue to use its significant purchasing power to accelerate strategies that pay for value over volume, increase transparency, and help all payers better align their efforts – focusing on the pharmaceutical industry in particular.

- Second, I urge you to increase investments in prevention in both public health and behavioral health. Benjamin Franklin was right when he said it represented the best value proposition.

- Finally, we ask that you work to protect the gains in coverage, care, and prevention of the ACA. Over time, access to a healthier workforce can help employers like King County and others across the region better fulfill their missions and strengthen our competitive edge.

Thank you and I look forward to your questions.



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Hidden treasure - lost life insurance policies

Thursday, November 15, 2018

Insurance Commissioner
Mike Kreidler
The Life Insurance Policy Locator — launched by Insurance Commissioner Mike Kreidler through the National Association of Insurance Commissioners — has matched consumers with policies totaling $7.3 million in the past two years.

The national association launched the free national locator service in November 2016 to make it easier to connect consumers with lost life insurance policies or annuities.

A total of 459 beneficiaries in Washington state have been matched with the $7.3 million in claims since November 2016.

“The response we’ve received to the policy locator has been greater than anyone could’ve anticipated,” Kreidler said. “State insurance regulators saw there was a need for a national service like this to help consumers. This tool connects consumers with lost policies and possibly money they’re owed.”

In its initial two years, the locator has matched nearly 25,000 consumers with policies, totaling $368 million nationwide.

Learn more about life insurance


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Eleven insurers approved to sell 74 plans in Washington's 2019 individual market

Tuesday, October 30, 2018

"Insurance costs may be hard for many to afford,
especially if they don't qualify for subsidies."
Washington state Insurance Commissioner Mike Kreidler has approved 11 health insurers to sell 74 plans in Washington's 2019 individual health insurance market.

Health insurers requested a 19.44 percent average increase, but Kreidler’s office determined that only 13.57 percent was justified. All 39 counties in the state will have at least one Exchange insurer.

“I’m grateful increases are down from last year and that we’re seeing some moderation of rate changes, but I know these costs may be hard for many to afford — especially if they don’t qualify for subsidies," said Kreidler.  
“Unfortunately, the Trump administration is focused on sowing uncertainty in the insurance markets and insurers are reacting. In addition, his administration and Congress have failed to address the underlying costs of health care in this country and until they do, individuals and businesses buying health insurance will be impacted.”

See individual market health insurers and plans available by county (PDF, 114.38 KB)

Search approved 2019 premiums by insurer and find decision memos and the complete filings for each insurer.

About 266,000 Washingtonians — about 4 percent of our state population — do not get employer or government-sponsored health insurance and must buy their own coverage. Individual health plans are available through the state Exchange, Washington Healthplanfinder, or directly from an insurer. However, financial subsidies are only available through the Exchange.

Last year, 207,000 people enrolled through the Exchange, and approximately 60 percent of them received a subsidy. Open enrollment — for coverage beginning Jan. 1, 2019 — starts Nov. 1 and ends Dec. 15, 2018.



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Open enrollment for Affordable Care Act insurance Nov 1 to Dec 15

Thursday, October 25, 2018


At a kick-off event at Maple Valley Fire Station No. 80, King County Executive Dow Constantine highlighted efforts by Public Health – Seattle and King County to enroll people in health insurance plans available on the state’s exchange, Washington Healthplanfinder.

“King County is a health reform success story. We embraced the ACA and drove down the uninsured rate in King County by more than half,” said Executive Constantine.

Public Health is the lead regional agency for helping local residents get health insurance during open enrollment, which runs from Nov. 1 to Dec. 15.

Outreach activities have already started in communities where the data shows people are eligible for low-priced insurance but haven’t enrolled.

For example, in Federal Way, Renton, Auburn, and other cities, health care Navigators have been meeting with local businesses, to educate them about helping part-time workers or small business employees get insurance.

In King County, people can choose from 20 different insurance plans.

The price of insurance for many people will be the same as last year, or even lower. More than half the customers who buy individual or family insurance plans from Washington Healthplanfinder get a discount, through credits that are based on income level.

Overall, approximately 7.6 percent of working-age adults remain uninsured in King County, and new health data shows that the percentages are different across the county, depending on location and demographic groups.

Reminder: Enrollment is offered year-round to individuals and families with lower incomes through Washington Apple Health (Medicaid). Customers enrolled in Apple Health will receive a notice of 60 days before the month they enrolled in or renewed their coverage last year.



