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January 2018

Start the Year Off Right: How to Get the Most Out of Your Health Care Benefits

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New health plan benefits began in January for many Texans. Now is a good time to understand your coverage so you can get the most out of your plan, stay healthier and even help save money in 2018.

These tips can help you maximize your health plan’s offerings:

Learn the lingo – Make sure to understand basic health plan terms such as deductible, copay, coinsurance and out-of-pocket maximum. A recent UnitedHealthcare survey found that just 9 percent of Americans could successfully define all four of these important terms. Need a refresher course? If so, spend a few minutes to better understand common health insurance terms and your specific plan amounts to help you make more informed decisions.

Know what’s covered – You can usually find your coverage and benefits information on your insurer’s website or in plan documents so you know what’s covered and what’s not. Review this information before you start using your plan and receiving treatment so you’re not surprised by costs later.

Stay in network – Choosing doctors in your plan’s care provider network will most likely mean you’ll pay less. Also, check out 24/7 telehealth services. “Virtual visits” can help save you time and money by providing convenient access to care for certain medical issues including allergies, bronchitis and seasonal flu.

Save on medications Make sure your medications are covered by your plan, and ask your doctor about generics to see if there’s a more affordable and equally effective alternative. Also, getting prescriptions through the mail is often a good cost-saving option. Most plans enable you to order up to a three-month supply of medication you take regularly, sometimes at a discount. Your medication will be delivered right to your home, saving you a trip to the pharmacy.

Shop around and get cost estimates – Several health insurers offer online health care tools and resources that enable you to check on the quality and cost of health care services and care providers before you make appointments. Be sure to double-check the cost with your care provider before getting treatments, as prices can vary significantly for the same procedure within the same city.

Take advantage of wellness programs – Many health plans offer discounts on gym memberships and provide financial incentives, some more than $1,000 per year, for completing health assessments, signing up for health coaching programs, lowering your cholesterol, losing weight, meeting walking goals or quitting smoking. Incentive-based wellness programs are designed to reward people for making healthier choices and being more engaged in improving their well-being.

Look for medical grants – Some charitable organizations offer child medical grants to middle- and low-income families who don’t qualify for Medicaid. For example, the UnitedHealthcare Children’s Foundation (UHCCF) provides families with grants of up to $5,000 annually per child ($10,000 lifetime maximum per child). Recipients do not need to have insurance through UnitedHealthcare to be eligible. Since 2007, UHCCF has awarded more than 15,000 grants valued at over $40 million to children and their families across the United States. Families can read eligibility criteria and complete an online application at www.uhccf.org.   

Dallas Cowboys’ Tyrone Crawford and UnitedHealthcare Donate Gym Equipment for Students at Voice of Hope Ministries

Dallas Cowboys defensive end Tyrone Crawford addresses children at Voice of Hope Ministries at a ceremony introducing new gym equipment made possible by a $10,000 donation from UnitedHealthcare of North Texas. Listening are, (l-r), Scott Flannery, CEO, UnitedHealthcare of North Texas and Edward L. Franklin, President and CEO, Voice of Hope Ministries.

Dallas Cowboys defensive end Tyrone Crawford and UnitedHealthcare of North Texas recently teamed up to donate new gym equipment to Dallas’ Voice of Hope Ministries, a non-profit organization that provides after-school and out-of-school care to low income children from pre-k to 12th grade. Crawford joined UnitedHealthcare leaders at a dedication ceremony at Voice of Hope on January 10.

(l-r) Flannery, Crawford and Franklin pose with the donation from UnitedHealthcare to Crawford’s Dreambuilders program.
Crawford helps a child use the climbing wall.
Children using the new climbing wall.
Crawford assists a child on the pull-up bars.

Dual Special Needs Plans Can Bring Added Benefits to the Aging, Simplify Life for Caregivers

Of the more than 40 million caregivers in the United States, about 90 percent are caring for an aging relative, often a parent, according to the Bureau of Labor Statistics. And their ranks are rapidly growing as the population ages.

Caregiving for an aging loved one can be incredibly challenging, encompassing a wide range of duties, from offering companionship and assisting with housework to providing medical care and serving as an overall advocate.

Much of the advocacy that caregivers do comes in the form of helping their loved ones with important health care decisions, including decisions about their Medicare coverage.

The Medicare Open Enrollment Period closed on Dec. 7, and caregivers might assume their opportunity to help their loved ones switch to a health plan that better meets their needs in 2018 is over. But if their loved ones are eligible for both Medicare and Medicaid, it’s important for them to be aware of a health plan option that offers both a convenient approach to managing their health care and the flexibility of enrolling at any time throughout the year. This option is called a Dual Special Needs Plan (DSNP), and it’s available to a growing number of people as new plans are being introduced across the country.

Coordinated coverage through a DSNP

Most people have heard of Medicare and Medicaid. Medicare provides health benefits for people over 65 and those under 65 who qualify due to a disability. Medicaid provides health benefits for people with low income.

About a third of people eligible for Medicare have opted to get their benefits through what’s known as a Medicare Advantage plan, which is offered by a private health insurance company approved by the federal government. Medicare Advantage combines a person’s Medicare benefits into one plan, including doctor and hospital coverage as well as Part D prescription drug coverage in most cases. The plans can also offer additional benefits above and beyond what’s available with Original Medicare, such as dental, vision and hearing coverage.

A DSNP is a special type of Medicare Advantage plan that provides health benefits for people who are “dually eligible,” meaning they qualify for both Medicare and Medicaid.

Why should a person consider a DSNP?

By coordinating Medicare and Medicaid benefits, DSNPs can make it simpler for caregivers and their loved ones to navigate the health care system. DSNPs encourage everyone involved in caring for a patient – including primary care doctors, specialists, hospitals and care managers – to work together, which can help improve people’s health as well as their experience with the health care system.

DSNPs usually offer additional benefits, which can include:

  • dental care, such as exams, X-rays, cleanings, fillings, crowns and extractions;
  • access to a health products catalogue to order over-the-counter items such as vitamins and first-aid supplies at a discount;
  • hearing exams and access to hearing aids at a reduced cost;
  • an annual eye exam and a credit for eyewear; and
  • transportation to health care visits and the pharmacy.

People who are eligible for a DSNP can usually enroll for no monthly premium, making it an affordable option.

Who qualifies?

Anyone who meets the eligibility criteria for both Medicare and Medicaid is qualified to enroll in a DSNP. Those who are eligible often face unique health needs. They may have a disabling condition, suffer from a mental disorder, receive care from multiple doctors, or be in need of in-home care providers or other health and social services.

How can someone learn more about DSNPs?

People who are eligible for a DSNP can enroll or switch to a new plan at any time during the year. To find out if a DSNP is available in your area, check out the Plan Finder on Medicare.gov. After entering some personal information, the secure online tool will show a list of private Medicare plans available in your zip code. Check to see if any of them include “Dual Special Needs Plan” in their name.

If you prefer to talk to someone about options, a trained insurance counselor through the State Health Insurance Assistance Program (SHIP) can help, or you can talk to a licensed insurance agent in your area who can meet in person or over the phone to determine whether a DSNP is a good fit.

UnitedHealthcare is the largest provider of Medicare Advantage plans, including DSNPs, serving nearly 4.4 million people nationwide.

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