HealthCare.gov Sees Signs of Sham Plan Sales

ALERT: HealthCare.gov Sees Signs of Sham Plan Sales

Agents may have enrolled some consumers in health coverage through HealthCare.gov for 2016 or 2017 without the consumers' permission, according to officials at the Centers for Medicare and Medicaid Services. (Source: Welltheos, a private exchange platform designed for consumers, brokers, and agencies.)

Online applications make it easier for unscrupulous agents do this mischief. More consumers and agents may be using online Direct Enrollment for 2018 plans since Open Enrollment is limited to only 45 days this year: November 1-December 15, 2017.

The Affordable Care Act makes it very difficult to undo problems and almost impossible to buy different health insurance after Open Enrollment closes.

Choose a licensed and certified health insurance agent. Get in touch with them in October to share your information, get advice and make certain your application is properly filed during Open Enrollment (Nov.1 – Dec. 15, 2017).

An agent's services should be free.

Jerry S. Pearlstein Insurance LTD, licensed and certified Affordable Care Act Experts.

847-362-8888

www.jpearlsteinltd.com


Open Enrollment 2018

We've just completed all the training and have been certified by the federal government to serve you during Open Enrollment for 2018 Health Insurance.

Open Enrollment this year begins November 1 and ends December 15, 2017.

That's half the time allotted in previous years.

Who needs to act during these 45 days?

  • People who want to change their current plan.
  • People who may be notified their current plan is not available in 2018.
  • People who are receiving premium assistance and must re-certify with the government to continue it.
  • People who are receiving premium assistance but will not be eligible in 2018.
  • People who have not previously qualified for premium assistance but will in 2018.
  • People who may be eligible to form a small group

Blue Cross will notify you if your plan will automatically re-up for 2018. We expect their letters to get to you in the next week or two. And we expect premium increases. If you want to change to a plan with a lower premium, you must do it within the Open Enrollment Period.

Except in clearly defined circumstances, 2018 Affordable Care Act health insurance cannot be bought or changed after December 15, 2017.

If you do not act between November 1 and December 15, you will be stuck with what you have for all of 2018.

We certified as early as we could to help you as early as we could. Please watch our emails. Let us know when you get your letters. We'll be setting up appointments with those clients receiving premium assistance.

We're here to take care of you.

Jerry Pearlstein   Rebecca Bloomfield


Why Your 18+ Child Needs a Power of Attorney for Health Care

Mrs. Applebee, the 6th grade teacher, poses the following problem to one of her math classes: "A wealthy man dies and leaves ten million dollars. One-fifth is to go to his wife, one-fifth is to go to his son, one-sixth to his butler, and the rest to charity. Now, what does each get?"

After a very long silence in the classroom, little Morris raises his hand. "Yes, Morris," the teachers says calling on him.

With complete sincerity in his voice, little Morris answers, "A good lawyer."

WHY YOUR 18+ CHILD NEEDS A POWER OF ATTORNEY FOR HEALTH CARE.

Guest contributor Marcia A. Franklin, Greenswag & Associates, P.C.

As your child heads off to college or out into the real world, in the event of a medical emergency, will you be able to participate in health care decisions or have access to important medical information?

In order to be able to assist your child under these circumstances, it is important to complete an Illinois Power of Attorney for Health Care that includes a right of access to medical information and records. With this document, at any time your adult child (over 18 years of age) is unable to consent to medical treatment or even give permission to allow you access to his or her medical information and/or records, you will be able to act on his or her behalf with full access to this information.

Without a valid Power of Attorney for Healthcare, doctors and other health care providers may be unable or unwilling to disclose vital information about your adult child and you may not be able to participate in decisions regarding that child's treatment if he or she is unable to make or communicate those decisions.

The Power of Attorney for Healthcare form is relatively simple but includes several elections that the Principal (your child) must make in giving direction to the person named as Agent, including: when it becomes effective, what kind of care should be provided in an end of life situation and whether the Principal wants to include any other specific limits on the Agent's authority.

While the form can be obtained online, it is generally better to sit down with your adult child and an attorney familiar with the process so that your child understands all of the options and elections to be made and the execution of the document is properly handled.