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What you need to know this Medicare enrollment season

Thursday, October 18, 2018

Catherine Field, Humana
By Catherine Field, Intermountain Market President, Humana

It’s that time of year when people with Medicare review their health insurance choices and enroll in a Medicare Advantage or Prescription Drug plan for the coming year.

People typically have a lot of questions as they research their Medicare options, which primarily include Original Medicare, Medicare Advantage and Medicare Supplement plans, before finding the plan that best fits their needs.

Here are some of the most commonly asked questions Humana licensed health insurance agents get from consumers during the Medicare Annual Election Period:

When is the annual enrollment period to choose a Medicare plan for 2019?

The Medicare Advantage and Prescription Drug Plan Annual Election Period takes place from Oct. 15 through Dec. 7, 2018, for coverage that takes effect Jan. 1, 2019.

Do I have to re-enroll in Medicare every year?

You don’t need to sign up for Original Medicare each year. However, you should review your Medicare Advantage or Prescription Drug Plan coverage annually, since Medicare plans and personal circumstances can change every year. If you take no action during the annual enrollment period, you’ll typically automatically be re-enrolled in your same medical or prescription plan for 2019.

Does Medicare include coverage for my prescription drugs?

Original Medicare does not cover most prescription drugs. Many Medicare Advantage plans include prescription drug coverage, or you can sign up for a Part D Prescription Drug Plan separately. A licensed agent can look up your medications and tell you what the cost of each drug would be on a plan.

How are health insurers like Humana able to offer Medicare Advantage plans with no monthly premium?

Private insurers keep premiums low through programs like disease and chronic care management, which help people better manage health conditions and, in turn, reduce health care costs. Keep in mind that you still need to pay your Medicare Part B premium, which covers medical services and preventive care. You might want to use the additional premium dollars you save for out-of-pocket medical costs, such as co-pays.

How do I find out if my doctors, hospitals and specialists are in my Medicare Advantage provider network?

Most Medicare Advantage plans offer easy-to-use online tools to help you find doctors and hospitals that are in the plan’s network. A licensed agent can also help you look up hospitals and doctors to see if they’re accepting a plan and taking new patients.

If I select a Medicare plan for the coming year, and then find I don’t like it, can I drop it and choose another plan?

The plan you select by December 7 will be your Medicare plan for all of 2019, with few exceptions, so it’s wise to research your options carefully.

If you sign up for a Medicare Advantage plan for 2019, and then find it’s not the right fit, between Jan. 1 and March 31, there will be an Open Enrollment Period during which you can switch from a Medicare Advantage or a Medicare Advantage-Prescription Drug Plan to another Medicare Advantage plan with or without prescription drug coverage, or choose Original Medicare with or without a stand-alone Prescription Drug Plan.

Full information on 2019 Medicare health and prescription drug plans is available on www.medicare.gov, and for Humana plans at www.humana.com/Medicare. You can also call 1-800-MEDICARE (1-800-633-4227) (or TTY: 1-877-486-2048) 24 hours a day, seven days a week, or call Humana at 1-877-877-0714 (TTY use 711) 8am to 8pm local time seven days a week.

Humana is a Medicare Advantage HMO, PPO, and PFFS organization, and stand-alone prescription drug plan, with a Medicare contract. Enrollment in any Humana plan depends on plan renewal.



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Keep yourself safe - avoid and report Medicare scams

Monday, September 3, 2018

New Medicare cards will look like this
From the Office of the Insurance Commissioner

With Medicare Open Enrollment just around the corner -- October 15 – December 7-- and new Medicare cards in the mail, be on the lookout for scam artists trying to get your personal information.

If you’re a Medicare beneficiary, Medicare will never call you uninvited and ask for your personal information, or to get your new Medicare Number and card.

If a scammer contacts you and asks for information or money, or threatens to cancel your health benefits, do not share any information. Hang up and call the Statewide Health Insurance Benefits Advisors (SHIBA) program at 1-800-562-6900.

SHIBA is a project of the office of the state insurance commissioner. In addition to providing free, unbiased help with your Medicare options, SHIBA is Washington state’s Senior Medicare Patrol project. We help clients prevent, detect and report Medicare and Medicaid fraud and abuse.



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Insurance Commissioner proposes rule for restrictions on new short-term medical plans

Friday, August 31, 2018

State Insurance Commissioner
Mike Kreidler
Insurance Commissioner Mike Kreidler has proposed a rule to restrict the sale of short-term limited duration medical plans to three months, prohibit renewal and require enhanced disclosure to consumers about the limitations of coverage. 