We thank Marcia Franklin who is an attorney practicing in Northfield, Illinois. Her practice concentrates on estate planning and representing closely held businesses and their owners in a variety of commercial areas. mfranklin@greenswaglaw.com


BCBSIL Responds to Declared Disaster Areas in Illinois

Some Illinois counties – Cook, Kane, Lake, and McHenry – have faced severe flooding and have been declared disaster areas. For those who live in these areas, use of phone, mail or other normal channels of communication may be unavailable. On July 17, 2017, the Illinois Department of Insurance (IDOI) issued a notice asking insurance companies to give employers and retail members extra time to pay their monthly premiums. We want to support our employers and retail members affected by this disaster during this stressful time.

A non-payment cancellation notice received by impacted employers or retail members between July 12, 2017, and Sept. 30, 2017, will be withdrawn. Their coverage won't be cancelled, and no new cancellation notices will be sent until after Sept. 30, 2017. However, the terms of coverage still apply. For those in a grace period as of July 12, some claims may not be paid and members should check their plan or call Customer Service for details.

Individual/family members and Medicare Supplement members

Call Customer Service using the number on the back of your card or 800-538-8833(under 65); 800-624-1723 (Med Supp) to

  • Explain benefits
  • Find a doctor, hospital or dialysis center
  • Refill prescription medications
  • Coordinate or transition member care

Or call us, Jerry S. Pearlstein Insurance 847-362-8888.


New Senate Bill Retains Medicaid Cuts, Provides More Money to Stabilize Individual Market

7.17.17 weekly update from Welltheos, a private exchange platform designed for consumers, brokers, and agencies.

Click Here to read New Senate Bill Retains Medicaid Cuts, Provides More Money to Stabilize Individual Market

A revised version of the Better Care Reconciliation Act retains significant cuts to Medicaid. Lawmakers have also decided to keep taxes on the wealthy and insurer CEO compensation, which are projected to bring in $232 billion over a decade. Rick Pollack, President of the American Hospitals Association released a statement saying that in the latest update released, “the unacceptable flaws of BCRA remain unchanged”. The bill adds more than $130 billion in spending, primarily for states to use for high-risk pools or reinsurance programs.* Other developments include the introduction of the Direct Enrollment Proxy Pathway and the Centers for Medicare and Medicaid Services’ decision to discontinue the Federally-Facilitated Small Business Health Options Program (SHOP exchanges).

*BCRA allows individual states to allow insurance companies to offer plans that do not accept people with pre-existing conditions. This would take us back to the days when the Illinois Comprehensive Health Insurance Plan took people the insurance companies had declined based on their medical history. ICHIP was “sundowned” when the Affordable Care Act required insurance companies to take all applicants regardless of medical history.

Insurance companies intending to offer health insurance in Illinois have already filed their plans and prices for 2018 with the Illinois Department of Insurance based on the current ACA.

While we don’t expect Congressional action to affect individual/family health insurance for 2018, we’ll keep you informed.

Jerry Pearlstein   Rebecca Bloomfield


Build A Better Business

A chemical engineer, electrical engineer, and a Microsoft engineer are on a road trip. The car breaks down.

The electrical engineer looks under the hood and can’t find anything wrong.

The chemical engineer checks the oil and fuel and can’t find anything wrong.

The Microsoft engineer says, “Close all the windows, and try again.”

Build A Better Business

On Monday, July 3rd, we’ll kick off Build A Better Business , a Summer School Series of podcasts produced by Sue Monhait. (You can access the podcast on iTunes, Stitcher, Soundcloud, Google Play and at GiftBizUnwrapped.com.)

Sue’s the owner of The Ribbon Print Company, a gold-standard business offering custom ribbon printing systems so businesses can provide product personalization right in their store or craft studio.¬†She’s been identified as an industry leader and trendsetter.

The mission of Jerry S. Pearlstein Insurance Ltd. has always been to serve those who have no company providing their health, life, long-term care, disability insurance and retirement plans.

We’re proud to work with others, like Sue, who support our entrepreneurial clients. Here’s a heads up on the valuable information she’s providing.

SUMMER SCHOOL SERIES – Build a Better Business

This is a special 5-Part series on the Gift Biz Unwrapped podcast. The series focuses on areas commonly skipped over in favor of the more glamorous parts of building and growing your business.