Currently, any insurer that wants to sell a short-term limited duration health plan in Washington state must first receive approval from the Office of the Insurance Commissioner (OIC). 

The federal rule expanding the duration of these plans to up to one year, with renewals for up to three years, also permits state insurance regulators to set standards for their own health insurance markets.

“Some consumers may be caught in a coverage gap and need a short-term medical plan,” Kreidler said. 
“But I want to be sure they understand the limitations of the coverage they’re buying, set minimum requirements for that coverage and do what I can to make sure that these plans do not destabilize our individual health insurance market.”

Kreidler’s office determined that although some circumstances exist where these types of plans can fill a coverage gap for consumers, they should not be considered an alternative to comprehensive health insurance. 

In addition, improved disclosure is needed to make sure that people understand what is not covered by these plans.

Under the proposed rule:
  • Short-term limited duration (STLD) medical plans can last no more than three months and are not renewable.
  • A consumer can have STLD coverage for no more than three months in a 12-month period.
  • Insurers selling STLD medical plans must provide consumers with the disclosure form included in the proposed rule that clearly states the limitations of the coverage and prompts consumers to check to see if they are eligible to purchase coverage through Washington’s Health Benefit Exchange before they buy an STLD medical plan. 
  • STLD medical coverage must offer major medical coverage, with a maximum total payment of at least $1 million. Any pre-existing condition look-back period cannot exceed 24 months. Consumer coinsurance cannot exceed 50 percent, and any insurer offering an STLD medical plan must offer at least one plan with a deductible of $2,000 or less.
  • STLD application forms, policies and rates must be approved by OIC prior to being offered or sold. 
  • STLD medical plan rescission and cancellation is limited to defined circumstances with requirements for adequate consumer notice. 

A public hearing on the proposed rule is scheduled for 1pm, September 26 at the Office of the Insurance Commissioner, 5000 Capitol Blvd. SE, Tumwater, WA 98501.



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The value of prescription drug benefits for Medicare enrollees

Monday, August 27, 2018

Catherine Field is Humana’s
market president in Washington
By Catherine Field, Washington Market President, Humana

If you currently have Medicare, or if you will soon become eligible for Medicare, prescription drug benefits should be an important part of your decision-making when it comes to choosing among various Medicare coverage options.

It’s important to know that Original Medicare provides very little prescription drug coverage. 

Therefore, if you are eligible for Medicare and want drug coverage, you will need to purchase it from a private insurer, like Humana. You can either buy a stand-alone prescription drug plan — commonly referred to as a PDP — or obtain Part D prescription coverage through a Medicare Advantage plan that includes drug coverage.

Even if you’re not currently taking prescription medications, it is still a good idea to look into getting prescription drug coverage as soon as possible.

One reason is that you may need to start taking a prescription medication sooner than you expect, but you can’t just sign up for coverage at any time. 

You can sign up for coverage only when you first become Medicare-eligible (typically at age 65) or during the Medicare Advantage and Prescription Drug Plan Annual Enrollment, which runs each year from Oct. 15 through Dec. 7, for coverage that starts on Jan. 1 of the following year. For example, if you are prescribed medication in July and don’t have drug coverage, you could have six months of paying for that new prescription out of your own pocket before your coverage kicks in on Jan. 1.

A second reason to enroll in Part D coverage as soon as you are eligible is to avoid an enrollment penalty.  (Ed.note: the penalty also applies to Medicare itself)

If you wait to sign up, the Centers for Medicare and Medicaid Services (CMS) can charge you a penalty every month, in addition to the plan’s monthly premiums. Penalties can range from a few dollars up to more than $20 each month on top of your premium. This can be a significant cost if you’re living on a fixed income. Once a penalty is assessed, it never goes away.

For these two reasons, it’s a good idea to sign up for drug coverage. The good news is that there are low-cost drug plans available. For example, there are Medicare Advantage plans that include drug coverage and have either a very low monthly premium or no monthly premium at all.

Fortunately, there are plenty of resources available to help you choose the drug coverage that is right for you. 
  • It’s always a good idea to find an insurance professional in your community who can help you look at the drugs you might want covered and how they match up with the prescription drug benefit of the various plans offered in your market. 
  • The government-run website Medicare.gov is also a great resource that allows you to compare all of the plans offered in your county and narrow down the options to the plan that will best meet your needs.
Even if you are already in a plan, the Medicare Advantage and Prescription Drug Plan Annual Enrollment Period (October 15 - December 7) is the time to take a good look at all your plan options and find the coverage that is right for you.


Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on plan renewal.


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