Every Monday in July Sue Monhait interviews experts who clarify and provide actionable steps on the topic at hand

Here’s the lineup for the Summer School Series –

July 3 – Life Insurance – Rebecca Bloomfield of Jerry S. Pearlstein Insurance discusses how life insurance can play an important role for your business today … not years from now.

July 10 – Nicole Walters of Nicole Walters TV. She is an income strategist and shares how she built her 7-figure business in 18 months.

July 17 – Goran Donev of Safe Haven IT talks about the risks of every business online today and how to protect yourself from these threats.

July 24 – Small Business Loans – Katie Wiswald of Highland Park Bank and Trust explains how to know if you should apply for a loan and what to expect through the process.

July 31 – Copyrights & Trademarks – Todd Timmerman of Shumaker, Loop & Kendrick covers the difference between the two and what you really need to protect your brand.

Over and above the Summer School Series, the Gift Biz Unwrapped podcast provides information weekly for small business owners. Find out how others have started their business and what is working for them today. It’s Sue’s goal that you find a piece of advice, a promotional strategy or a new tool that can incorporated into you biz throughout the week. Just in time for the new episode the following Monday!

Thanks, Sue!


Important information for Aetna and Coventry clients:

Aetna and Coventry left the northern Illinois market for individuals and families at the end of last year. Here is their news for 2018.

As a result of financial risk and an uncertain outlook for the Individual marketplace, Aetna (including Coventry) has decided that we will no longer offer individual health products in the following states AR, AZ, CT, FL, GA, IL, KS, KY, LA, ME, MI, MO, NC, OH, PA, SC, TN, TX, UT, and WV for 2018.

Your clients' existing coverage in these states will continue until their policy period ends on December 31, 2017. They will not be able to renew their plan when their policy term ends.

Member outreach will take place by July.

We will continue to keep you updated on the latest news affecting individual and family health insurance.


ACA Changes for Special Enrollment Begin June 23

The changes impact whether you can buy health insurance for the rest of 2017, what information you need to apply and when the insurance will start. While we are providing this overview, it is best to call us at 847-362-8888 to discuss your individual circumstances and options.

The federal government, under the Affordable Care Act, regulates when individuals can buy health insurance for themselves and their families.

Open Enrollment for 2017 ended January 31st of this year.

You may qualify for Special Enrollment if you:

  1. lose group (employer, college, Medicaid) health insurance
  2. reach the end of COBRA
  3. move to a new home in a new zip code, county or country.
  4. turn 26
  5. are adding dependents to your insurance
  6. are receiving government assistance with your premiums and have a change of circumstance
  7. experience miscellaneous other qualifying events

You have 60 days from the date of the qualifying event in which to apply.

You must apply by the 15th of the month for your insurance to start the 1st of the month after the qualifying event.

A document that verifies your qualifying event (notice of cancellation from an employer or insurer, permanent change of address card filed with USPS, marriage license, divorce decree, birth or adoption certificate) must accompany the application or be submitted within 30 days of application for new insurance.

Coverage will not begin until verification of the qualifying event has been received.

We work directly with insurers like Blue Cross. We work with the federal marketplace for clients who qualify for premium assistance. We are fully aware of and educated in current requirements and what they mean to you who need to get your own health insurance.

We urge you not to buy health insurance online at this time.

Call Jerry or Rebecca (847-362-8888) to discuss your situation. The call is free, confidential and without obligation.


You need 15 for LIFE

Term Life Insurance ended so you have no benefits after you paid premiums for 10 or 15 or 20 years?
Has the stock market plummeted taking with it the gains you were depending on?
Must you pay federal taxes or penalties to get needed cash from 401K or IRAs?

You need 15 for LIFE

15 for LIFE is a practical, dependable platform that combines Life Insurance+ Long-term Care Insurance+ Cash growth at a guaranteed rate.

And here’s the kicker: you can choose to pay premiums for just 15 years.

Even if you stop paying premiums after 15 years

your death benefit continues to grow
money for Long-term Care continues to grow
money accrued through guaranteed annual dividend payments continues to grow

The cash you’ve earned is always available – as a loan or a withdrawal – without penalty and without paying federal taxes.

We all have to make decisions about insurance for protecting our families, leaving a legacy, being taken care of if we’re not able to do it alone, having tax-free money for a long and wonderful life.

Have the conversation to know if 15 for LIFE is right for you. Call us at 847-362-8888.

We’ll work with you using Pearlstein Principle #1: Never Run Out of Money.


LONG-TERM CARE: Who Pays for What?

WHAT IS LONG-TERM CARE?
Long-term = beyond 100 days
Care= help because health or mental impairment cause an inability to do at least two of the Activities of Daily Living

  1. Ability to get up out of a bed or chair
  2. Ability to transfer (walk) from one place to another
  3. Ability to use the toilet or deal with continence
  4. Ability to bathe yourself
  5. Ability to dress yourself
  6. Ability to feed yourself

Underlying medical issues may be addressed in a hospital. The above issues are addressed through a Skilled Nursing Facility, Assisted Living Facility, Home Care, Adult Day Care Center. Where will the money come to pay for them?

MEDICARE
Medicare is health insurance for most US citizens over the age of 65.

Medicare does not pay for Assisted Living, Adult Day Care Centers, transportation services..

It provides a maximum of 100 days of skilled care in a Skilled Nursing Facility or at home under the following circumstances:

  • A physician has designed a plan of care for the patient that is approved by Medicare.
  • The plan of care has included 3 days and nights in the hospital.
  • The patient cannot do at least two of the Activities of Daily Living.
  • The plan of care calls for skilled help with the goal of getting the patient capable of doing those activities. When it is determined the goal has been met or the goal cannot be met, Medicare will cease paying for services.

AN EXCEPTION TO THE 100-DAY LIMIT: MEDICARE HOSPICE

If a doctor has determined the condition of the patient is terminal (life expectancy is not more than six months), Medicare will pay for hospice care to the end of life.
The care is “palliative”, it is not meant to treat the condition, it is meant to keep the patient comfortable through the passing.
Care may be in a facility or in home.
Medicare pays for prescription medicine, nurse/doctor monitoring, medical equipment, skilled care for the Activities of Daily Living, social services for the patient and family.
It does not pay for unskilled caregiving.

MEDICAID

Medicaid is a federal/state entitlement providing care based on economic need.

PACE (Program of All-inclusive Care for the Elderly) is a state/federal program of Medicaid with the purpose of keeping frail, elderly persons in their homes rather than in facilities.

Granting of benefits by the state is based on:

  1. Medical criteria certified by a doctor
  2. Strict limits on personal (including spousal) income and asset holdings. Examination of finances is strict. There is a 5-year look-back from the time of application confirming eligibility and transfer of assets.
  3. Availability of services. Long-term Care providers paid by Medicaid are dependent on state/federal funding. When that funding is cut, services are usually cut as well. Care providers and facilities are not required to take clients paid for by Medicaid. Since that payment is about 72% of market, not all long-term care providers will take Medicaid recipients.

VETERAN’S BENEFITS
The VA offers health care to persons with military service related injuries within Priority Levels based on the percentage of disability the injury causes.

The VA encourages citizens over 65 who have served in the military to have Medicare for health insurance as well.

VA Nursing Home is available for person’s whose service related injury causes 70% disability or more.

Aid and Assistance Pensions are available to those who have served and their spouses based on economic need and regardless of service related injury.

The VA suggests contacting the Social Work Department at the nearest VA facility for information.

LONG-TERM CARE INSURANCE
Long-term Care insurance is not health insurance. It provides money for care of an individual needed after 100 days and because the individual cannot do two of the Activities of Daily Living. The individual pays for the insurance based on age, health, family history and the amount of money made available.

Long-Term Care insurance plans can be freestanding. Many of these plans pay directly to Assisted Living or Skilled Nursing Facilities or on a schedule for skilled services.

Long-Term Care insurance plans can be based on a whole life insurance policy. They’re

designed to provide money to the policyholder which they can spend on any care.

We are experts in Long-Term Care planning and insurance.

Jerry S. Pearlstein Insurance partner, Rebecca Bloomfield, has earned a national Certification in Long-Term Care. She delivers a free program: Long Term Care. Who pays for What? to groups throughout the Northshore and Chicago.

Designing a Long-Term Care Insurance plan to meet your needs requires a thorough and confidential conversation. Call us to begin: 847-362-8888.

A note: If you are single, believe you will be the surviving spouse or that your family will be scattered, Long-Term Care Insurance is an essential investment in yourself.